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Liver and Friends > viral hepatitis > Flashcards

viral hepatitis Flashcards

1
Q

what is hepatitis

A

inflammation of the liver

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2
Q

acute vs chronic hep

A

acute less than 6 monts
chronic more than 6 months

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3
Q

symptoms of acute hepatitis

A

None or non-specific, e.g. malaise, lethargy, myalgia
Gastrointestinal upset, abdominal pain
Jaundice + pale stools / dark urine

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4
Q

signs of acute hep

A

Tender hepatomegaly ± jaundice
± signs of fulminant hepatitis (acute liver failure), e.g. bleeding, ascites, encephalopathy

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5
Q

bloods for acute hep would show

A

Raised transaminases (ALT/AST&raquo_space; GGT/ALP) ± raised bilirubin

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6
Q

infectious causes of acute hep can be split into

A

viral
non viral

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7
Q

viral causes of acute hep

A

Hepatitis A, B ± D, C & E
Human herpes viruses, e.g. HSV, VZV, CMV, EBV
Other, e.g. influenza, SARS-CoV-2

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8
Q

non viral causes of acute hep

A

Spirochaetes, e.g. leptospirosis, syphilis
Mycobacteria, e.g. M. tuberculosis
Bacteria, e.g. bartonella
Parasites, e.g. toxoplasma

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9
Q

non infectious causes of acute hep

A

Drugs
Alcohol
Other toxins / poisoning
Non-alcoholic fatty liver disease
Pregnancy
Autoimmune hepatitis
Hereditary metabolic causes

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10
Q

patients with chronic hep may have signs of …

A

liver disease
clubbing, palmar erythema, Dupuytren’s contracture, spider naevi, et

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11
Q

compensatory mechanism of chronic hep

A

liver function maintained

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12
Q

decompensated mechanism of chronic hep

A

coagulopathy (↑PT, INR)
jaundice (↑bilirubin)
low albumin
ascites (± bacterial peritonitis)
encephalopathy

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13
Q

infectious causes of chronic hep

A

Hepatitis B ± D, C (& E)

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14
Q

non infectious causes

A

Drugs
Alcohol
Other toxins / poisoning
Non-alcoholic fatty liver disease
Autoimmune hepatitis
Hereditary metabolic causes

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15
Q

link between hep b and d

A

a patient needs hep b to have hep d

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16
Q

What is Hep A?

A

The Hepatitis A virus is a non-enveloped single-stranded RNA virus.

Acute only

17
Q

Hep a is spread through?

A

contaminated food and water

18
Q

RFs for Hep A

A
  • Travel: those travelling to endemic areas
  • Sexual:**high risk activities (e.g analingus, digital-rectal contact, chemsex), multiple partners
  • Haematological disorders: factor VIII and factor IX concentrates have been implicated in transmission
  • Occupational risks: for example laboratory or sewage workers
  • IV drug users:**known to be at increased risk
19
Q

Pathophysiology of Hep A

A
  • Hep A is a picornavirus
  • Replicates in the liver, is excreted in bile then excreted in the faeces for about 2 weeks before the onset of clinical illness and for up to 7 days after
  • infectious JUST BEFORE the onset of jaundice
  • Short incubation period of 2-6 weeks
  • Causes ACUTE HEPATITIS ONLY
  • 100% immunity after infection
20
Q

Phases of Hep A

A

Hepatitis A is said to follow four clinical phases (though significant variation exists).

  1. Incubation:**Hepatitis A has a relatively long incubation period that may last from 2 - 6 weeks (mean 28-30 days).
  2. Prodromal: Early part of the disease, characterised by fever, joint pain and rash. Flu-like symptoms may be present
  3. Icteric:**In addition to jaundice, the icteric phase is characterised by anorexia, abdominal pain and change in bowel habit.
  4. Convalescent:**Recovery phase as the body returns to normal and symptoms subside. Symptoms like malaise may last months.
21
Q

presentation of Hep a

A

non specific symptoms
RUQ tenderness
jaundice
Hepatomegaly
Nausea

22
Q

what would you see in antibody test (serology) for HeP A (GS 1st line investigation)

A
  • +ve HAV-IgM, +ve HAV-IgG:**Likely acute hepatitis A infection
  • +ve HAV-IgM, -ve HAV-IgG:**May indicate acute infection or false positive IgM
  • -ve HAV-IgM, +ve HAV-IgG:**Indicates previous infection or vaccine based immunity
  • -ve HAV-IgM, -ve HAV-IgG:**No evidence of infection, may be very early or still in the incubation phase
23
Q

Hep A management

A

supportive
monitor liver function
vaccine

24
Q

Complications of Hep A

A
  • Relapsing hepatitis(may occur in 5-15%)
  • Fulminant liver failure
  • Prolonged cholestasis
  • Others(interstitial nephritis, acute pancreatitis, red cell aplasia, Guillian-Barre syndrome)
25
Q

What is Hep E

A

Hepatitis E is a small, non-enveloped RNA virus that can lead to acute and chronic hepatitis.

26
Q

What can Hep E cause?

A
  • Asymptomatic infections
  • Acute viral hepatitis
  • Chronic viral hepatitis
  • Extra-hepatic manifestations
27
Q

Hep E is spread through

A
  • contaminated food and water
  • undercooked meat
28
Q

presentation of Hep e

A

95% asymptomatic

29
Q

serological response of hep e

A

IgM present before 6 months
after 6 months IgG

30
Q

Hep e management

A

supportive
monitor for fulminant hepatitis

31
Q

how is Hep B spread

A

Mother-to-child***
Household contact
Blood products
Iatrogenic
Occupational
Sexual
Injecting drug use

32
Q

serological response for hep b would be

A
33
Q

TREATMENT option for hep b

A

1st line - peglyated interferon -a-2a

34
Q

TREATMENT option for hep b 1st line

A

1st line - peglyated interferon -a-2a

35
Q

Other treatment options for hep b

A

oral nucleotides- inhibit viral replication

36
Q

Hep B prevention involves

A
  • antenatal screening
  • childhood immunisation
  • screening and immunisation of household and sexual contacts
37
Q

HEP C TRANSMISSION is via ….

A

Mother-to-child
Household contact
Blood products
Iatrogenic
Occupational
Sexual (MSM)
Injecting drug use***
Tattoos, piercings, etc

Liver and Friends (17 decks)

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