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LC Gastroenterology Week 7 > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

How is hepatitis A spread?

A

Faecal-oral
Poor hygiene/overcrowding

Some cases are imported

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2
Q

Who usually gets hep A?

A

Gay men

People who inject drugs

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3
Q

What might be the clinical presentation of hep a?

A

Acute hep, no chronic infection

Peak incidence of symptomatic disease in older children/younger adults

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4
Q

What might you find on investigation when diagnosing hep?

A

Hep A IgM

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5
Q

How would you treat/control hep a?

A

Supportive treatment
Hygiene
Vaccine prophylaxis - takes about 10 days to take effect

Infected food handlers excluded from the workplace

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6
Q

Where is hep e more common?

A

In the tropics

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7
Q

What is the transmission of hep e?

A

Faecal oral transmission

Zoonoses (infected animals can pass it onto humans)

Causes acquired in the topics are thought to be human to human spread

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8
Q

Can hep E become chronic?

A

Not usually but some immunocompromised humans can get chronic infection

No vaccine yet

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9
Q

When do you find hep D?

A

Only found with Hep B

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10
Q

What does hep D do to help B?

A

Exacerbates hep b virus infection

Co-infection or superinfection

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11
Q

How is hep B viruses transmitted?

A

Blood-Blood
Sexual transmission
Vertical transmission - mother to child

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12
Q

When are you more likely to get chronic infection of hep B?

A

If you had your first exposure in childhood

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13
Q

Who are at a higher risk of getting hep B in the UK?

A

People who are born in areas of intermediate/high prevalence
Multiple sexual partners
People who inject drugs
Children of infected mothers

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14
Q

Describe HBsAg?

A

Present in the blood of all infectious individuals

Present for more than 6 months in chronic infection

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15
Q

Describe HBeAg?

A

Occurs shortly after HBsAg usually indicates highly infectious individual

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16
Q

Describe Hep B virus DNA

A

Gives indication of infectivity - the more you have the more infectious you are

Also used to predict risk of chronic liver disease and to monitor therapy

17
Q

Describe Hep B IgM?

A

Most likely to be present in recently infected - acute

18
Q

Describe Anti-HBs?

A

Present in immunity

19
Q

Are HBV DNA more or less sensitive predictors or prognosis and infectivity than HBeAg?

A

More sensitive

20
Q

What might immunity be due to?

A

vaccine or due to past infection

21
Q

How would you control and treat Hep B?

A

minimise exposure - safe blood, sex, needle exhancge, screening of pennant women

Pre-exposure vaccination - vaccination of at risk people, vaccination of all children/adolescents

Post exposure prophylaxis - vaccine, plus HBIG (hyperimmune Hep B immunoglobulin)

22
Q

What is the transmission of hep c?

A

Similar to hep B

blood/sexual

23
Q

What is the treatment for hep c?

A

No vaccine available

24
Q

What does infection of hep c usually result in?

A

Chronic infection

25
Q

If a patient comes back with positive for hep c virus antibody, how do you know if they have an active infection or a past infection?

A

Test for hep c virus RNA by PCR

Negative - past
Positive - active

26
Q

How many months of an infection defines chronic?

A

More than 6 months

27
Q

How long does is usually take from the time of infection to develop cirrhosis?

A

Typically >20 years

28
Q

How long does it usually take from the time of infection to develop hepatocellular carcinoma?

A

Typically >30 years

29
Q

What is the management of acute viral hepatitis?

A 
Symptomatic 
No antivirals given 
Monitor for encephalopathy 
Monitor for resolution (of hep b,c, or e if immunocompromised)
Notify public health 
Immunisation of contacts
Test for other infections if at risk 
Vaccinate against other infections if at risk
30
Q

What is the management of chronic viral hepatitis?

A

Antivirals

Vaccination
- other hepatitis viruses, if cirrhotic - influenza, pneumococcal

Infection control
Alcohol decrease
Hepatocellular carcinoma awareness/screening

31
Q

What are the common antivirals used in chronic infection?

A

Adefovir

Entecavir

32
Q

Who do you treat with antivirals?

A

Those with HCV RNA present and genotype known
HBsAg and Hep B DNA present

Risk of complications

Fit for treatment - liver cancer = contraindication

33
Q

What is interferon alfa?

A

A human protein - part of the immune response to viral infection

34
Q

What are some adverse effects of peginterferon?

A

Flu like symptoms - chills, sore muscles, malaise

Less common but more severe - thyroid disease, autoimmune disease

35
Q

What is an adverse effect of Ribavirin?

A

Anaemia

36
Q

Describe 2 diffrent options to treat chronic hep b?

A

1 - Peginterferon alone. (HBsAg and HBeAg positive - compensated disease and prediction of good chance of cure)

2 - Suppressive antiviral drug (entecavir, tenofovir) - safer, suppression not a cure

37
Q

When do you know if you have cured hep B?

A

When there is loss of HbsAg

38
Q

What is response defined by in hep C?

A

By loss of HCV RNA in the blood sustained to 6 months after end of therapy

39
Q

What is the aim in Hep C therapy?

A

Move towards interferon free combination drugs

LC Gastroenterology Week 7 (4 decks)

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