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Year Two - Gastroenterology System > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

What is hepatitis?

A

It is defined as a condition in which there is inflammation in the liver

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2
Q

What is hepatitis A?

A

It is defined as an acute infection of the liver caused by the hepatitis A virus

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3
Q

What type of virus is hepatitis A?

A

RNA picornavirus

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4
Q

What is the incubation period of hepatitis A?

A

2 - 4 weeks

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5
Q

How is hepatitis A transmitted?

A

Faecal oral route, usually in contaminated water or food

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6
Q

In exam questions, when does hepatitis A usually present?

A

2 - 4 weeks following travel to an at risk country (India, Thailand,

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7
Q

What are the eight clinical features associated with hepatitis A?

A

Flu-Like Prodrome

Right Upper Quadrant Pain

Nausea & Vomiting

Hepatomegaly

Dark Coloured Urine

Pale Stools

Jaundice

Anorexia

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8
Q

What investigation is used to diagnose hepatitis A?

A

Blood tests

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9
Q

What four blood test results indicate hepatitis A?

A

Increased AST Levels

Increased ALT Levels

Increased ALP Levels

Increased Bilirubin Levels

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10
Q

How do we manage hepatitis A? Why?

A

We provide conservative reassurance advice and basic analgesia

This is due to the fact that it is a self-limiting acute infection, which usually resolves without treatment in one to three months

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11
Q

Is there an immunisation available for hepatitis A?

A

Yes

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12
Q

What is the vaccine type used in hepatitis A?

A

Inactivated preparation

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13
Q

Who is administered the hepatitis A vaccine?

A

It It is not routinely offered and is instead administered to high risk groups

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14
Q

Which six patient groups receive the hepatitis A vaccine?

A

Travellers To High Prevalence Areas

Chronic Liver Disease Patients

Haemophilia Patients

Intravenous Drug Users

Men Who Have Sex With Men

Occupational Risk

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15
Q

What is hepatitis B?

A

It is defined as an infection of the liver caused by the hepatitis B virus

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16
Q

What type of virus is hepatitis B?

A

Double stranded DNA hepadnavirus

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17
Q

What is the incubation period of hepatitis B?

A

6 - 20 weeks

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18
Q

In what three ways is hepatitis B transmitted?

A

Parenterally via direct contact with infected blood or bodily fluids

Sexually via sexual intercourse

Vertically from mother to child, during pregnancy or delivery

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19
Q

What are the five clinical features associated with hepatitis B?

A

Fever

Right Upper Quadrant Pain

Nausea & Vomiting

Jaundice

Anorexia

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20
Q

What investigation is used to diagnose hepatitis B?

A

Blood tests

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21
Q

What seven blood tests are used to diagnose hepatitis B?

A

Hepatitis B Surface Antigen (HBsAg)

Hepatitis B Surface Antigen Antibody (Anti-HBs)

Hepatitis B Core Antigen (HBcAg)

Hepatitis B Core Antigen Antibody (Anti-HBc)

Hepatitis B Envelope Antigen (HBeAg)

Hepatitis B Envelope Antibody (Anti-HBe)

Hepatitis B Virus DNA (HBV-DNA)

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22
Q

What is the hepatitis B surface antigen (HBsAg)?

A

It is a protein found on the surface of HBV

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23
Q

What does a positive HBsAg result indicate?

A

Infection

In cases where there is persistence of HBsAg for a period greater than six months, chronic infection is indicated

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24
Q

What is the hepatitis B surface antigen antibody (anti-HBs)?

