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Gastrointestinal and Liver 2.0 > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

How long does hepatitis persist for to be deemed chronic?

A

6 months.

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2
Q

Give 3 infective causes of acute hepatitis.

A
  1. Hepatitis A to E infection.
  2. EBV.
  3. CMV.
  4. Toxoplasmosis.
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3
Q

Give 3 non-infective causes of acute and chronic hepatitis.

A
  1. Alcohol.
  2. Drugs.
  3. Toxins.
  4. Autoimmune.
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4
Q

Give 3 symptoms of acute hepatitis.

A
  1. General malaise.
  2. Myalgia.
  3. GI upset.
  4. Abdominal pain.
  5. Raised AST, ALT.
  6. +/- jaundice.
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5
Q

Give 3 infective causes of chronic hepatitis.

A
  1. Hepatitis B (+/-D).
  2. Hepatits C.
  3. Hepatitis E.
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6
Q

What are the potential complications of chronic hepatitis?

A

Uncontrolled inflammation -> fibrosis -> cirrhosis -> HCC.

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7
Q

Is HAV a RNA or DNA virus?

A

HAV is a RNA virus.

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8
Q

How is HAV transmitted?

A

Faeco-oral transmission. E.g. contaminated food/water; shellfish.

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9
Q

Who could be at risk of HAV infection?

A

Travellers and food handlers.

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10
Q

Is HAV acute or chronic?

A

Acute! There is 100% immunity after infection.

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11
Q

How might you diagnose someone with HAV infection?

A

Viral serology: initially anti-HAV IgM and then anti-HAV IgG.

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12
Q

Describe the management of HAV infection.

A
  1. Supportive.
  2. Monitor liver function to ensure no fulminant hepatic failure.
  3. Manage close contacts.
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13
Q

Describe the primary prevention of HAV.

A

Vaccination.

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14
Q

Is HEV a RNA or DNA virus?

A

HEV is a small RNA virus.

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15
Q

How is HEV transmitted?

A

Faeco-oral transmission.

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16
Q

Is HEV acute or chronic?

A

Usually acute but there is a risk of chronic disease in the immunocompromised.

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17
Q

How might you diagnose someone with HEV infection?

A

Viral serology: Initially anti-HEV IgM and then anti-HEV IgG.

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18
Q

Describe the primary prevention of HEV.

A
  1. Good food hygiene.

2. A vaccine is in development.

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19
Q

Is HBV a RNA or DNA virus?

A

HBV is a DNA virus! It replicates in hepatocytes.

20
Q

How is HBV transmitted?

A

Blood-borne transmission e.g. IVDU, needle-stick, sexual, MTCT.

HBV is highly infectious!

21
Q

Describe the natural history of HBV in 4 phases.

A
  1. Immune tolerance phase: unimpeded viral replication -> high HBV DNA levels.
  2. Immune clearance phase: the immune system ‘wakes up’. There is liver inflammation and high ALT.
  3. Inactive HBV carrier phase: HBV DNA levels are low. ALT levels are normal. There is no liver inflammation.
  4. Reactivation phase: ALT and HBV DNA levels are intermittent and inflammation is seen on the liver -> fibrosis.
22
Q

What HBV protein triggers the initial immune response?

A

The core proteins.

23
Q

How might you diagnose someone with HBV?

A

Viral serology: HBV surface antigen can be detected from 6w - 3m or anti-HBV core IgM after 3 months.

24
Q

Describe the management of HBV infection.

A
  1. Supportive.
  2. Monitor liver function.
  3. Manage contacts.
  4. Follow up at 6 months to see if HBV surface Ag has cleared. If present -> chronic hepatitis.
25
Q

How would you know if someone had acute or chronic HBV infection?

A

You would do a follow up appointment at 6 months to see if HBV surface Ag had cleared. If it was still present then the person would have chronic hepatitis.

26
Q

What are the potential consequences of chronic HBV infection?

A
  1. Cirrhosis.
  2. HCC.
  3. Decompensated cirrhosis.
27
Q

How can HBV infection be prevented?

A

Vaccination - injecting a small amount of inactivated HbsAg.

28
Q

Describe two treatment options for HBV infection.

A
  1. Alpha interferon - boosts immune system.

2. Antivirals e.g. tenofovir. They inhibit viral replications.

29
Q

HBV treatment: give 3 side effects of alpha interferon treatment.

A
  1. Myalgia.
  2. Malaise.
  3. Lethargy.
  4. Thyroiditis.
  5. Mental health problems.
30
Q

Is HDV a RNA or DNA virus?

A

It is a defective RNA virus. It required HBsAG to protect it.

31
Q

Infection with what virus is needed for HDV to survive?

A

HDV can’t exist without HBV infection! It needs HBsAg to protect it.

32
Q

How is HDV transmitted?

A

Blood-borne transmission, particularly IVDU.

33
Q

Is HCV a RNA or DNA virus?

A

HCV is a RNA virus.

34
Q

How is HCV transmitted?

A

Blood borne.

35
Q

Give 4 risk factors for developing HBV/HCV infection.

A
  1. IVDU.
  2. People who have required blood products e.g. blood transfusion.
  3. Needle-stick injuries.
  4. Unprotected sexual intercourse.
  5. Materno-foetal transmission.
36
Q

How might you diagnose someone with current HCV infection?

A

Viral serology - HCV RNA tells you if the infection is still present.

37
Q

You want to find out if someone has previously been infected with HCV. How could you do this?

A

Viral serology - anti-HCV IgM/IgG indicates that someone has either a current infection or a previous infection.

38
Q

Describe the treatment for HCV.

A

Lots of new drugs have been developed recently for HCV infection. Direct acting antivirals (DAA) are currently in use e.g. NS5A and NS5B.

39
Q

What percentage of people with acute HCV infection will progress onto chronic infection?

A

Approximately 70%.

40
Q

What percentage of people with acute HBV infection will progress onto chronic infection?

A

Approximately 5%.

41
Q

How can HCV infection be prevented.

A
  1. Screen blood products.
  2. Lifestyle modification.
  3. Needle exchange.

There is currently no vaccination and previous infection does not confer immunity.

42
Q

What types of viral hepatitis are capable of causing chronic infection?

A

Hepatitis B (+/-D); C and E in the immunosuppressed.

43
Q

How long after infection with hepatitis B virus is HBsAg present in the serum for?

A

HBsAg will be present in the serum from 6 weeks - 3 months after infection.

44
Q

How long after infection with hepatitis B virus is anti-HBV core (IgM) present in the serum for?

A

Anti-HBV core (igM) slowly rises from 6 weeks after infection and its serum level peaks at about 4 months.

45
Q

How would you know if an individual had been vaccinated against hepatitis B?

A

They would have anti-HBV IgG in their serum.

Gastrointestinal and Liver 2.0 (3 decks)

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