Viral Hepatitis Flashcards
What are the common causes of viral hepatitis. (5)
Hepatitis A. Hepatitis B. Hepatitis C. Hepatitis D. Hepatitis E.
What are the less common causes of viral hepatitis. (2)
Cytomegalovirus.
Epstein-Barr Virus.
What are the rare causes of viral hepatitis. (2)
Herpes Simplex.
Yellow Fever.
Which of the viral hepatitis viruses are commonly transferred via faeces. (2)
Hepatitis A.
Hepatitis E.
Which of the viral hepatitis viruses are commonly transferred via blood. (3)
Hepatitis B.
Hepatitis C.
Hepatitis D.
Which of the viral hepatitis viruses are commonly transferred via saliva. (3)
Hepatitis A.
Hepatitis B.
Hepatitis C.
Which of the viral hepatitis viruses are commonly transferred via sexual contact. (2)
Hepatitis B.
Hepatitis D.
Which of the viral hepatitis viruses can cause chronic infection. (3)
Hepatitis B.
Hepatitis C.
Hepatitis D.
What is the main route of transmission of hepatitis A virus. (2)
Faecal-oral.
Shellfish.
What sort of virus is the hepatitis A virus.
RNA virus.
Does hepatitis A cause cirrhosis.
No.
What increases the chances of contracting hepatitis A virus.
Poor hygiene correlates with increased risk.
What are the symptoms associated with hepatitis A viral infection. (9)
Nausea. Anorexia. Vomiting. Diarrhoea. Weakness. Fever. Malaise. Arthralgia. Dark urine.
What are the physical signs associated with hepatitis A infection. (4)
Jaundice.
Hepatomegaly.
Splenomegaly.
Lymphadenopathy.
What are the investigations carried out if you suspect hepatitis A infection. (5)
LFTs: Raised transaminases (very high in acute infection), raised bilirubin (indicates the degree of liver damage).
A prolonged PT time indicates the severity of the hepatitis.
FBC: Leucopenia with a relative lymphocyosis.
AST and ALT rise 22-40days after exposure.
Serological tests are usually carried out to confirm the aetiology of infection. In hepatitis A, only anti-HAV IgM are of diagnostic value.
What is the treatment for a patient with viral hepatitis A infection. (3)
Supportive.
Avoid alcohol.
Rarely, interferon-alpha for fulminant hepatitis.
How long do individuals infected with hepatitis A virus excrete the virus in their faeces before exhibiting symptoms.
Asymptomatic individuals excrete the virus in their faeces for about 2-3 weeks before the onset of symptoms.
For how long do patients infected with hepatitis A virus excrete the virus in their faeces after the onset of symptoms.
For 2 weeks.
Is infection with hepatitis A virus more common in childhood or adulthood.
In childhood.
It is often asymptomatic.
Where is infection with hepatitis A virus more common.
Infection is more common in areas of overcrowding and poor sanitation.
Does a chronic carrier state occur in patients infected with hepatitis A virus.
No.
What are some complicates of acute viral hepatitis. (5)
Acute liver failure. Cholestatic hepatitis (hepatitis A). Aplastic anaemia. Chronic liver disease and cirrhosis (hepatitis B and C). Relapsing hepatitis.
What sort of virus is hepatitis B.
DNA.
What are the routes of transmission for hepatitis B. (3)
Parenteral.
Sexual.
Vertical.
What are the symptoms of hepatitis B infection. (9)
Nausea. Anorexia. Vomiting. Diarrhoea. Weakness. Fever. Malaise. Arthralgia. Dark urine. Symptoms tend to be more severe than that of hepatitis A.
What are the signs of hepatitis B infection. (6)
Pruritus. Tender hepatomegaly. Jaundice. Urticaria. Lymphadenopathy. Splenomegaly.
What is the only carrier of hepatitis B.
Humans.
What is the most common cause of chronic liver disease and hepatocellular carcinoma worldwide.
Hepatitis B infection.
What type of infection does hepatitis B cause. (2)
Acute viral hepatitis.
Chronic viral hepatitis.
What is the most common route of transmission of hepatitis B worldwide.
Vertical.
What is the risk of chronic infection of hepatitis B with horizontal transmission.
10%.
What is the risk of chronic infection of hepatitis B with vertical transmission.
90%.
What are some routes of horizontal transmission of hepatitis B. (5)
IVDU. Infected unscreened blood products. Tattoos/acupuncture needles. Sexual contact. Close living quarters.