A

It is the antibody produced by the host in response to HbsAg exposure

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25
What does anti-HBs demonstrate?
It indicates the clearance of HbsAg, and therefore resolution and immunity to hepatitis B infection
26
What does a positive anti-HBs result indicate?
Immunity No current infection
27
What is the hepatitis B core antigen (HBcAg)?
It is a component of the nucleocapsid within HBV
28
What does a positive HBcAg result indicate? What is important to note?
Infection It is not routinely measured in clinical practice
29
What is the hepatitis B core antigen antibody (anti-HBc)?
It is the antibody produced by the host in response to HbcAg
30
What does anti-HBc demonstrate?
It indicates current/past hepatitis B infection
31
In clinical practice, how do we use anti-HBc results?
It can be used to determine whether the infection is acute or chronic by identification of the immunoglobulin type present
32
What two immunoglobulin types are present in anti-HBc?
IgM IgG
33
What immunoglobulin is present at the start of hepatitis B infection?
Anti-HBc IgG
34
Over time, what is anti-HBc IgM gradually replaced with?
Anti-HBc IgG
35
What does a positive anti-HBc IgM result indicate?
Acute infection
36
What does a positive anti-HBc IgG result indicate?
Chronic infection OR Acquired natural immunity
37
What is acquired natural immunity?
It is immunity obtained from a previous infection
38
What is the hepatitis B envelope antigen (HBeAg)?
It is the antigen located between the core and lipid envelope within HBV
39
What does a HBeAg demonstrate?
It indicates that the virus is actively replicating
40
What does a positive HBeAg result indicate?
Active infection, with a higher risk of transmissibility
41
In clinical practice, how do we use HBeAg results?
It is used to distinguish between active chronic infection and inactive chronic infection
42
What is hepatitis B envelope antibody (anti-HBe)?
It is the antibody produced by the host in response to HbeAg
43
What does a positive anti-HBe result indicate?
Inactive chronic infection OR Acquired natural immunity
44
What does the hepatitis B virus DNA (HBV-DNA) determine?
The viral load of hepatitis B infection
45
In which individuals do we conduct a hepatitis B virus DNA (HBV-DNA)?
In individuals with positive hepatitis B infection serological markers
46
What does a high HBV-DNA viral load indicate?
Active chronic infection - with an increased risk of complication development
47
What does a low HBV-DNA viral load indicate?
Acute infection OR Inactive chronic infection
48
What are the two initial serology markers used to diagnose hepatitis B? What is each serology marker used to identify?
Anti-HBs = to identify previous infection HbsAg = to identify active infection
49
What two further serology markers are used to diagnose hepatitis B - following initial positive results?
HbeAg HBV DNA
50
What does a positive HBsAg result indicate?
Acute infection Active chronic infection Inactive chronic infection
51
What does a positive anti-HBs result indicate?
Natural immunity Passive immunity
52
What does a positive anti-HBc IgM result indicate?
Acute infection
53
What does a positive anti-HBc IgG result indicate?
Active chronic infection Inactive chronic infection Natural immunity
54
What does a positive HBeAg result indicate?
Acute infection Active chronic infection
55
What does a positive anti-HBe result indicate?
Inactive chronic infection Natural immunity
56
What does a high HBV-DNA result indicate?
Inactive chronic infection
57
What does a low HBV-DNA result indicate?
Active chronic infection
58
What other blood test can be used to diagnose hepatitis B?
LFTs
59
What are transaminases?
ALT AST
60
What is the transaminase level in acute hepatitis B infection?
Increased
61
What is the transaminase level in active chronic hepatitis B infection?
Increased
62
What is the transaminase level in inactive chronic hepatitis B infection?
Normal
63
What is the transaminase level in hepatitis B natural immunity?
Increased/normal
64
What is the transaminase level in hepatitis B passive immunity?
Normal
65
In what four ways do we manage hepatitis B conservatively?
Smoking Cessation Advice Alcohol Cessation Advice Blood Born Virus Screening Public Health Notification
66
What three blood born viruses do we screen for in hepatitis B positive patients?
Hep A HIV STIs
67
How do we pharmacologically manage hepatitis B?
Anti-viral drugs
68
Name four anti-viral drugs
Pegylated (PEG) interferon alpha-21 Tenofovir Entecavir Telbivudine
69
In which hepatitis B patients, do we administer anti-virals to?
In individuals with a viral load count > 20,000 IU/mL
70
How do anti-virals manage hepatitis B?
They are used to slow disease progression and reduce infectivity
71
Is there an immunisation against hepatitis B?
Yes
72
What vaccine type is used in hepatitis B?
Conjugate
73
What does the hepatitis B vaccine consist of?
It involves injection of the hepatitis B surface antigen (HbsAg) prepared from yeast cells using recombinant DNA technology
74
How many doses of the hepatitis B vaccine are administered?
3 doses
75
What serology marker is produced as a result of hepatitis B immunisation?
anti-HBs
76
Which seven patient groups are offered the hepatitis B vaccine?
Children Immunisation Programme Chronic Liver Disease Patients Chronic Kidney Disease Patients Regular Blood Transfusion Patients Intravenous Drug Users Healthcare Workers Sex Workers
77
At what three ages do children receive the hepatitis B vaccine?
2 months old 3 months old 4 months old
78
How do we confirm response to the hepatitis B vaccine?
We conduct anti-HBs serology testing 1 to 4 months after primary immunisation
79
What does an anti-HBs level of > 100 indicate about response to the hepatitis B vaccine? What is the further management option?
There is an adequate response These individuals only require a roster at 5 years
80
What does an anti-HBs level of 10 - 100 indicate about response to the hepatitis B vaccine? What is the further management option?
There is a suboptimal response These individuals require one additional vaccine dose
81
What does an anti-HBs level of <10 indicate about response to the hepatitis B vaccine? What is the further management option?
