viral hepatitis

Question 1

what is hepatitis

Answer 1

inflammation of the liver

Question 2

acute vs chronic hep

Answer 2

acute less than 6 monts
chronic more than 6 months

Question 3

symptoms of acute hepatitis

Answer 3

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

Question 4

signs of acute hep

Answer 4

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

Question 5

bloods for acute hep would show

Answer 5

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

Question 6

infectious causes of acute hep can be split into

Answer 6

viral
non viral

Question 7

viral causes of acute hep

Answer 7

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

Question 8

non viral causes of acute hep

Answer 8

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

Question 9

non infectious causes of acute hep

Answer 9

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

Question 10

patients with chronic hep may have signs of …

Answer 10

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

Question 11

compensatory mechanism of chronic hep

Answer 11

liver function maintained

Question 12

decompensated mechanism of chronic hep

Answer 12

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

Question 13

infectious causes of chronic hep

Answer 13

Hepatitis B ± D, C (& E)

Question 14

non infectious causes

Answer 14

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

Question 15

link between hep b and d

Answer 15

a patient needs hep b to have hep d

Question 16

What is Hep A?

Answer 16

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

Acute only

Question 17

Hep a is spread through?

Answer 17

contaminated food and water

Question 18

RFs for Hep A

Answer 18

• 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

Question 19

Pathophysiology of Hep A

Answer 19

• 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

Question 20

Phases of Hep A

Answer 20

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.

Question 21

presentation of Hep a

Answer 21

non specific symptoms
RUQ tenderness
jaundice
Hepatomegaly
Nausea

Question 22

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

Answer 22

• +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

Question 23

Hep A management

Answer 23

supportive
monitor liver function
vaccine

Question 24

Complications of Hep A

Answer 24

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

Question 25

What is Hep E

Answer 25

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

Question 26

What can Hep E cause?

Answer 26

• Asymptomatic infections
• Acute viral hepatitis
• Chronic viral hepatitis
• Extra-hepatic manifestations

Question 27

Hep E is spread through

Answer 27

• contaminated food and water
• undercooked meat

Question 28

presentation of Hep e

Answer 28

95% asymptomatic

Question 29

serological response of hep e

Answer 29

IgM present before 6 months
after 6 months IgG

Question 30

Hep e management

Answer 30

supportive
monitor for fulminant hepatitis

Question 31

how is Hep B spread

Answer 31

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

Question 32

serological response for hep b would be

Question 33

TREATMENT option for hep b

Answer 33

1st line - peglyated interferon -a-2a

Question 34

TREATMENT option for hep b 1st line

Answer 34

1st line - peglyated interferon -a-2a

Question 35

Other treatment options for hep b

Answer 35

oral nucleotides- inhibit viral replication

Question 36

Hep B prevention involves

Answer 36

• antenatal screening
• childhood immunisation
• screening and immunisation of household and sexual contacts

Question 37

HEP C TRANSMISSION is via ….

Answer 37

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