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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
What does high AST suggest?
Extrahepatic bile duct/gall stone issue
26
Findings for intrahepatic jaundice?
High bilirubin | High AST/ALT
27
Hepatitis B transmission
Vertical mostly (from mother) some sexual contact, drugs, needlestick injuries
28
Acute Hep B symptoms
Jaundice (only tell tale) ``` Vague: Fatigue Abdominal pain Nausea Vomiting Joint stiffness ```
29
Incubation Hep B
6 weeks - 6 months
30
What usually happens after infection with Hep B?
Most people clear infection within 6 months 10% -> chronic (if infancy infection 90% are chronic)
31
Hep B serology measurements
Surface antigen and antibody E antigen and antibody Core antibody (can't measure antigen in blood)
32
Core antibody Hep B
HBcAb = IgM and IgG
33
Core antibody change
Initial /acute infection: IgM | Chronic/had before: IgG
34
Serology Hep B short hand
HBsAb / HBsAg HBeAb / HBeAg HBcAb
35
1st stage of Hep B infection
Surface antigen (HBsAg)
36
2nd stage Hep B infection
E antigen (HBeAg) = highly infectious
37
3rd stage Hep B infection
Core antibody (IgM)
38
4th stage Hep B infection
E antibody (HBeAb) removes E antigen
39
5th stage hep B infection
``` Surface antibody (HBsAb) last antibody = CLEARANCE ```
40
6th stage hep B infection
Core antibody (IgG) | good for life
41
Hep B stages of infection | SECESC
``` surface antigen E antigen Core antibody (IgM) E antibody Surface antibody Core antibody (IgG) ```
42
Chronic Hep B infection define
Persistance of HBsAg (Surface antigen) for longer than 6 months
43
What can hep B lead to?
Cirrhosis | Hepatocellular Carcinoma
44
Treatment Chronic Hep B
Life long Anti Virals (suppress replication) some people are inactive carriers with no damage so this is not required
45
Prevention Hep B
Vaccination - surface antigen | Produced Surface Antibody response
46
Hep C whos at risk
IV drug users mostly can be sexual contact, needlestick, transfusions
47
Disease outcome Hep C
CHRONIC (80%) (unlike hep B) | remember hep C = CCChronic
48
Secondary development Hep C
``` Cirrhosis = Decompensated liver disease Hepatocellular carcinoma (primary liver cancer) Transplant Death ```
49
Symptoms Hep C
80% = no symptoms 20% have vague (fatigue, nausea, ab pain)
50
Blood tests hep C
Serology for Anti Hep C antibody | THEN PCR to confirm if ongoing/chronic
51
What can occur after clearance of Hep C?
Can be re infected even though presence of life long antibody
52
Treatment Hep C
Cure | ANTIVIRAL drug combo
53
Problems with Hep C treatment
Can get re infected Costly NO VACCINE
54
What is PEP
Post exposure prophylaxis
55
When is PEP used?
Suspected contact with HIV or Hep B No pep exists for Hep C
56
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 ```
57
Risk of needlestick injuries HepB, C and HIV
Hep B - 1/3 (if vaccinated much lower) Hep C - 1/30 HIV - 1/300
58
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? ```
59
HIV PEP
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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