Viral Hepatitis Flashcards
CFx of viral hepatitis?
- Flu like prodrome (N/V/anorexia/arthralgia)
- Some progress to icteric phase lasting days to weeks
What are the features of the icteric phase of viral hepatitis?
- Pale stools and dark urine 1-5d prior to icteric phase
- Hepatomegaly and RUQ pain
- Splenomegaly and cervical lymphadenopathy
Ix in acute viral hepatitis?
- AST and ALT (x10-20 N)
- ALP and bilirubin mildly elevated
- Viral serology
Rx acute viral hepatitis?
- Supportive
- Admit if: encephalopathy, coagulopathy, severe vomiting, hypoglycemia
DDx for hepatitis?
- Viral infection
- EtOH
- Drugs
- Immune mediated
- Toxins
Mx HBV?
- Counselling re progression
- HCC screening with q6m U/S
- Consider pharmacological Rx
- HAV vax
- Blood and sexual precautions
Treatment options in HBV?
- Interferon
- Tenofovir
- Entacavir
- Lamivudine
- Adeofivr
What is the treatment goal in HBV Rx?
Reduce serum HBV-DNA to undetectable level
What are the phases of chronic HBV infection?
- Immune tolerance
- Immune clearance
- Immune control
- Immune escpae
What is the immune tolerance phase of HBV infection?
- Extremely high HBV-DNA
- HBeAG +ve but normal LFTs
- Little immune control and minimal immune mediated liver dage
- Characteristic of perinatal infection / incubation period in adult
What is the immune clearance phase of HBV infection?
- Falling but elevated HBV-DNA
- HBeAG +ve
- Immune attack on HBV and immune-mediated liver damage
- Progressive disease w/o Rx and increasing liver fibrosis
- Likely to benefit from Rx
What is the immune control phase of HBV infection?
- Lower HBV DNA
- HBeAG -ve, Anti HBeAb +ve
- ALT/AST normal
- Immune control w/o immune mediated liver damage
- risk of reactivation esp w/ immunosuppression
What is the immune escape phase of HBV infection?
- Elevated HBV-DNA
- HBeAG -ve due to core promoter gene mutation
- Anti-HBeAb +ve
- ALT/AST high
- Characterised by progressive disease w/o treatment and increasing liver fibrosis
- Likely to benefit from treatment
Contrast risk of HCC in HBV and HCV.
Risk of HCC in HBV increases w/ increasing age; ?surrogate for increasing liver fibrosis.
Risk of HCC in HCV increases only after cirrhosis develops.
What is Hep D?
Defective RNA virus requiring HBsAg for entry into hepatocyte; therefore only infects pts with HBV
-More aggressive disease than HBV alone
Mx HDV?
Low dose IFN and liver transplant for end stage disease
RFx for HCV?
- IVDU
- blood transfusion pre 1992
- Tattoos
- Intranasal cocaine use
When do clinical manifestations of HCV occur?
6-8/52 after exposure
Dx of HCV?
- Elevated ALT/AST
- +ve anti HCV
- Detectable HCV-RNA in serum
Mx HCV?
- Blood borne precautions
- Vax HAV, HBV
- Avoid EtOH
What is the Rx and aim in HCV Mx?
Pegylated IFNa + ribavarin aims to clear HCV infection; only 50-80% success.
Success determined by fall in HCV-RNA
AEx of HCV Rx?
- Depression/fatigue
- Haemolysis
- Bone marrow suppression
- Fever
- Precipitate Ai disease
Prognosis HCV?
- 80% acute HCV becomes chronic; 20% of these evolve to cirrhosis
- Risk of HCC inc if cirrhotic
What is the meaning of the following test results?
- HBsAg =NEG
- Anti-HBc =NEG
- Anti-HBs =NEG
Susceptible, consider vaccination
What is the meaning of the following test results?
- HBsAg =NEG
- Anti-HBc =POS
- Anti-HBs =POS
Resolved HBV infection
What is the meaning of the following test results?
- HBsAg =NEG
- Anti-HBc =NEG
- Anti-HBs =POS
Vaccinated
What is the meaning of the following test results?
- HBsAg =POS
- Anti-HBc =POS
- IgM anti HBc (high titre)
- Anti-HBs =NEG
Acute HBV infection
What is the meaning of the following test results?
- HBsAg =NEG
- Anti-HBc =POS
- IgM anti HBc = NEG
- Anti-HBs =NEG
Chronic HBV infection
What is the meaning of the following test results?
- HBsAg =NEG
- Anti-HBc =POS
- Anti-HBs =NEG
Isolated core antibody positive
- distant resolved HBV infection (high risk Hx)
- false positive (low risk Hx)
- resolving acute HBV (between HBsAg loss and detectable antiHBs)
- passive transfer of maternal anti HBc