What are some complications of chronic hepatitis B infection. (5)
Hepatocellular carcinoma. Cirrhosis. Fulminant hepatic failure. Cholangiocarcinoma. Cryoglobulinaemia.
What are the five phases of chronic hepatitis B infection.
- Immune tolerant phase.
- Immune reactive (HBeAg - positive chronic hepatitis phase).
- Inactive carrier phase.
- HBeAg- negative chronic hepatitis phase.
- HBsAg-negative phase.
Note that not all patients will go through all five phases.
What is the serology in hepatitis B infections. (7)
HBsAg: it is the first serological marker, it usually becomes undetectable at 6 months.
HBsAb: This becomes detectable once HBsAg clears. It remains indefinitely.
HBcAg: this is not routinely detectable.
HBcAb: this is detectable 1-2 weeks after HBsAg (IgM initually, then IgG)
HBeAg: this occurs shortly after HBsAg. It correlates with viral replication.
HBeAb: it correlates with lower viral replication and infectivity.
HBV DNA by PCR: this quantifies viral replication.
How is hepatitis B diagnosed.
Serology testing.
What is HBsAg used for.
It is used as an indicator of active infection.
What does the persistence of HBsAg for more than 6 months usually indicate.
Chronic hepatitis B infection.
What is HBsAg indicative of. (2)
It is the first serological marker in acute hepatitis B infection.
In acute cases, it becomes undetectable at 6 months.
What is HBsAb indicative of. (2)
It is the antibody to HBsAg.
It is detectable once HBsAg has cleared.
It remains indefinitely.
What is HBcAg indicative of.
It is an antigen that is not detectable in the blood.
What is HBcAb indicative of. (3)
It is the antibody to HBcAg.
It is detectable early in the illness (1-2weeks after HBsAg).
It is detected as IgM initially, then IgG.
What is HBeAg indicative of.
It is the antigen that occurs shortly after HBsAg.
It correlates with active viral replication in the liver.
What is HBeAb indicative of. (2)
It is the antibody to HBeAg.
It correlated with lower viral replication levels.
What is the purpose of HBV DNA by PCR. (2)
It quantified viral replication.
It is a way of measuring viral load.
How do you treat an acute hepatitis B infection. (3)
Treatment is supportive, with monitoring for acute liver failure. (it occurs in >1% of cases)
Alcohol avoidance is recommended.
Refer everyone with chronic liver inflammation for antiviral therapy.
In what percentage of patients with acute hepatitis B infection does a full recovery occur.
90-95%.
In what percentage of patients who contract hepatitis B go on to develop chronic hepatitis B.
10%.
When does recovery from acute hepatitis B infection occur.
Within 6 months.
How do you treat a chronic hepatitis B infection.
Antivirals are used (although none can completely eradicate the infection). Antivirals used are: Lamivudine. Pegylated interferon. . Adefovir. Tenofovir. Entecavir. Telbivudine. IFN-alpha.
What is the purpose of antiviral therapy in chronic hepatitis B infection. (3)
HBeAg seroconversion.
Reduction in HBV-DNA.
Normalisation of LFTs.
How infectious is hepatitis B.
It is about 10 times more infectious than hepatitis C. (which in turn is about 10 times more infectious than HIV).
How can you prevent hepatitis B infection.
There is a vaccine, containing HBsAg, that is capable of producing active immunisation in 95% of normal individuals.
What sort of virus is hepatitis D.
RNA virus.
How does Hepatitis D cause infection.
It can only be present with hepatitis B.
It does not exist independently.
What are the symptoms of hepatitis D.
They are the same as those for hepatitis B.
Where is HBV endemia. (3)
Parts of the Mediterranean Basin.
Africa.
South America.
What investigations are used to diagnoses hepatitis D. (2)
HdAb are produced in response to HdAg antigens (anti-HDV) which can be detected.
RNA by PCR.
How do you manage a patient with hepatitis D.
Effective management of the hepatitis B infection will prevent the hepatitis D infection.
What sort of virus is hepatitis C.
RNA.
How many genotypes exist for hepatitis C.
6.
_______infection with hepatitis C is ______
Acute infection.
Rare.
When do patients usually become aware that they are infected with hepatitis C.
When they develop chronic liver disease.
What percentage of individuals exposed to hepatitis C become chronically infected.
80%
Late spontaneous viral clearance of hepatitis C is _____
Rare.
