Viral Hepatitis

Question 1

List the mode of transmission for each type of viral hepatitis.

Answer 1

A: faecal-oral

B: birth>blood>sex

C: blood>birth=sex

D: blood>birth=sex

E: faecal-oral

Question 2

Which viral hepatitis subtypes are acute and which are chronic?

Answer 2

A: Acute only

B: Acute + chronic

C: Acute + chronic

D: Acute + chronic

E: Acute only

*B and C most dangerous

Question 3

Summarise the management for viral hepatitis.

Answer 3

• 15-45% clear hep C without treatment
• Direct acting antivirals
• NSAID, opiod, anti-emetic, cream for itch
• Hep A usually self-limiting; give supportive therapy
• Hep B peginterferon alpha or nucleoside reverse transcriptase inhibitors (tenofovir/entefovir)
• Hep C sofosbuvir, ledipasvir, grazoprevir (directly acting antivirals)
• Hep D most need transplant in the end
• Hep E ribovarin
• Only types A and C are curable

Question 4

Summarise the investigations for viral hepatitis.

Answer 4

• In acute disease- ALT and AST are usually >1000 (ALT > AST typically)
• In chronic disease- ALT and AST are only mildly elevated (<100IU/l)
• Hep A elevated IgM, not infective during jaundice. IgM means acute, IgG means chronic
• Hep B anti HBe means exposure to live virus, anti HBs is given in vaccines. Can be chronic, often sub-clinical. Core IgM acute
• HCV antibody test and RNA test