Viral hepatitis

Question 1

What is the dual blood supply of the liver?

Answer 1

hepatic portal vein
hepatic arteries

Question 2

What blood does the hepatic portal vein carry?

Answer 2

venous blood from spleen, stomach, pancreas + small intestine

Question 3

Define hepatitis

Answer 3

acute or chronic parenchymal liver damage

Question 4

What is the dominant symptom of hepatitis?

Answer 4

jaundice (icterus)
(detectable clinically when serum bilirubin >50 micromol/L

Question 5

Hepatitis histological features

Answer 5

hepatocytes show degenerative changes (swelling, cytoplasmic granulation, vacuolation)

hepatocytes undergo necrosis (become shrunken, eosinophilic councilman bodies)

necrosis maximal in zone 3

Question 6

Hepatitis causes

Answer 6

viral infections
bacterial infections
drugs
alcohol
poisons
other (pregnancy, Wilson’s disease, circulatory insufficiency)

Question 7

What infectious agents can cause hepatitis?

Answer 7

systemic viral infections:
- EBV
- CMV
- HSV
- VZV
- yellow fever
- viral haemorrhagic fevers
- rubella
- mumps
- adenovirus
- HIV
- Coxsackie B

Bacterial infections:
- leptospira
- coxiella
- brucella
- borrelia

Hepatotropic viruses

Question 8

What are the major hepatotropic viruses?

Answer 8

Hep A, B, C, D, E

Question 9

Most common blood borne infection in UK

Answer 9

Hep C

Question 10

What disease processes are associated with HCV?

Answer 10

liver disease
diabetes
B-cell proliferative disorders
depression
cognitive disorders

Question 11

Most important risk factor for HCV infection?

Answer 11

injecting drugs

Question 12

Risk factors associated with transmission of HCV?

Answer 12

transfusion with infected blood
injecting drug use
haemodialysis (rare in UK)
accidental injuries with needles/sharps
sexual/household exposure
multiple sex partners
birth to HCV-infected mother

Question 13

Diagnosis of HCV infection

Answer 13

HCV antibody - diagnoses in chronic disease (not useful acutely as takes 12 weeks for antibody to appear)

HCV RNA - can be used in acute phase

HCV antigen

Question 14

What antivirals can be used to treat HCV?

Answer 14

protease inhibitors - Telaprevir, Boceprevir

NS5A inhibitors - Ombitasvir, Elbasvir

NS5B inhibitors - Sofosbuvir, Dasabuvir

Question 15

When does HDV occur?

Answer 15

occurs as a result of either an acute HBV coinfection or a superinfection in patients chronically infected with HBV

Question 16

What is HDV coinfection?

Answer 16

infection with both HBV and HDV in HBV-susceptible individuals
presentation resembles acute Hep B

Question 17

What is HDV superinfection?

Answer 17

infection with HDV in an individual chronically infected with HBV
presents as acute severe hepatitis or exacerbation of chronic Hep B

Question 18

Factors associated with HDV infection

Answer 18

close contact with anti-HDV positive person
IVDU
sexual contact with an IVDU
liver cirrhosis
geographical origin (high prevalence area)

Question 19

How is Hepatitis E diagnosed?

Answer 19

serological tests needed
Anti-HEV IgM during acute phase
PCR virus load to monitor treatment response

Question 20

Prevention measures for HEV

Answer 20

avoid drinking water of unknown purity, uncooked shellfish, and uncooked fruit/veg

in UK - avoid eating inadequately cooked pork meat

Vaccine developed - used in China + Nepal

Question 21

Modes of transmission of Hep B virus

Answer 21

sexual - sex workers and MSM
parenteral - IVDU, health workers
perinatal - antenatal women chronically infected with HBV
transfusion - screening + viral inactivation have eliminated this in Europe

Question 22

Prevention of HBV infection

Answer 22

UK antenatal screening
renal unit policy
exposure prone procedures for HBV infected healthcare workers
global eradication programme (immunisation)

Question 23

Hep A virus transmission

Answer 23

close personal contact
homeless persons - poor hygiene
drug use - poor hygiene
contaminated food/water
blood exposure (rare)