Viral hepatitis

Question 1

What is hepatitis?

Answer 1

Inflammation of the liver

Question 2

How many types of viral hepatitis are there?

Answer 2

5

Question 3

What would the liver function tests for a ‘hepatic picture’ show?

Answer 3

A hepatic picture on liver function tests refers to high transaminases (AST and ALT) with proportionally less of a rise in ALP. Bilirubin can also rise due to the inflammation of the liver cells.

Question 4

What are transaminases?

Answer 4

Liver enzymes released into the blood due to inflammation of the liver cells.

Question 5

What hepatitises are transmitted via the fecal-oral route?

Answer 5

Hep A and B

Question 6

What hepatitis’s transmitted by only blood?

Answer 6

hepatitis c

Question 7

What hepatitis’s transmitted by blood and bodily fluids?

Answer 7

hep b

Question 8

What kind of hep B infection would the patient have if they were positive for Hep B core IgM?

Answer 8

acute infection

Question 9

What kind of infection for hep b would it indicate if you had HBcAb and HBsAb?

Answer 9

You have had the infection and got rid of it completely

Question 10

What kind of infection would it suggest if you had only the HBsAb?

Answer 10

Immunization to hep B, implied resolution of HBV infection if other markers were negative.

Question 11

What kind of infection would it suggest if you had had the HBsAg and HBsAb?

Answer 11

It would suggest a chronic infection

Question 12

Why would you test for HBV DNA?

Answer 12

To determine the infectivity of an individual

Question 13

Why are HBe Ag and HBeAb measured?

Answer 13

They are markers of infectivity. People with the antigen are more infective than those with the antibody

Question 14

What are the pharmacological options for hep B?

Answer 14

Antiviral medication can be used to slow the progression of the disease

Question 15

What is the treatment cure for hepatitis C?

Answer 15

Direct-acting antiviral medications, eg sofosbuvir and daclatasvir

Question 16

Why is hepatitis C RNA testing done?

Answer 16

To confirm the diagnosis of hepatitis C, calculate the viral load and identify the genotype?

Question 17

What is autoimmune hepatitis?

Answer 17

A rare cause of chronic hepatitis, it appears to occur due to a combination of genetic and environmental factors.

Question 18

When does type 1 autoimmune hepatitis usually present?

Answer 18

Type 1 typically affects women in their late forties or fifties. It presents around or after menopause with fatigue and features of liver disease on examination. It takes a less acute course than type 2.

Question 19

When does type 2 autoimmune hepatitis usually present?

Answer 19

Type 2 usually affects children or young people, more commonly girls. It presents with acute hepatitis with high transaminases and jaundice.

Question 20

How would the LFT blood test in autoimmune hepatitis usually present?

Answer 20

Investigations will show high transaminases (ALT and AST) and minimal change in ALP levels (a “hepatitic” picture). Raised immunoglobulin G (IgG) levels are an important finding. Also raised autoantibodies.

Question 21

What are the autoantibodies in type 1 autoimmune hepatitis?

Answer 21

Anti-nuclear antibodies (ANA)
Anti-smooth muscle antibodies (anti-actin)
Anti-soluble liver antigen (anti-SLA/LP)

Question 22

What are the autoantibodies in type 2 autoimmune hepatitis?

Answer 22

Anti-liver kidney microsomes-1 (anti-LKM1)
Anti-liver cytosol antigen type 1 (anti-LC1)

Question 23

What would the biopsy finding be for autoimmune hepatitis?

Answer 23

Key histology findings are interface hepatitis and plasma cell infiltration.