Viral Hepatitis

Question 1

Causes of infectious hepatitis

Answer 1

primary
Hep A-E

Secondary
EBV
CMV
HIV
Adenovirus
…

Question 2

ASDFGHJKL;P’;’[PL./’PL./P./PL./’L./PTransmission of Hep A

Answer 2

Face oral route
person to person contact
contaminated food or drink

Question 3

incubation period of Hep A

Answer 3

4w - check

6-8

Question 4

Sx of acute hep

Answer 4

fever
malaise
fatigue
anorexia
abdo pain
jaundice
dark urine
pale stool
pruritus

Question 5

Hep A lab Ix

Answer 5

Anti HAV IgM (if ALT >500 u/L

may be negative in week 1 of sx

Question 6

When should you request Hep A IgM?

Answer 6

if ALT > 500 u/L

in that phase it is too early and would not be detectable -> false reassurance

Question 7

How long should people isolate for with Hep A?

Answer 7

7d from Sx onset

Question 8

should you report Hep A?

Answer 8

yes

Question 9

should you report Hep A?

Answer 9

yes

Question 10

Complications

Answer 10

XXXXXX

• cirrhosis (child-push score) - transient elasticity? shows amount of fibrosis
• HCC (APF and imaging)
• polyarteritis nodosa????

Question 11

Incubation period of Hep B

Answer 11

2-6m

Question 12

Transmission of Hep B

Answer 12

parental
sex
materno fetal

Question 13

Acute Hep A inf

Answer 13

if <5yo 90% are asyx but 90% progress to chronic hep B inf
adults 20-40% ssxx, 10% progress to chronic hep B

Question 14

Hep B serology

Answer 14

HBsAg - current HBV infection
HBeAg - high viral replicaation/high infectivity
HBcIgM - acute infection <3m
AntiHBc - exposure to HBV, past or present HBV infection
AntiHBe - immune control, imminent or already achieved eAg clearance
AantiHBs - immunity (natural or induced via vaccination)

Question 15

What Hb serology marker shows current infection?

Answer 15

HBsAg

Question 16

Wich HepB antibody is positive if someone had vaccine but never infection?

Answer 16

ANti-HBs

Question 17

What drives considerations for treatment of Hep B?

Answer 17

viral load

Question 18

Mx of Hep B

Answer 18

1. pegylated IFN-a (bad flue like sx)
2. neucleos(t)ide analogues (entecavir, tenofovir, long term oral treatment)

Question 19

prevention of Hep B

Answer 19

vaccination
screening in pregnancy

Question 20

Mum has Hep B in pregnancy Mx

Answer 20

HbsAG + EAG - VACCINE AT BRTH

OTHER WITH HBIG AT BIRTH AND VACCINE

Question 21

Hep C global prevalence

Answer 21

1%

Question 22

Transmission of Hep C

Answer 22

blood products
sharing needles
sharing bank notes tto insufflate reacreational drugs

Question 23

incubation period for Hep C

Answer 23

2w-6m

Question 24

acute Hep C infection

Answer 24

mostly asymptomatic
20-40$ spsontenoussly clear inf
40-60% progress to chronic infection

Question 25

complications of Hep C infection

Question 26

Tests for Hep B

Answer 26

Anti HCV HCV PCR

Question 27

Management of HepC

Answer 27

now curable disease - every pt should be considered for treatment (1 pill/day for 12 weeks), very good against all genotypes.// direct-acting antivirals every p

Question 28

Prevention of Hep C///o

Answer 28

no vaccine screening of blood products

Question 29

Pt has anti-HCV reactive , HCV RNA not detected, no fibrosis on fibroscan

Answer 29

no hep C (because no RNA) no treatment required pt spontaneously cleared the infection and did not develop a chronic infection and no damage to the liver so they do not need any FU

Question 30

Hep D - what does it need to function?

Answer 30

needs Hep B co-infection to function then goes on to destroy hepatocytes

Question 31

Hep D - course of diseaes

Answer 31

severe acute disease low risk of chronic infection if already infected with Hep B: get chronic Hep D superinfection and this triggers accelerated liver damage and cirrhosis

Question 32

How do we prevent Hep D?

Answer 32

prevent Her B PEP educate pts with hep B about risky behaviours such as sharing needles, UPSI

Question 33

Hep E - incubation period

Answer 33

2-8 w

Question 34

Hep E - disease course

Answer 34

mild disease 30% mortality in pregnant women (high ALT and unwell) chronic infection only if immunocompromised

Question 35

diagnostic assays in Hep E

Answer 35

HEV IgM and IgG (immunocompetent) HEV RNA (immunocompromised - HEV Ab often undetectable)

Question 36

extra hepatic manifestations of viral hepatitis E

Answer 36

thrombocytopenia red cell aplasia proximal myopathy necrotising myositis encephalitis s ataxia brachial neuritis GBS IgA nephropathy membranoproliferative glomerulonephritis

Question 37

Is treatment of acute and chronic Hep C differnet/

Answer 37

no its the same, 1 pill every day for 3m/12w

Question 38

Hep B - extrahepatic manifestations

Answer 38

polyartereritis nodosa vassculitis

Question 39

Hep C - extra hep manifestatons

Answer 39

cryoglobulineamia

Question 40

what is cryoglobulinaemia an extra hep manifestation of?

Answer 40

Hep C