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GI and liver > Viral hepatitis > Flashcards

Viral hepatitis Flashcards

1
Q

What is viral hepatitis?

A

RNA virus

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2
Q

How is Hep A spread?

Epidemiology?

A

Faeco-oral or shell fish

Common infection
Endemic in south America and Africa
Common in children

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3
Q

Clinical presentation of hep A

A

Incubation = 2-6wks

Acute hepatitis only- no chronic disease.
Fever
Malaise
Anorexia
Nausea
Arthralgia
THEN: Hepatospenomegaly, Jaundice, Lymphadenopathy

100% immunity after infection

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4
Q

Tests for hep A?

A

AST and ALT rise 22 to 40 days after exposure

IgM detection shows it is a recent infection

IgG is detectable for life

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5
Q

Treatment for hep A

A 
Supportive 
Rarely developes to fulminant hepatitis. If so interferon A
Active immunisation (vaccination for travellers) with an inactivated protein derived from HAV
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6
Q

What is fulminant hepatic failure (acute liver failure) ??

A

Rapid development of acute liver injury
with severe impairment of synthetic function and hepatic encephalopathy in a patient without obvious previous liver disease

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7
Q

What is hepatitis B

A

DNA virus

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8
Q

How is hep B spread

A

Blood products, IVDU, sexual and direct contact

Very infectious

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9
Q

Epidemiology of hep B

A

Endemic in – Far East, Africa, Mediterranean

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10
Q

Clinical presentation of hep B

A

Incubation= 1-6 months
Resemble hepatitis A
Arthralgia and urticaria are more common

Chronic Hep B causes Hepatitis

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11
Q

Diagnostic tests and results for hep B?

A

HB surface antigen persists over 6 months–> carrier status

HB core antigen only present for 1.5 months after acute illness

Biopsy indicated unless ALT normal

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12
Q

Vaccination – passive immunisation given to non-immune contacts after high-risk exposure

Aim of Hep B treatment is to clear HBsAg and prevent cirrhosis and hepatocellular carcinoma (HCC)

Treatment for Hep B?

A

Avoid alcohol

Immunise sexual contacts

Those with chronic liver inflammation 2 options:

1) Boost immune system (IFNα) – Old, less effective
2) antiviral drugs

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13
Q

Side effects of anti viral medication

A

flu like illness, autoimmune disease,

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14
Q

Complications of chronic hepatitis

A

Uncontrolled liver inflammation (ALT & AST rise)
Fibrosis&raquo_space;> Cirrhosis&raquo_space;> Hepatocellular carcinoma
(Fulminant hepatic failure)

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15
Q

What is hepatitis C

A

RNA flavivirus
Spread by blood, transfusion, IVDU, sexual, acupuncture
Prevalent in UK

Early infection is mild/asymptomatic
85% develop silent chronic infection
25% get cirrhosis in 20yrs

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16
Q

Most Hep C infection go on to get chronic infection

What are risk factors for progression to chronic disease?

A

Male, Older, Higher viral load, Alcohol use

HIV, HBV

17
Q

Diagnostic tests and results for Hep C

A

LFTs

Anti-HCV antibodies confirms exposure

HCV-PCR confirms on-going infection/chronicity

Biopsy if HCV-PCR +ve – assess liver damage and need for treatment

18
Q

Treatment for Hep C

A

Direct acting antivirals- protease inhibitors

Combine with PEGinterferon-α and ribavirin, different success rates in different viral genotypes (not that effective against genotype 1)

19
Q

What hepatitis are spread enterally?

Parenterally?

A

Enteral= Hep A and E

Parenterally= Hep B and C

20
Q

Which viral hepatitis are acute?

Which can be chronic?

A

Hep A and Hep E are always acute

Hep B and C can progress to chronic

21
Q

Describe general treatment for chronic hepatitis

A

Old= IFNa (stimulate immune response) and ribavirin (antiviral)

New= DAA (direct acting antivirals)
Protease inhibitors
Polymerase inhibitors

22
Q

What is Hepatitis D

A

Incomplete RNA virus – needs HBV for assembly
HBV vaccination thus prevents HDV infection
5% of HBV carriers have HDV co-infection
May cause acute liver failure/cirrhosis

23
Q

Tests for HDV?

Treatment?

A

Anti-HDV antibody

pegylated interferon-α has limited success
Liver transplant may be needed

24
Q

What is Hepatitis E?

A 
endemic in UK 
RNA virus
Similar to Hep A Virus
Waterborne faeco-oral transmissionor food borne 
Common in Indochina
Mortality is high in pregnancy
Associated with pigs (sausages!) 
Epidemics occur
25
Q

Tests and treatment for Hep E

A

Tests – serology check for Hep E IgM and IgG

Treatment- IFNa + ribavirin 
AND DAA (non specific)
26
Q

Ways to remember

A

E is Even in England and can be Eaten, if not always beaten
B is Blood-Borne and if not Beaten can Be Bad
B and D is DastarDly
C is usually Chronic but Can be Cured – at a Cost

GI and liver (18 decks)

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