There has been no response These individuals need tested for infection and require a further vaccine course (3 doses)
82
What are the six complications of hepatitis B?
Chronic Hepatitis Liver Failure Hepatocellular Carcinoma Membranous Glomerulonephritis Polyarteritis Nodosa Cryoglobulinemia
83
What is a feature of chronic hepatitis B on light microscopy?
Ground glass hepatocytes
84
What is hepatitis C?
It is defined as an infection of the liver caused by the hepatitis C virus
85
What type of virus is hepatitis C?
RNA flavivirus
86
What is the incubation period of hepatitis C?
6 – 9 weeks
87
How many strains are there of hepatitis C?
Six
88
What are the two most common strains of hepatitis C?
Genotype one Genotype three
89
In what three ways is hepatitis C transmitted?
Parenterally via direct contact with infected blood or bodily fluids Sexually via sexual intercourse Vertically from mother to child, during pregnancy or delivery
90
Is breastfeeding contraindicated in mothers with hepatitis C?
No
91
What are the nine clinical features associated with hepatitis C?
Fever Right Upper Quadrant Pain Nausea & Vomiting Pruritis Jaundice Purpura Arthralgia Ascites Anorexia
92
What investigation is used to diagnose hepatitis C?
Blood tests
93
What two blood tests are used to diagnose hepatitis C?
Hepatitis C Antibody Hepatitis C RNA
94
What is the hepatitis C antibody blood test?
It determines whether an individual has been exposed to the virus by testing for the presence of antibodies
95
How is the hepatitis C antibody blood test used to investigate hepatitis C?
It is used to screen for infection
96
What does a positive hepatitis C antibody blood test result mean?
It indicates that an individual has been infected with hepatitis C, however it is undetermined whether this infection is currently present or has been cleared
97
What is the hepatitis C RNA blood test?
It determines whether there is replication of the virus, and therefore whether there is current infection within the body In addition, this blood test can be used to determine the virus genotype, which allows the most appropriate management to be administered
98
How is the hepatitis C RNA blood test used to investigate hepatitis C?
It is used to diagnose current hepatitis C infection
99
In what four ways do we conservatively manage hepatitis C?
Smoking Cessation Advice Alcohol Cessation Advice Blood Born Virus Screening (Hep A, HIV, STIs) Public Health Notification
100
What is the pharmacological management option for hepatitis C?
Direct Acting Anti-Virals (DAAs)
101
What are direct acting anti-virals (DAAs)?
They are drugs that target the specific viral genotype
102
Name four direct acting anti-virals (DAAs) used to manage hepatitis C
Sofosbuvir Ledipasvir Ombitasvir Ribavirin
103
What is the aim of direct acting anti-virals (DAAs) management of hepatitis C?
Sustained virological response (SVR) This is defined as undetectable serum HCV RNA six months after the end of therapy
104
Is there an immunisation available for hepatitis C?
No
105
What are the eight complications associated with hepatitis C?
Chronic Hepatitis C Liver Failure Hepatocellular Carcinoma Arthritis Sjogren’s Syndrome Cryoglobulinemia Porphyria Cutanea Tarda Membranoproliferative Glomerulonephritis
106
What is hepatitis D?
It is defined as an infection of the liver caused by the hepatitis D virus
107
What type of virus is hepatitis D?
A single stranded RNA virus
108
What is the incubation period of hepatitis D?
2 - 8 weeks
109
How is hepatitis D transmitted?
Parenterally via direct contact with infected blood or bodily fluids
110
What is required for hepatitis D infection to occur?
It requires hepatitis B surface antigens (HbsAg)
111
What is co-infection - in terms of hepatitis D?
It is the infection of both hepatitis B and D
112
What is superinfection - in terms of hepatitis D?
It when HBsAg positive patients develop hepatitis D
113
What are the five clinical features of hepatitis D?
Fever Right Upper Quadrant Pain Nausea & Vomiting Jaundice Anorexia
114
What investigation is used to diagnose hepatitis D?
Blood tests
115
What blood test is used to diagnose hepatitis D?
Reverse PCR Hepatitis D RNA
116
What is reverse PCR hepatitis D RNA?
This test involves the synthesis of DNA from RNA by using an RNA-dependent DNA polymerase
117
In what four ways do we conservatively manage hepatitis D?
Smoking Cessation Advice Alcohol Cessation Advice Blood Born Virus Screening (Hep A, HIV, STIs) Public Health Notification
118
What is the pharmacological option for hepatitis D?
Anti-Viral Drugs
119
Name an anti-viral drug used to manage hepatitis D?
Pegylated (PEG) interferon alpha-21
120
Is there a cure for hepatitis D?
No The management options are therefore used to slow down the progression of disease only
121
Is there an immunisation available for hepatitis D?
Yes The hepatitis B vaccine can be used to prevent hepatitis D infection, due to the requirement of co-infection
122
What is hepatitis E?
It is defined as an infection of the liver caused by the hepatitis E virus
123
What type of virus is hepatitis E?
RNA hepevirus
124
What is the incubation period of hepatitis E?
3 – 8 weeks
125
How is hepatitis E transmitted?
Faecal-oral route, usually in contaminated water or food
126
In exam questions, how does hepatitis E infection tend to transmit?
Undercooked pork
127
What are the five clinical features of hepatitis E?
Fever Right Upper Quadrant Pain Nausea & Vomiting Jaundice Anorexia
128
What investigation is used to diagnose hepatitis E?
Blood tests
129
What four blood test results indicate hepatitis E?
Increased AST Levels Increased ALT Levels Increased ALP Levels Increased Bilirubin Levels
130
How do we manage hepatitis E? Why?
We provide conservative reassurance advice and basic analgesia This is due to the fact that it is a self-limiting acute infection, which usually resolves without treatment in one to three months
131
In which patient group does hepatitis E carry a high mortality in?
Pregnant patients
132
Is there an immunisation available for hepatitis E?
No

Year Two - Gastroenterology System (33 decks)

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