Viral Hepatitis Flashcards
What is hepatitis and what are some of its causes?
Liver inflammation and it can be caused by; Infections such as Hepatitis A-E, cytomegalovirus and epstein barr virus. Drugs, 1 autoimmune and ischaemia
What are the main symptoms of hepatitis?
- Asymptomatic,
- Fever,
- Jaundice,
- Malaise,
- Diarrhoea/vomiting,
- Acute liver failure
What is the most common cause of hepatocellular carcinoma?
Worldwide - Hepatitis B,
Europe - Hepatitis C
Describe the epidemiology of hepatitis A?
Spread via faecal-oral route. Has an incubation period of 2-6weeks. Water borne epidemics with sporadic infections from shellfish.
Describe how hepatitis A presents?
- Hepatomegally,
- Jaundice,
- Fatigue,
- Arthralgia,
- Poor appetite
PJHAF
Describe the serology/investigations for hepatitis A?
- Hep A IgM - positive in acute infection.
- Hep A IgG - indicates immunity
Vaccinations for what types of hepatitis virus exist?
A and B worldwide and E in china
What is the management of hepatitis A?
Self-resolving infection so just supportive treatment. No cases of chronic hep A, lifelong immunity and less than 0.5% will develop acute liver failure
Describe the transmission of Hepatitis B
Horizontal - Unprotected sex, contaminated needles, breaks in mucous membranes, blood transfusion.
Vertical - From mother to baby in child birth
Describe the presentation of Hepatitis B
Jaundice, Poor appetite, Myalgia, Fever, Tender hepatomegaly JPMFT
What markers are present when vaccinated against Hepatitis B
Anti-HBs
What markers are present in an acute hepatitis B infection
HBsAg, HBeAg, anti-HBc IgM
What markers are present in a chronic hepatitis B infection
HBsAg, Anti-HBc IgG
What markers are present when recovering from a hepatitis B infection?
Anti-HBs, Anti-HBc IgG
What are some treatment options for hepatitis B?
Nucleotide analogues,eg, tenofovir which are lifelong treaments.
Pegylated alpha interferon - 48 weeks long
Describe the presentation of Hepatitis C
- Asyptomatic,
- Poor appetite,
- Myalgia,
- Fever,
- Jaundice,
- Tender hepatomegaly
What are the investigations for Hep C?
Blood tests;
If hepatitis C RNA is present then there is an active infection.
If Anti-Hepatitis C antibody present then recovery or chronic infection
What are the modes of transmission for hepatitis C?
Horizontal - Contaminated needles, blood transfusion, breaks in mucous membranes, unprotected sex.
Vertical - Mum to baby in childbirth
What are some extrahepatic manifestations of chronic hepatitis C?
Autoimmune - Thyroid disease,
Haematological - Lymphoma,
Pulmonary - Fibrosis,
Renal - Membraneoproliferative glomerulonephritis,
Skin - Lichen planus and porphyria cunea tardia
What is the treatment for hepatitis C?
Direct acting antivirals which take 12-24 weeks and cure is achieved in 95% cases;
Protease inhibitors - Paritaprevir,
NS5A inhibitors - Ledipasvir,
RNA polymerase inhibitors - Sofosbuvir
What is specific about the epidemiology of hepatitis D?
Only possible to be infected if you already have hepatitis B
Describe the clinical presentation of hepatitis D
It cannot be distinguished from hepatitis B
Describe the hepatitis D serology
Hepatitis D IgM - acute infection,
Hepatitis D IgG - indicates immunity
What are some of the complications of hepatitis D
The co-infection of hepatitis B and D represents the most severe form of hepatitis due to rapid progression and development of hepatocellular carcinoma
Describe the treatment for hepatitis D
The antivirals for hep B don’t work for hep D so pegylated interferons are the only treatment option
Describe the presentation of Hepatitis E?
95% are asymptomatic but those who do have symptoms have;
- Diarrhoea,
- Vomiting,
- Fevers,
- Neurological symptoms
What are the treatments and complications for hepatitis E?
It is a self limiting disease so only supportive care. However it is the most common cause of acute hepatitis in the uk and 25% of pregnant women die
