Viral Hepatitis Flashcards
What is viral vs non viral hepatitis?
Non-viral is inflammation of the liver by another cause e.g. autoimmune/drugs/alcohol
Can lead to liver damage and cirrhosis
Viral is liver inflammation due to viral infection
Which is more common in World/uk HepB or C
Hep B world 400,000,000
Hep C uk (1:1000 compared to 1:200)
Which leads to worse consequences if not treated?
Hep C - 80% liver cirrhosis compared to Hep B 10%
Can both lead to hepatocellular carcinoma?
Yes
What is specific about hepatitis viruses compared to viruses that can have an effect on the liver (EBV, CMV, VZV) (2)?
They replicate in hepatocytes
They destroy hepatocytes
What happens over time if hepatocytes are destroyed?
Cirrhosis
What is the incubation period for Hep B vs Hep C
Hep B - 6wks-6months
Hep C- 6-12 weeks
What is the viral structure of HepB vs C
Hep B - DNA double stranded enveloped
Hep C - RNA - ss + sense enveloped
What blood test abnormalities might you see with Hepatitis and why?
Raised bilirubin - due to problem with conjugation to albumin during Haem (from RBC) metabolism
Raised ALT/AST - indication of cellular integrity
Raised ALP (not as much as raised ALT/AST though - more raised if blocked bile duct due to something else EXTRAHEPATIC
Raised INR/PT - due to coag factors made in liver
Low albumin - gives idea of liver FUNCTION - as it’s a protein made in the liver
What are some extra hepatic causes of jaundice and what blood test in particular might be raised?
ALP
Carcinoma of bile duct etc
Common duct stones
Cholangitis
What are the two causes of intrahepatic jaundice that show similar blood results?
Paracetamol overdose and hepatitis
Which of Hep B and Hep C can be vertically transmitted?
Hep B
What are symptoms of Hep B? Are there always symptoms?
Jaundice Fatigue Abdo pain Anorexia/Nausea/Vomitting Arthralgia
Up to half no/vague symptoms
What % of Hep B goes on to be chronic in adult and children? Is Hep B normally cleared? Can it lead to liver failure?
10% go on to chronic Hep B as adults
90% as children
Yes normally cleared within 6months
1% can lead to liver failure
What serology can you do to test for Hep B?
Surface Antigen E antigen Core antibody IgM E Antibody Surface antibody Core antibody IgG
What is chronic Hep B defined by in the serology? What is the outcome of these patients?
Persistence of surface antigen after 6 months
25% lead to cirrhosis
5% develop hepatocellular carcinoma
If someone has surface antibody or core antibody IgG what does it mean?
Means infection clearing or cleared
What test would you do for management of Hep B?
Hep B virus PCR
Is there a cure for Hep B and why? What is the treatment?
No cure because it integrates into host genome
Lifelong anti-virals to suppress viral replication
What is an inactive carrier of Hep B?
Presence of surface antigen but no symptoms, normal LFTs, low viral load, no liver damage - do need to be monitored though as this can change
What is the vaccination for Hep B?
Genetically engineered surface antigen
3 doses + boosters if required
Produces surface antibody response
>100 = long term protection
Why would you have + core antibody (IgG) but no surface antibody in chronic Hep B infection?
Because surface antibody indicates infection is clearing and chronic infection infection is not yet cleared
Who is most at risk for Hep C?
IVDU
Can you get vertical transmission?
Yes
