Viral Hepatitis

Question 1

What’s chronic hepatitis?

Answer 1

Hepatitis present for more than 6 months.

Causes variable changes in liver function

Question 2

Name three causes of acute hepatitis.

Answer 2

Infection 
Toxins/drugs/alcohol
Autoimmune
- wilson's 
- heamochromatosis

Question 3

Name some causes of infectious hepatitis.

Answer 3

EBV/cytomegalovirus
Toxoplasmosis
Leptospirosis
Q fever
Syphilis
Malaria
VHF - viral haemorrhagic fevers (e.g. Ebola)

Question 4

What antibiotics are created in a hepatitis infection?

Answer 4

IgM is made first

IgG is made second

Question 5

What class of virus is hepatitis A?

Answer 5

It’s an ssRNA virus enterovirus (infects the enteric tract)

Question 6

How is hepatitis A transmitted?

Answer 6

Feaco-oral
Contaminated food or water.
Human only reservoir

Question 7

How long can hepatitis A survive inside and outside of the body?

Answer 7

Can survive for months in contaminated water.

There is no chronic carriage in humans.

Question 8

Is hepatitis A likely to return after one infection?

Answer 8

No- there is a good immunity after infection

Question 9

What is acute hepatitis and what does it cause?

Answer 9

Inflammation of the liver.

It raises ALT/AST and causes jaundice and clotting problems.

Question 10

What are the clinical features of hepatitis A?

Answer 10

Fever
Abdominal Pain
Diarrhoea
Jaundice
Itch
Muscle Pain
However it is a self-limiting illness

Question 11

What is the fatality rate of hepatitis A?

Answer 11

0.4% (1.75% in over 50s)

Question 12

What is the treatment of hepatitis A?

Answer 12

No specific treatment

• maintain hydration
• avoid alcohol
• no vaccine to treat

Question 13

How is hepatitis A diagnosed?

Answer 13

• Yields a positive IgM serology test
• RNA can be found in blood and/or stool
• IgG in the blood suggest they had it once, not currently

Question 14

Who is normally vaccinated against hepatitis A?

Answer 14

Travellers
Gay men
IVDU
Chronic liver disease patients
- to contain any outbreak

Question 15

What class of virus is hepatitis E?

Answer 15

A calicivirus (ssRNA)

Question 16

How is hepatitis E transmitted?

Answer 16

Feaco-oral

Feacal contamination of water supply

Question 17

What is the incubation period of hepatitis E?

Answer 17

40 days

Question 18

What are the clinical features of hepatitis E?

Answer 18

Fever 
Abdominal Pain
Diarrhoea
Jaundice
Itch
Muscle Pain
Some rare neurological effects

Question 19

What is the fatality rate of hepatitis E?

Answer 19

1-3% (15-25% in pregnant women)

Question 20

What is the treatment for hepatitis E?

Answer 20

• supportive
• pooled IgG doesn’t prevent infection
• no vaccine to treat

Question 21

Does the body chronically carry hepatitis E?

Answer 21

Yes - but usually only in immunosuppressed patients

Question 22

Name the feaco-orally transmitted forms of hepatitis

Answer 22

A and E

Question 23

Name the blood bourne hepatitis viruses.

Answer 23

B, C and D

Question 24

What class of virus is hepatitis B?

Answer 24

It’s a DNA virus (the only one out of A,B,C,D and E)

Question 25

What are the vaccination guidelines for hepatitis B? (The most common hepatitis virus in the world?

Answer 25

Not commonly vaccinated against, unless in a high risk profession like medicine.

Question 26

How is hepatitis B transmitted?

Answer 26

- vertical transmission - contaminated needle - child to child - transplants/fluid - most cases in the UK are from immigrants (picked up at antenatal screening)

Question 27

Acute hepatitis has an incubation period of 2-6 months, and can cause what symptoms?

Answer 27

``` Fever Fatigue Jaundice Myalgia Joint Pain ```

Question 28

If a child is infected with hepatitis B, what other symptoms might they have?

Answer 28

- asymptomatic | - can lead to chronic infection

Question 29

How does clearing affect adults with hepatitis B?

Answer 29

At first they present symptomatically, but once they've cleared the virus, it attacks the liver

Question 30

What's the fatality rate of hepatitis B?

Answer 30

0.5-1%

Question 31

What are the problems associated with chronic hepatitis B?

Answer 31

- weight loss - chronic liver damage - abdominal pain/masses - fever - cachexia - bloody ascites - cirrhosis - hepatocellular carcinoma - death

Question 32

What's the serology for hepatitis B?

Answer 32

Hep B antigen positive

Question 33

What's the difference between a positive eAg serology and a negative?

Answer 33

eAg positive = high viral load, highly infectious, higher risk of CLD and hepatocellular carcinoma eAg negative = opposite, but still has a small level of infection

Question 34

What is the treatment for hepatitis B?

Answer 34

Acute has no treatment Chronic has two types of therapy - immunological - anti-viral drugs

Question 35

Describe the immunological and anti-viral treatment for hepatitis B.

Answer 35

Immunological - pegylated interferon increases cellular immune response, but has lots of side effects Anti-viral drugs - tenofovir/entecavir suppress viral replication

Question 36

How is vertical transmission of hepatitis B prevented?

Answer 36

- HBV vaccination for all newborns - HBV immunoglobulin if eAg is positive - Tenofovir is given to the mother during the last trimester

Question 37

Hepatitis D needs which other hepatitis virus to replicate?

Answer 37

Hepatitis B - so therefore has the same transmission - vertical transmission is rare

Question 38

How is hepatitis D acquired?

Answer 38

Co-infection with hepatitis B | Super infection of chronic HBV carries

Question 39

How is hepatitis D treated?

Answer 39

Pegylated interferon alpha

Question 40

How is hepatitis C transmitted?

Answer 40

Injections Transfusion/transplant Sexual Vertical (rare)

Question 41

How is hepatitis C prevented?

Answer 41

- no vaccine | - no reliable immunity after infection

Question 42

How is hepatitis C diagnosed?

Answer 42

Because it's mostly asymptomatic, its normally picked up at screening. HCV IgG positive means a chronic or cleared infection. PCR positive means they currently have an infection

Question 43

What's the treatment for hepatitis C?

Answer 43

There's a cure | Pegylated interferon alpha and ribavirin

Question 44

In all hepatitis infections, what does sAg and sAb mean?

Answer 44

``` sAg = surface antigen, a marker of infection sAb = surface antibody, a marker of immunity ```

Question 45

In all hepatitis infections, what does cAb mean?

Answer 45

cAb = core antibody, means they have chronic or acute hepatitis

Question 46

In all hepatitis infections, what does eAg and eAb mean?

Answer 46

``` eAg = suggests high infection eAb = suggests low infection ```