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Gastrology > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

Acute hepatitis definition

A

Inflammation of the liver

Raised ALT/AST/jaundice/clotting derrnagments

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2
Q

Chronic hepatitis definition

A

hepatitis virus present for more than 6 months

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3
Q

Hepatitis A (HAV) type of organsims

A

picornavirus (ssRNA)

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4
Q

Transmission of hepatitis A virus

A

Faeco-oral transmisson
Contaminated water and food with infected faeces or urine
Humans only reservoir

Virus can survive for months in contaiminated water
Virus shed via bilary tree into gut
no chronic carriage
good immunity after infection

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5
Q

Hepatitis A- Clinical features

A

Incubation period 30 days

Many infections are asymptomatic.
Nausea, fever, malaise, and anorexia may last for 2-7 days before jaundice develops

usually self limiting illness

Mostly asymptomatic in children. Jaundice is more common in adults and is associated with dark urine, pale stools and tender hepatomegaly

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6
Q

Treatment of hepatitis A

A

Symptomatic treatment-
maintain hydration, avoid alcohol
no role for vaccine or igG in the treatment.
Vaccine should be considered for close contacts

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7
Q

Vaccine in hepatitis A

A

Inactivate virus
95% efficacy
Protection 4 weeks after 1st dose
2nd dose gives long term cover

Pre-exposure
-travelers/homosexual men/IVDU/Chronic liver lisease pts

Post-exposure

  • outbreak control
  • effective up to 7 days after exposure
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8
Q

Alternative vaccine in hepatitis A

A

pooled immunoglobulin

Pre-exposure
-if vaccine allergic

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9
Q

Hepatitis E type of virus

A

calcivirus (RNA)

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10
Q

Transmission of hepatitis E

A

faeco-oral
faecal contamination of water supply
-minimal person-to-person transmission

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11
Q

Incubation period for hepatitis E

A

40 days

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12
Q

Clinical features of hep E

A

Anorexia, jaundice, nausea, joint pains, fever

In pregnant women (fetal and materanal mortality of 25%

Self-limiting illness

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13
Q

Treatment of hep E

A

supportive

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14
Q

Chronicity in hepatitis E

A

No

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15
Q

Vaccine for hep E

A

No

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16
Q

Hepatitis B type of virus

A

hepadnavirus (DNA)

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17
Q

Transmission of hep B

A

Blood, sexual, Vertical (mother to baby)

18
Q

Concentration of HBV in body fluids

A

High

  • blood
  • wound exudates

Moderate

  • semen
  • vaginal fluid
  • saliva

Low/not detectable

  • urine
  • faeces
  • sweat
  • tears
  • breast milk
19
Q

Incubation period in hep B

A

2-6months

20
Q

Clinical features of hep B

A

fever, fatigue, jaundice, myalgia, joint pains

Age at the time of illness determines:

  1. severity of illness
  2. risk of chronic HBV infection

Infection at birth/young child is asymptomatic but leads to chronic
infection an an adult is symptomatic but cleared

21
Q

Complications of chronic HBV

A

chronic liver disease in 25%
cirrhosis
hepatocelular carcinoma
death

22
Q

Hepatitis B serology

A

HBsAg (Hep B surface antigen)
HbsAB (hep B surface antibody)
cAb - core antibody
eAB- e anti-body

HBV DNA

23
Q

HbsAG Hep B surface antigen

A

Carrier of infection

>6 months then chronic carrier

24
Q

HbsAB (hep B surgace antibody)

A

Infection in the past and cleared through vaccination

25
Q

cAB core antibody

A

previous infection through natural immunity

26
Q

How to tell how infectious a patient is?

A

eAg - high infectivity

eAb - low infectivity

27
Q

Chronic hepatitis markers

carrier >6 months

A

eAg +ve

  • high viral load
  • high risk of CLD and HCC
  • highly infectious

eAg-ve

  • low viral load
  • lower risk of CLD and HCC
  • less infectious
28
Q

Treatment for hepatitis B

A

Acute
-no treatments

Chronic

  • treat those with liver inflammation
  • small number, 5% will clear sAg spontaneously
  • aim of treatment is NOT to cure, but to suppress viral replication a/- to convert from eAg to eAb+
29
Q

Two types of HepB therapy

A

Immunological

  • pergylated interforn alpha
    a. increases cellular immune responses
    b. lots of side-effects

Antiviral drugs (nucleoside/tides) to suppress viral replication

a. tenofovir
b. entecavir

30
Q

Prevention of HbV

A

Education (safe sex, injecting etc)
screening (pregnancy etc)
Protect blood supply & hospital supples
Immunisation
a. active (HBVsAG vaccine)
(high risk grouups in UK and all in USA, most african/asian)
b. passive (HBIG)
-babies born to some HBV+ mothers, post exposure in non-immune

31
Q

Pregnany - prevention of HBV transmission

A

Three interventions

  1. HBC vaccination to all newborns
  2. HBV immunoglobulins if eAG or high VL
  3. tenofovir during the lst trimester if high VL
32
Q

Hepatitis D type of virus

A

ssRNA

33
Q

Transmission of hepatitis D

A

requires HBV to replicate
Vertical tm rare

acuired by:

  • co-infection with HBV
  • super-infection of chronic HBV carriers

Increases risk of chronic liver disease

34
Q

Hepatitis C type of virus

A

ssRNA flavivirus

35
Q

Transmission of hepatitis C

A

injecting drugs
transfusion + transplant
-sexual/ verticlal rare

36
Q

Prevention of hepatitis C

A

No vaccine, no post exposure prophylaxis
No reliabble immunity after infection
multiple genotypes of HCV

37
Q

Incubation period of hepatitis C

A

6-7 weeks

38
Q

Complications of hepatitis C

A

70% develop crhonic hepatitis
25% develop chronic liver disease (cirrhosis, liver transplantation, and hepatoceullar carcinoma

multitude of extra-hepatic manifestations
-cryglobuminaemia, vasculitis, glomerulopnephritis

39
Q

HCV diagnosis

A

mostly asymptomatic
Most diagnsed by screenign of high risk groups
-drug users
-immigrants to UK from high prevalance countries
Anti-HCV IgG positive = chronic infection or cleared infection
PCR positivity = current infection

40
Q

Treatment

A

Aim

  • cure= PCR negative
  • Prevent and reverse fibrosis

Who to treat
- acute infections failing to clear virus by 3/12
-chronic infections
(especially those with significant liver fibrosis and inflammation)
-assess liver using LFT, liver biopsy and fibroscan

Treatment

  • Pegalated interferon alpha
  • Ribavirin (anti-viral)
  • Protease inhibitor - Bocepravir and telapravir

Sustained virological response = PCR -ve 6/12 after treatment

Gastrology (19 decks)

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