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Week 10 -GI > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

Describe the differences in acute and chronic hepatitis in terms of blood tests and presentation

A
  • Acute will normally be symptomatic i.e. fever/flu like symptoms, usually jaundiced
  • Acute: ALT and AST will most likely be raised
  • Chronic are usually asymptomatic and blood tests/LFTs will most likely show mild abnormalities
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2
Q

What infections cause acute hepatitis?

A
  • Hep A, B, C, D, E
  • EBV, CMV, Toxoplasmosis
  • Leptospirosis
  • Q fever
  • Syphilis
  • Malaria
  • Viral haemorrhagic fever
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3
Q

What are the non infectious causes of acute hepatitis?

A
  • Toxins
  • Drugs
  • Alcohol
  • Autoimmune
  • Wilsons
  • haemochromatosis
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4
Q

Describe the laboratory diagnosis of viral hepatitis

A
  • Detection of specific immune response (IgM or IgG)

* Viral nucleic acid detection (RNA or DNA), or antigen detection (HBV and HCV)

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5
Q

What is the transmission of Hepatitis A?

A
  • Faeco-oral
  • Human reservoir
  • Virus can survive for months in contaminated water
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6
Q

What is the incubation period of Hepatitis A?

A

2-4 weeks

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7
Q

What is the main determinant of severity of hepatitis A, how does this impact severity?

A
  • Age
  • Mostly asymptomatic in children <5 years
  • Mortality rate is 1.5% if >50
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8
Q

Describe the clinical management of hepatitis A

A
  • Tends to be supportive, there are no specific treatments
  • Maintain hydration and avoid alcohol
  • Usually self limiting
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9
Q

What serology results indicated an acute hepatitis A infection ?

A

IgM positive or HAV RNA in blood or stool

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10
Q

What serology result indicates previous hepatitis A or vaccination against Hep A?

A

IgG positive

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11
Q

Hepatitis A vaccination

A
  • Inactivated virus
  • 95% efficacy after 4 weeks
  • 2nd dose gives lifelong protection
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12
Q

Who gets the hepatitis A vaccine?

A
  • Travellers
  • Men who have sex with men
  • Intravenous drug users
  • Chronic liver disease patients
  • Those at risk in an outbreak post exposure
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13
Q

Who gets the hepatitis A immune Globulin?

A
  • Those allergic to the vaccine
  • If it is less than 4 weeks to travel
  • post exposure to control an outbreak
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14
Q

How long does the immunity of the hepatitis A globulin last?

A

3-6 months

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15
Q

What is the transmission of Hepatitis E?

A
  • Faeco-oral
  • Pork products
  • Minimal person to person transmission
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16
Q

What is the incubation period of hepatitis E?

A

40 days

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17
Q

What are the symptoms of hepatitis E?

A
  • Diarrhoea
  • fever
  • myalgia
  • jaundice
  • Rare reports of neurological effects
18
Q

Which patient groups are seen with chronic hepatitis E?

A

Very immunosuppressed patients e.g. bone marrow transplant

19
Q

What is the treatment of Hepatitis E?

A
  • Supportive, normally resolves without involvement

* Ribavirin in those who are immunocompromised/chronic hep E

20
Q

Explain the hep E neurological manifestations

A
  • Genotype 3 associated
  • Guillain barre syndrome
  • Encephalitis
  • Ataxia
  • Myopathy
21
Q

What is the most common transmission of Hepatitis B?

A

Mother to baby - vertical transmission

22
Q

What is the transmission of Hepatitis B?

A
  • Vertical
  • Transfusion
  • Fluids
  • Organs and tissue transplantation
  • child to child
  • Contaminated needles and syringes
23
Q

What is the incubation period of hepatitis B?

A

2-6 months

24
Q

What does age at the time of hepatitis B infection determine?

A
  • Severity of acute illness: younger = usually asymptomatic
  • Risk of chronic HBV infection: younger = more likely to lead to chronic infection, in adults it is normally cleared
25
Q

What are the complications of chronic HBV?

A
  • 25% develop chronic liver disease

* Cirrhosis, decompensation, hepatocellular carcinoma, death

26
Q

Explain the hepatitis B lab tests

A
  • sAg - surface antigen, tells if currently infected
  • sAb - surface antibody, marker of immunity (previous infection or vaccination)
  • cAb - core antibody, will be positive only in those who have previously had the infection
  • eAg - e antigen, suggests there is high infectivity
  • eAb - e antibody, suggests a low infectivity
  • HBV DNA
27
Q

When is hepatitis B diagnosed (lab tests)

A

If sAg or DNA are detectable

28
Q

What defines chronic Hepatitis B infection?

A

•sAg detectable for >6 months

29
Q

What are the two groups of chronic Hepatitis B infection?

A
  • eAg positive (early disease)

* eAg negative (late disease)

30
Q

Describe eAg positive chronic hep B infection

A
  • high viral load
  • high risk of CLD and HCC
  • Highly infectious
31
Q

Describe eAg negative chronic HBV infection

A
  • Low viral disease
  • Lower risk of CLD and HCC
  • Less infectious
  • e antibodies
  • Late disease
32
Q

What is the treatment of acute Hepatitis B infection?

A

Usually no treatment is needed and it resolves

33
Q

What is the treatment of chronic hepatitis B?

A
  • Most do not need treatment
  • Treat those with liver inflammation (raised ALT or biopsy) or fibrosis (on fibroscan or biopsy)
  • Immunoglobulins-modulatory treatment- interferon
  • Suppress viral replication - tenofovir or entecavir
  • Treatment is not curative, aims to suppress viral replication and prevent further liver damage
34
Q

What are the prevention measures of hepatitis B?

A

•HBV sAg vaccine
•Education (safe sex, injecting etc.)
•Prevention of mother to child transmission
•Prevention of mother to child transmission
- HBV vaccination to newborn (first within 24 hours of birth
- HBV immunoglobulin if eAg+ or high VL
- Tenofovir during the last trimester if high viral load

35
Q

What is hepatitis D?

A

ss RNA virus which requires HBV to replicate

36
Q

How is hepatitis D acquired?

A
  • Co infection with HBV
  • Super infection of chronic HBV carriers
  • Infection is only possible in people who are HBV sAg positive
37
Q

What is the treatment of hepatitis D?

A
  • Interferon

* New: Bulevirtide (suppressive treatment)

38
Q

What is the transmission of hepatitis C?

A
  • Injecting drugs
  • Transfusion and transplant
  • Sexual/vertical rare
39
Q

What is the incubation period of hepatitis?

A

6-7 weeks

40
Q

How are the majority of hepatitis c infections diagnosed?

A

Via screening of high risk groups (drug users and immigrants to the UK from high prevalence countries)

41
Q

What does Anti HCV IgG positive mean?

A

Chronic infection or cleared infection

42
Q

What are the treatments of hepatitis C infection?

A
  • Direct acting antivirals that inhibit different stages of the replication cycle
  • Aim is to cure the infection

Week 10 -GI (8 decks)

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