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Infection 2023 > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

Define hepatitis

A

Inflammation of the liver

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2
Q

Viruses that can cause liver damage (not Hep)

A

Epstein-Barr virus
Cytomegalovirus (herpes)
Varicella-zoster virus (chicken pox)

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3
Q

What are hepatitis viruses?

A

Viruses that replicate within hepatocytes (heptatotropic)

Destroy hepatocytes

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4
Q

Hepatitis groups and chronic?

A 
A (No)
B (YES)
C (YES)
D (Yes usually with Hep B)
E (not usually)
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5
Q

Spread of Hep B and D

A

Blood, sex, vertical

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6
Q

Spread of Hep C

A

Blood (sex not as common)

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7
Q

Spread of Hep A and Hep E

A

Faeco-oral (usually caught after travelling)

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8
Q

Viral structure Hep B

A

DNA
Double stranded
Enveloped

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9
Q

Viral structure Hep C

A

RNA
Single stranded
Enveloped

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10
Q

Hepatitis presentation

A

Jaundice (Icteric Sclera yellow eye)
Fatigue
Loss of appetite
Nausea

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11
Q

Risk factors Hepatitis

A

Recent travel
Unprotected sex
Drug taking

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12
Q

Blood tests Hepatitis results

A

Raised bilirubin

Raised ALT/AST (alanine and aspartate)

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13
Q

Liver function tests

A 
Bilirubin
Liver transaminases (ALT, AST)
Alkaline phosphatase (ALP)
Albumin 
Coagulation tests (liver produces clotting factors)
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14
Q

Coagulation tests

A 
INR (international normal ratio)
Prothrombin time (PT) - clotting takes longer in liver damage
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15
Q

Why is bilirubin raised in hepatitis?

A

Liver produces bile
Bile contains bilirubin
If bilirubin cannot be conjugated = not water soluble
YELLOW

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16
Q

Production of bilirubin is made by…

A

Breakdown of RBC’s

Haemoglobin -> bilirubin

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17
Q

How is bilirubin transported to liver?

A

Bound to albumin

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18
Q

How is bilirubin conjugated?

A

In liver by UDP glucuronyl transferase

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19
Q

What happens to conjugated bilirubin?

A

Urine
Urobilinogen (urine)
Urobilin Stercobilin (faeces)

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20
Q

Types of jaundice (2 division)

A 
Prehepatic 
Cholestatic (Intrahepatic or extrahepatic)
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21
Q

Prehepatic jaundice cause

A

Haemolysis (high RBC breakdown)

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22
Q

Intrahepatic jaundice cause

A

VIRAL HEPATITIS

drugs, alcohol, cirrhosis

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23
Q

Extrahepatic jaundice

A 
Duct stones (gall bladder stones)
Cholestasis

(gall bladder issue)

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24
Q

What does high ALT and AST show?

A

Liver inflammation and damage

25
Q

What does high AST suggest?

A

Extrahepatic bile duct/gall stone issue

26
Q

Findings for intrahepatic jaundice?

A

High bilirubin

High AST/ALT

27
Q

Hepatitis B transmission

A

Vertical mostly (from mother)

some sexual contact, drugs, needlestick injuries

28
Q

Acute Hep B symptoms

A

Jaundice (only tell tale)

Vague:
Fatigue
Abdominal pain
Nausea
Vomiting
Joint stiffness
29
Q

Incubation Hep B

A

6 weeks - 6 months

30
Q

What usually happens after infection with Hep B?

A

Most people clear infection within 6 months
10% -> chronic

(if infancy infection 90% are chronic)

31
Q

Hep B serology measurements

A

Surface antigen and antibody
E antigen and antibody
Core antibody (can’t measure antigen in blood)

32
Q

Core antibody Hep B

A

HBcAb = IgM and IgG

33
Q

Core antibody change

A

Initial /acute infection: IgM

Chronic/had before: IgG

34
Q

Serology Hep B short hand

A

HBsAb / HBsAg
HBeAb / HBeAg
HBcAb

35
Q

1st stage of Hep B infection

A

Surface antigen (HBsAg)

36
Q

2nd stage Hep B infection

A

E antigen (HBeAg) = highly infectious

37
Q

3rd stage Hep B infection

A

Core antibody (IgM)

38
Q

4th stage Hep B infection

A

E antibody (HBeAb) removes E antigen

39
Q

5th stage hep B infection

A 
Surface antibody (HBsAb) 
last antibody = CLEARANCE
40
Q

6th stage hep B infection

A

Core antibody (IgG)

good for life

41
Q

Hep B stages of infection

SECESC

A 
surface antigen
E antigen
Core antibody (IgM)
E antibody 
Surface antibody 
Core antibody (IgG)
42
Q

Chronic Hep B infection define

A

Persistance of HBsAg (Surface antigen) for longer than 6 months

43
Q

What can hep B lead to?

A

Cirrhosis

Hepatocellular Carcinoma

44
Q

Treatment Chronic Hep B

A

Life long Anti Virals (suppress replication)

some people are inactive carriers with no damage so this is not required

45
Q

Prevention Hep B

A

Vaccination - surface antigen

Produced Surface Antibody response

46
Q

Hep C whos at risk

A

IV drug users mostly

can be sexual contact, needlestick, transfusions

47
Q

Disease outcome Hep C

A

CHRONIC (80%) (unlike hep B)

remember hep C = CCChronic

48
Q

Secondary development Hep C

A 
Cirrhosis = 
Decompensated liver disease
Hepatocellular carcinoma (primary liver cancer)
Transplant
Death
49
Q

Symptoms Hep C

A

80% = no symptoms

20% have vague (fatigue, nausea, ab pain)

50
Q

Blood tests hep C

A

Serology for Anti Hep C antibody

THEN PCR to confirm if ongoing/chronic

51
Q

What can occur after clearance of Hep C?

A

Can be re infected even though presence of life long antibody

52
Q

Treatment Hep C

A

Cure

ANTIVIRAL drug combo

53
Q

Problems with Hep C treatment

A

Can get re infected
Costly
NO VACCINE

54
Q

What is PEP

A

Post exposure prophylaxis

55
Q

When is PEP used?

A

Suspected contact with HIV
or Hep B

No pep exists for Hep C

56
Q

HIV, HEP B HEP C contrasts

A 
HIV 
Symptoms: flu like
prevention: condoms 
Outcome: AIDS
Treatment: life long anti retro virals

Hep B: jaundice, abdo pain, nausea
Vaccination
Cure = majority
if chronic long term antivirals

Hep C
no symptoms 
avoid risks 
chronic infection is very common
treatment - 8/12 weeks of antivirals
57
Q

Risk of needlestick injuries HepB, C and HIV

A

Hep B - 1/3 (if vaccinated much lower)
Hep C - 1/30
HIV - 1/300

58
Q

Measures for needlestick injuries

A 
Bleed and wash wound
Collect blood from patient and med student 
Inform occupational health 
Check med students vaccination status 
Do we need PEP?
59
Q

HIV PEP

A

Give 3 Anti-retroviral drugs for 28 days

HIV test at baseline, 1 month and then 3 months

Infection 2023 (29 decks)

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