Viral Hepatitis Flashcards
what are the other infectious agenst (aside from hep A B C D E) that can cause hepatitis?
- delta agent
- EBV - this is called infective mononucleosis
- yellow fever virus
- CMV
- HSV
- toxoplasmosis
hepatitis ___ causes damage to cells cytopathologically - i.e. the virus kills the liver cells
A
interface hepatitis (piecemeal necrosis), portal inflammation, lobular inflammation and fibrosis are features of ____ viral hepatitis
chronic
what is interface hepatitis
piecemeal necrosis) is a process of inflammation and erosion of the hepatic parenchyma at its junction with portal tracts or fibrous septa
what is a councilman body (chronic viral hepatitis)
pink cells representing a dying hepatocyte surrounded by normal parenchyma
which liver disease shows mallory bodies?
alcoholic liver disease
There has been a decline in Hep ___due to vaccination and better housing
Hep B is now diagnosed mainly in _____ minorities who acquired it outside of the UK
Rise in Hep __ - it is now by far the most common cause of ACUTE hepatitis, since Hep __ and Hep __ present in the chronic phase and Hep __ is rare
There has been a decline in Hep A due to vaccination and better housing
Hep B is now diagnosed mainly in ethnic minorities who acquired it outside of the UK
Rise in Hep E - it is now by far the most common cause of acute hepatitis, since Hep C and Hep B present in the chronic phase and Hep D is rare
how is hep A spread?
faecal oral
how is hep B spread?
blood products, sexually, IVDU, mother to child
how is hep C spread?
blood products, IVDU, uncommon for sex
how is hep D spread?
blood products, sexually, IVDU, mother to child
same as B
how is hep E spread?
faecal-oral - pork
which are the RNA hepatitis viruses?
A, C, D, E
which are the DNA hepatitis viruses?
B
hep ___ and __ damages cells by triggering immune destrution?
B and C
what is a co-infection of hep D?
get them both at the same time
what is a super- infection of hep D?
hep b first then hep d
which hep results in chronic infection in 75% of cases
hep C
result in acute infection
hep A and E
can lead to chronic infection
B, C, D
which Hep have a vaccine?
A and B
If infected as young children - unlikely to get symptoms.
The peak incidence of symptomatic disease in older children/young adults
hep A
Chronic infection more likely if first exposure is in childhood - this is why the mother to child infection is important
Acute infection increases as age increases
hep B
people who are immunocompromised might get chronic infection but usually doesnt cause chronic infection
Hep E
diagnosed by IgM o virus ?
Hep A
Hep B _____ present in blood of all infectious people and can indicate acute or chronic infection
Hep B surface antigen (HBsAg) present in blood of all infectious people
HB _____ - usually present in highly infectious people
HB e Ag - usually present in highly infectious people
Hep B _____ always also present in high titre in highly infectious people (more sensitive than ‘e’)
Hep B virus DNA always also present in high titre in highly infectious people (more sensitive than ‘e’)
hep B ______ - present in immunity
Anti - HBsAg present in immunity
Hep B ____ indicates more likely acute
Hep B IgM - more likely acute
how is Hep C diagnosed?
test for Hep C antibody
if hep C antibody present what does this indicate?
active or past infection
if Hep C virus RNA negative
past infection
if Hep C virus RNA positive
active infection
how is Hep E diagnosed?
antibody to Hep E
who gets the Hep B vaccine?
vaccination of at risk people (UK)
vaccination of all children / adolescents
spontaneous cure not uncommon, even after many years of infection
hep B
once chronic infection is established, spontaneous cure is not seen
hep C
what is done in acute viral hepatitis?
- Symptomatic
- No antivirals given
- Monitor for encephalopathy
- Monitor for resolution
of Hep B or Hep C, or Hep E if immunocompromised - Notify Public Health
- Immunisation of contacts
- Test for other infections if at risk
- Vaccinate against other infections if at risk
what is done in chronic viral Hep
- antivirals
- vaccination
- alcohol down
- hepaticellular carcinoma screening - AFP - cancer marker
Genotype of Hep ___ V (1 to 6) important in deciding antiviral regime
Genotype of HCV (1 to 6) important in deciding antiviral regime
how do you treat chronic hep B?
antivirals - adefovir, tenofivir, entacavir and peginterferon
treatment for chronic hep b in HBsAg and HBe Ag positive patients and a predictin of a good cure?
peginterferon
response in hep C is defined by what?
Response defined by loss of HCV RNA in blood sustained to 6 months after end of therapy
- virological cure
- known as Sustained Virological Response or SVR
- relapse after SVR is rare
- reinfection can occur
antivirals used for all genotypes of hep C
peginterferon and ribavirin
antivirals used for onyl genotype 1 of hep C
Telaprevir and Boceprevir
