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Gastrointestinal > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

What is viral hepatitis?

A

Liver inflammation due to a viral infection

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2
Q

What are the causes of acute hepatitis?

A

Hepatitis infection, alcohol, drugs, EBV, CMV, toxoplasmosis, haemochromatosis, toxins, autoimmune

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3
Q

What is the pattern of infection of acute hepatitis?

A
  1. Prodromal: flu-like symptoms: fatigue, nausea, vomiting, pain; liver symptoms: clay-coloured stools
  2. Jaundice: 1-2 weeks later, spleno/hepatomegaly
  3. Recovery: resolution of symptoms but elevation of LFTS
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4
Q

What is chronic hepatitis?

A

Hepatitis present for > 6 months, with variable changes in liver function.

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5
Q

What clinical symptoms are there in acute hepatitis?

A

Raised ALT/AST, jaundice, clotting derangements.

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6
Q

What types of hepatitis cause only acute hepatitis?

A

Hepatitis A

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7
Q

How are the hepatic acinar zones affected in hepatitis?

A

Zone 1: sees oxygenated blood first, so most susceptible to hepatitis
Zone 3: more susceptible to ischaemia

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8
Q

What is the pathophysiology of chronic hepatitis?

A

Hepatocytes degenerate: swelling, cytoplasmic granularity and vacuolation.
Multiacinar necrosis occurs as inflammatory lymphocytes infiltrate into lobules and portal tracts.

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9
Q

What kind of virus is hepatitis A?

What is the epidemiology of hepatitis A?

A

Single-stranded RNA virus, with a single serotype.

Travel-related, most common acute viral hepatitis.

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10
Q

How is hepatitis A transmitted?

A

Faecal-oral route vie food and water.

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11
Q

What is the lifecyle of hepatitis A?

A

Replicates in the liver, is excreted in bile and then in faeces 2 weeks before onset of clinical symptoms with 1 month incubation.
No chronic carriage and good immunity.

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12
Q

What are the clinical features of hep A?

A

Flu symptoms.
Jaundice due to intrahepatic cholestasis
Age determinant of severity,

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13
Q

Investigations/diagnosis of hep A?

A

IgM positive or RNA in the blood or stool in acute hep A.

If previously infected or vaccinated, IgG positive

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14
Q

What vaccinations are there for hep A?

A

Active:
- inactivated virus, 95% efficacy. MSM, IVDV, travellers, outbreak control.

Passive:
- pooled immunoglobulins, if allergic to vaccine or before 4 weeks of travel; 3-6 month efficacy

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15
Q

What kind of virus is hepatitis E?

A

RNA virus

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16
Q

How is hep E transmitted?

A

Faecal-oral route; pork, water

Incubation period 40 days

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17
Q

How many genotypes does hep E have?

A
  1. 3rd is linked to neurological problem e.g. GB syndrome, encephalopathy, alaxia, myopathyin 5% patients
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18
Q

What are the symptoms of hep E?

A

General flu-like symptoms

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19
Q

What is treatment of hep E?

A

Supportive treatment, since there is no vaccine.

Chronic can be seen (rarely) in immunocompromised patients e.g. bone marrow transplants

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20
Q

How is hep E diagnosed?

A

IgG and IgM and antiHEV

21
Q

What are the complications of hep E?

A

High mortality rates, especially in pregnancy with the GT 1 serotype

22
Q

What kind of virus in hepatitis B?

A

Hepadnavirus DNA virus

23
Q

Hep B epidemiology?

A

300 million cases worldwide, 2 million deaths a year

24
Q

What is the difference between the surface antigen and the e-antigen in HBV?

What does the core antibody indicate?

What is the difference between the surface antibody and the core antibody?

A

Surface antigen: present in all carriers. If present for over 6 months, chronic.
E-antigen: reflects high infectivity

Core antibody: previous infection

Surface antibody: marker of immunity
E-antibody: reflects low infectivity

25
Q

How is hep B transmitted?

A

Vertically from mother to child in womb.

Horizontally via transfusion, needles, blood, semen etc.

26
Q

What are the symptoms of hep B?

A

Fever symptoms: myalgia, joint pain; jaundice, weight loss, abdominal pain, bloody ascites
Incubation period: 2-6 months

27
Q

How does the age of infection affect the severity of the acute illness and the severity of chronic infection with hep B?

A

Babies are less likely to get an acute infection but they are also more likely to become carriers (70-90%) and have the chronic disease later in life, since they have no immune system to attack the virus when they’re young.

28
Q

What complications can chronic hep B cause?

A

Liver cirrhosis in 25%.
Hepatocellular carcinoma
Chronic active HBV
Upper GI haemorrhage and varices

29
Q

What is the main route of hep B transmission in UK?

A

Sex

30
Q

How is HBV diagnosed?

A

Surface antigen (marker of infection) present, or if DNA is detectable

31
Q

Which aminotransferase increases in chronic HBV infection?

A

ALT: increases during immune clearance, and decreases at reactivation

32
Q

What 2 groups are hep B carriers divided into?

A

eAG positive: early disease. High risk of chronic liver disease and hepatocellular carcinoma.
eAG negative: late disease. Low risk.

33
Q

What is the treatment for acute and chronic hep B?

A

Acute: none
Chronic: treat liver inflammation; aim is to suppress viral replication and convert eAg +ve to -ve (less infectious)

Immunological: pegylated interferon alpha weekly for 1 year to increase cellular immune responses; side effect of constant flu.

Antiviral drugs: suppress viral replication.

  • Tenofovir
  • Entecavir
34
Q

How can hepatitis B be prevented?

A
  • Education: condoms and needle awareness.

- Screening in pregnancy.

35
Q

What immunisation is available for hep B?

A

Active: HBV sAg antigen in high risk groups.
Passive: babies to HBV+ve mums

36
Q

What interventions can be made in pregnancy to prevent hep B?

A
  1. HBV vaccination to newborn
  2. HBV Ig, if eAg+ve
  3. Tenofovir in last trimester for mum
37
Q

What kind of virus is hep D?

A

ss RNA virus

38
Q

What other hepatitis is hep D always present with?

A

Hep B: needs it to replicate

39
Q

How is hep D transmitted?

A

Same as hep B. Can be coinfected with hep B (coinfection) or infect someone already with HBV (superinfection)
vertical is rare

40
Q

What treatment is there for hep D?

A

Pegylated interferon alpha injections only.

41
Q

What kind of virus is hep C, and how many genotypes?

A

RNA flavirus with 6 genotypes

42
Q

What type of hepatitis is most common in IV drugs users in Glasgow?

A

Hepatitis C: 0.7% Scottish population

43
Q

How is hep C transmitted?

A

Parenteral transmission (same as hep B/D)
>50% IV drug users have HCV
Vertical: mother to baby

44
Q

What is the incubation period of hep C?

A

6-8 weeks

45
Q

What are the symptoms of hep C?

A

Asymptomatic in 90% of cases and 35-40% is undiagnosed.

46
Q

What are the complications for HCV carriers?

A

60-90% have risk of developing chronic active hepatitis, liver cirrhosis and hepatocellular carcinoma.

47
Q

Do those that have been infected with HCV become immune? Is there a vaccine?

A

No reliable immunity after infection

No vaccine

48
Q

How is HCV diagnosed?

A

Anti HCG Ig +ve = chronic OR cleared infection

PCR/antigen +ve = current infection/viraemia

49
Q

How can HCV be treated?

A

Pegylated interferon alpha
Ribavicin
- cures 40-60% after 24-48 weeks
Also: direct acting antiviral to increase chance of a cure.

Gastrointestinal (10 decks)

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