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13. GI and Liver > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

Of the hepatitis viruses, which ones are transmitted via faeco-oral transmission?

Which ones are transmitted via blood?

A

FAECO-ORAL:
Hepatitis A
Hepatitis E

BLOOD-BORNE:
Hepatitis B
Hepatitis C
Hepatitis D

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2
Q

Define acute hepatitis.

A

Inflammation in the liver

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3
Q

Define chronic hepatitis.

A

Inflammation in the liver persisting for more than 6 months

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4
Q

What is the incubation period of hepatitis A?

What are the symptoms of acute hepatitis A? (6)

A

30 days

SYMPTOMS:
Fever
Abdominal pain
Diarrhoea
Jaundice
Itch
Muscle pains
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5
Q

List 2 complications of hepatitis A infection.

A

Fulminant hepatitis

Relapsing hepatitis

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6
Q

How would you treat hepatitis A? (2)

A

Self-limiting

Supportive treatment, e.g. hydration

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7
Q

Which 3 serology tests would you do to detect hepatitis A infection?

What does each one indicate?

A

Hep A IgM
-New infection and acute hepatitis

Viral RNA in blood/stool
-New infection and acute hepatitis

Hep A IgG

  • Previous infection or vaccination
  • Immunity
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8
Q

How would you diagnose hepatitis A? (3)

A

Hep A IgM positive
Viral RNA positive
Abnormal LFTs

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9
Q

How is hepatitis A immunity acquired? (3)

A

Hepatitis A vaccine
Hepatitis A immunoglobulin
Previous infection

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10
Q

Is the hepatitis A vaccine live or inactivated?

Who is it used for? (2)

A

Inactivated vaccine

Used for:

  • High risk groups (e.g. travelers)
  • Outbreak control PEP
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11
Q

How long does immunity given by hep A immunoglobulin last?

Who is it used for? (2)

A

3-6 months

Used for:

  • Patients allergic to vaccine
  • Household contacts of infected patients
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12
Q

What type of virus is hepatitis B?

What is the most common route of transmission?

A

Hepadnavirus (DNA)

Vertical transmission (mother-child)

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13
Q

What are the 2 types of chronic carriers of hepatitis B?

What does each suggest about the viral load?

A

eAg positive (high viral load)

eAg negative (low viral load)

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14
Q

What is the incubation period for acute hepatitis B?

Describe the symptoms of acute hepatitis B. (5)

A

2-6 months

Fever
Fatigue
Jaundice (BUT only in 10%)
Muscle pain
Joint pain
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15
Q

List 4 complications of acute hepatitis B.

A

Weight loss/cachexia
Abdominal mass (e.g. hepatocellular carcinoma)
Bloody ascites
Chronic hepatitis B

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16
Q

List 5 complications of chronic hepatitis B.

A 
Chronic liver disease
Cirrhosis
Decompensation
Hepatocellular carcinoma
Death
17
Q

How would you treat acute hepatitis B? (1)

A

Usually self-limiting

18
Q

How would you treat chronic hepatitis B? (2)

List the indications for treatment. (2)

A

TREATMENT:
First line: pegylated interferon alpha
Second line: antiviral drugs (e.g. tenofovir, entecavir)

INDICATIONS:
Evidence of active infection
-Viral load: 2000+
Evidence of inflammation
-Fibrosis
-Raised LFTs
-Biopsy
-Cirrhosis
19
Q

What are the 6 different types of antigens/antibodies detected in hepatitis B serology?

A 
HBV surface antigen (sAg)
HBV surface antibody (sAb)
HBV core antibody (cAb)
e antigen (eAg)
e antibody (eAb)
HBV DNA
20
Q

Which hepatitis B serology markers indicate new infection and acute hepatitis?

A

HBV surface antigen (sAg)

HBV DNA

21
Q

In hepatitis B serology, what does HBV surface antibody (sAb) indicate?

What does HBV core antibody (cAb) indicate?

A

Surface antibody (sAb): immunity due to previous infection OR vaccination

Core antibody: (cAb): immunity due to previous infection ONLY

22
Q

In hepatitis B serology, what does e antigen (eAg) indicate?

What does e antibody (eAb) indicate?

A

e antigen (eAg): high viral load in chronic carriers

e antibody (eAb): low viral load in chronic carriers

23
Q

How to you acquire hepatitis B immunity?

A

Previous infection
Vaccination
HBV immunoglobulin

24
Q

What type of vaccine is the hepatitis B vaccine?

What does it contain?

A

Recombinant vaccine

Contains HBV surface antigen (sAg)

25
Q

What type of virus is hepatitis D?

What is it associated with?

A

ssRNA virus

Coinfection/superinfection with hepatitis B

26
Q

Describe the clinical features of hepatitis D. (1)

How is it diagnosed? (2)

A

CLINICAL FEATURES:
Increased risk of chronic liver disease development

DIAGNOSIS:
Delta antibodies
Hepatitis D RNA

27
Q

What type of virus is hepatitis C?

Which genotypes are most common in Glasgow?

A

ssRNA flavivirus

Type 1 and type 3

28
Q

How is hepatitis C most often transmitted?

A

Blood-borne (e.g. IVDUs, needle-stick injury etc.)

29
Q

How do you acquire immunity to hepatitis C?

A

You don’t - there is NO immunity

30
Q

What is the incubation period of hepatitis C infection?

What are the clinical features of chronic hepatitis C? (5)

A

6-12 weeks

Chronic liver disease, including:

  • Cirrhosis
  • Hepatocellular carcinoma

Extra-hepatic manifestations, including:

  • Cryoglobulinaemia
  • Vasculitis
  • Glomerulonephritis
31
Q

How would you treat hepatitis C infeciton? (3)

List 2 indications for treatment.

A

TREATMENT:
Pegylated IFN alpha WITH Ribavirus
Other direct acting anti-virals (DAAs)
Liver transplant

INDICATIONS:
Acute infections lasting longer than 3 months
Chronic infections (especially with liver damage)
32
Q

Which 2 serological markers are used to investigate hepatitis C infection?

What does each one indicate?

A

HCV IgG

  • Chronic infection
  • Cleared infection

PCR positive for HCV RNA
-Current infection

33
Q

What type of virus is hepatitis E?

A

ssRNA calicivirus

34
Q

How do you acquire immunity to hepatitis E?

A

You don’t - there is NO immunity

35
Q

Can you become a chronic carrier of hepatitis E?

A

Yes - but only in immunocompromised patients

36
Q

What is the incubation period of hepatitis E?

Describe the symptoms of acute hepatitis E. (7)

A

40 days

SYMPTOMS:
Fever
Abdominal pain
Diarrhoea
Jaundice
Itching
Muscle pain
Neurological effects
37
Q

List 4 complications of hepatitis E infection.

A

Fulminant hepatitis
Haematological problems
Neurological problems
Chronic hepatitis

38
Q

How would you treat hepatitis E? (1)

A

Supportive treatment

39
Q

What serological features are used to diagnose hepatitis E? (3)

What does each one indicate?

A

HEV IgM
-New infection and acute hepatitis

HEV IgG
-Cleared infection

HEV RNA in stool
-Current infection and acute hepatitis

13. GI and Liver (9 decks)

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