What are the symptoms of hepatitis C infection. (2)
Patients tend to by asymptomatic until they progress to chronic liver disease, or it is an incidental finding of abnormal LFTs.
Fatigue may be pronounced.
What are some risk factors for hepatitis C infection. (6)
IVDU (95% of new cases in UK). Unscreened blood products. Vertical transmission (3% risk). Needlestick injury (3% risk). Iatrogenic parenteral transmission. Sharing toothbrushes/rasors.
What are the signs of hepatitis C infection. (2)
Jaundice (rare, usually only appears in end-stage cirrhosis).
Hepatomegaly.
What are the investigations for a patient suspected to have hepatitis C infection. (3)
HCV antibody (may take 6-12 weeks to appear following acute infection).
HCV RNA by PCR (as early as 2-4 weeks after infection).
LFTs may be normal or show fluctuating serum transaminases.
How do you determine the degree of liver fibrosis in hepatitis C infection.
Liver biopsy.
Serum transaminase levels in hepatitis C are a poor predictor of the degree of liver fibrosis.
What is the most common genotype of hepatitis C infection in Northern Europe. How easy is it to eradicate.(2)
- It is less easy to eradicate with traditional pegylated interferon alpha/ribavirin based treatments than genotypes 2 and 3.
What is the aim of hepatitis C treatment.
Treatment aims to eradicate the infection.
What is the treatment for hepatitis C infection. (2)
Triple therapy with pegylated interferon-alpha, ribavirin and protease inhibitors.
Liver transplant.
What is the response rate for hepatitis C treatment.
40-70%
What adversely affects the treatment of hepatitis C infection. (7)
HCV genotypes 4, 5, or 6. Increased viral load. Older patients. Delay before treatment is started. Black patients (versus caucasians). Men. If HIV positive.
What are some complications associated with hepatitis C infection. (7)
Glomerulonephritis. Cryoglobulinaemia. Thyroiditis. Autoimmune hepatitis. PAN. Polymyositis. Porphyria cutanea tarda.
What are risk factors for the progression of chronic hepatitis C to cirrhosis. (6)
Immunocompromised (eg HIV). Alcohol misuse. Male. Older. Prothrombotic states. Higher viral load.
What is the prevalence of hepatitis C infection in the UK.
> 200,000
What is the progression rate of chronic hepatitis C infection to cirrhosis.
20% in 20 years.
What is the 5 and 10 year survival for patients who have progressed from hepatitis C infection to cirrhosis.
5 year = 95%.
10 year = 81%.
How many people with cirrhosis (due to hepatitis C) will develop complications within 10 years.
25%
What percentage of patients who have developed complications (such as ascites) due to hepatitis C infection will go on to develop primary hepatocellular carcinoma.
2-5%/year.
What is the 5 year survival rate for patients who have developed cirrhosis (due to hepatitis C infection).
5 years = 50%
What sort of virus is hepatitis E.
RNA.
What is the route of transmission for hepatitis E.
Faecal-oral.
What are the clinical presentations of hepatitis E.
Very similar to those of hepatitis A.
How does hepatitis E present.
It presents as a self-limiting acute hepatitis.
Does hepatitis E cause chronic liver disease.
Not usually. Although some cases have been described.
What is a complication of hepatitis E infection.
In pregnant women, it is associated with the development of fulminant hepatic failure (20%).
What is the treatment for hepatitis E infection. (2)
Supportive.
Prevention by improvements in sanitation.
Where is hepatitis E usually found. (2)
India.
Middle East.
Where is hepatitis A endemic to. (2)
Africa.
South America.
What immunoglobulin is detectable for life after hepatitis C infection.
IgG.
Is there immunisation available for hepatitis A. (2)
Yes.
Havrix Monodose is an inactive protein derived from HAV.
What is the incubation period for hepatitis A.
2-6weeks.
What is the incubation period for hepatitis B.
1-6months.
Can a carrier state develop after infection with hepatitis B.
Yes.
What is the most common hepatitis occurring worldwide.
Hepatitis A.
What is the prognosis for patients with Hepatitis A.
Excellent.
Mortality is 0.1%, but increases with age.
What is death due to in cases of hepatitis A infection.
Due to fulminant hepatic necrosis.
What is ‘cholestatic viral hepatitis’
A potential consequence of hepatitis A infection.
It is a severe jaundice with cholestasis which lasts between 7-20 weeks.
What is ‘post-hepatic syndrome’
Where patients may complain of debility for several months following resolution of their symptoms (hepatitis A).
