Viral Hepatitis Flashcards
Define hepatitis
Inflammation of the liver
Viruses that can cause liver damage (not Hep)
Epstein-Barr virus
Cytomegalovirus (herpes)
Varicella-zoster virus (chicken pox)
What are hepatitis viruses?
Viruses that replicate within hepatocytes (heptatotropic)
Destroy hepatocytes
Hepatitis groups and chronic?
A (No) B (YES) C (YES) D (Yes usually with Hep B) E (not usually)
Spread of Hep B and D
Blood, sex, vertical
Spread of Hep C
Blood (sex not as common)
Spread of Hep A and Hep E
Faeco-oral (usually caught after travelling)
Viral structure Hep B
DNA
Double stranded
Enveloped
Viral structure Hep C
RNA
Single stranded
Enveloped
Hepatitis presentation
Jaundice (Icteric Sclera yellow eye)
Fatigue
Loss of appetite
Nausea
Risk factors Hepatitis
Recent travel
Unprotected sex
Drug taking
Blood tests Hepatitis results
Raised bilirubin
Raised ALT/AST (alanine and aspartate)
Liver function tests
Bilirubin Liver transaminases (ALT, AST) Alkaline phosphatase (ALP) Albumin Coagulation tests (liver produces clotting factors)
Coagulation tests
INR (international normal ratio) Prothrombin time (PT) - clotting takes longer in liver damage
Why is bilirubin raised in hepatitis?
Liver produces bile
Bile contains bilirubin
If bilirubin cannot be conjugated = not water soluble
YELLOW
Production of bilirubin is made by…
Breakdown of RBC’s
Haemoglobin -> bilirubin
How is bilirubin transported to liver?
Bound to albumin
How is bilirubin conjugated?
In liver by UDP glucuronyl transferase
What happens to conjugated bilirubin?
Urine
Urobilinogen (urine)
Urobilin Stercobilin (faeces)
Types of jaundice (2 division)
Prehepatic Cholestatic (Intrahepatic or extrahepatic)
Prehepatic jaundice cause
Haemolysis (high RBC breakdown)
Intrahepatic jaundice cause
VIRAL HEPATITIS
drugs, alcohol, cirrhosis
Extrahepatic jaundice
Duct stones (gall bladder stones) Cholestasis
(gall bladder issue)
What does high ALT and AST show?
Liver inflammation and damage
What does high AST suggest?
Extrahepatic bile duct/gall stone issue
Findings for intrahepatic jaundice?
High bilirubin
High AST/ALT
Hepatitis B transmission
Vertical mostly (from mother)
some sexual contact, drugs, needlestick injuries
Acute Hep B symptoms
Jaundice (only tell tale)
Vague: Fatigue Abdominal pain Nausea Vomiting Joint stiffness
Incubation Hep B
6 weeks - 6 months
What usually happens after infection with Hep B?
Most people clear infection within 6 months
10% -> chronic
(if infancy infection 90% are chronic)
Hep B serology measurements
Surface antigen and antibody
E antigen and antibody
Core antibody (can’t measure antigen in blood)
Core antibody Hep B
HBcAb = IgM and IgG
Core antibody change
Initial /acute infection: IgM
Chronic/had before: IgG
Serology Hep B short hand
HBsAb / HBsAg
HBeAb / HBeAg
HBcAb
1st stage of Hep B infection
Surface antigen (HBsAg)
2nd stage Hep B infection
E antigen (HBeAg) = highly infectious
3rd stage Hep B infection
Core antibody (IgM)
4th stage Hep B infection
E antibody (HBeAb) removes E antigen
5th stage hep B infection
Surface antibody (HBsAb) last antibody = CLEARANCE
6th stage hep B infection
Core antibody (IgG)
good for life
Hep B stages of infection
SECESC
surface antigen E antigen Core antibody (IgM) E antibody Surface antibody Core antibody (IgG)
Chronic Hep B infection define
Persistance of HBsAg (Surface antigen) for longer than 6 months
What can hep B lead to?
Cirrhosis
Hepatocellular Carcinoma
Treatment Chronic Hep B
Life long Anti Virals (suppress replication)
some people are inactive carriers with no damage so this is not required
Prevention Hep B
Vaccination - surface antigen
Produced Surface Antibody response
Hep C whos at risk
IV drug users mostly
can be sexual contact, needlestick, transfusions
Disease outcome Hep C
CHRONIC (80%) (unlike hep B)
remember hep C = CCChronic
Secondary development Hep C
Cirrhosis = Decompensated liver disease Hepatocellular carcinoma (primary liver cancer) Transplant Death
Symptoms Hep C
80% = no symptoms
20% have vague (fatigue, nausea, ab pain)
Blood tests hep C
Serology for Anti Hep C antibody
THEN PCR to confirm if ongoing/chronic
What can occur after clearance of Hep C?
Can be re infected even though presence of life long antibody
Treatment Hep C
Cure
ANTIVIRAL drug combo
Problems with Hep C treatment
Can get re infected
Costly
NO VACCINE
What is PEP
Post exposure prophylaxis
When is PEP used?
Suspected contact with HIV
or Hep B
No pep exists for Hep C
HIV, HEP B HEP C contrasts
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
Risk of needlestick injuries HepB, C and HIV
Hep B - 1/3 (if vaccinated much lower)
Hep C - 1/30
HIV - 1/300
Measures for needlestick injuries
Bleed and wash wound Collect blood from patient and med student Inform occupational health Check med students vaccination status Do we need PEP?
HIV PEP
Give 3 Anti-retroviral drugs for 28 days
HIV test at baseline, 1 month and then 3 months
