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Y1 GI > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

what are the 5 hepatitis viruses

A 
Hep A
Hep B 
Hep C 
Hep D
Hep E
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2
Q

Transmission of Hep A

A 
grows in liver 
excreted down via bile ducts into gut 
spreads faecal-orally 
facilitated by poor hygiene and overcrowding 
Some clusters in gay men and IVDUs
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3
Q

Clinical presentation of Hep A

A

Acute hepatitis - no chronic infection
Lasts days/weeks
Peak incidence of symptomatic disease is in older children/young adults
if infected in early childhood there are no symptoms

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4
Q

Investigations for Hep A

A

Lab confirmation
clotted blood for serology
looking for Hep A IgM

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5
Q

How to reduce HepA outbreaks

A

Improve hygiene
reduce overcrowding
vaccine prophylaxis - given to those at greater risk, those travelling etc, gay men, and injecting drug users

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6
Q

Which hepatitis viruses are common in UK

A

Hep E
More common in tropics
More common than hep A in UK

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7
Q

How does Hep E present

A

Like Hep A

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8
Q

How is Hep E transmitted

A

faecal orally

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9
Q

What animal does hep E come from

A

Pigs

zoonoses

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10
Q

What Hep E genotypes are associated with severe disease in pregnant women

A

tropical genotypes

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11
Q

Who gets chronic Hep E infections

A

those who are immunocompromised

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12
Q

What virus do those with Hep D have

A

Hepatitis B virus
Makes the Hep B virus worse
Parasite of a parasite
rare in Scotland

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13
Q

How is Hepatitis B transmitted

A

Sex
Mother to child at delivery
Blood to blood contact (sharing needles)

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14
Q

Who gets chronic hep B infections

A

those who have first exposure in childhood

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15
Q

Who is at greater risk in the of getting Hep B

A

Those born in areas of high prevalence
Those with multiple sexual partners
People who inject drugs
Children of infected mothers

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16
Q

Which hepatitis vaccine is given in early childhood in UK

A

Hep B

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17
Q

Investigations for Hep B

A

Lab confirmation
Hep B surface antigen (HBsAG) present in blood of all infectious individuals
Hep B virus DNA also present in highly infectious individuals
Hep B DNA tests also used to predict risk of chronic liver disease
Hep B IgM present in those recently infected
Hep B antibodies present in blood after infection

18
Q

What is the definition of a chronic Hep B infection

A

HBsAG in blood for more than 6 months

19
Q

How can you control Hep B

A 
Minimise exposure 
-safe blood 
-safe sex 
-safe needle exchange 
-prevention of needle sticks 
-screening of pregnant women 
Give immunisation 
-all children born since 2007 vaccinated 
-vaccination of all at risk older children and adults 
Post-exposure prophylaxis 
-vaccine 
-plus HBIG (hyperimmune Hep B immuonglobin)
20
Q

Hepatitis C has a vaccine true/false

A

False

no vaccine available as it is a diverse collection of viruses

21
Q

How is Hep C transmitted

A

same as Hep B
sex
blood
mother to child

22
Q

What happens when injected with Hep A

A

Infection

  • asymptomatic
  • acute hepatitis - can lead to chronic infection
  • acute liver failure (rare) - causes death
23
Q

What happens in chronic infection of Hep A

A
  • chronic hepatitis
  • cirrhosis
  • chronic liver failure - death
  • OR cancer - death
24
Q

Can Hep B be spontaneously cured

A

YES even after many years of infection

25
Q

Can hep C be spontaneously cured

A

NO

26
Q

How long does it take from infection to cirrhosis

A

> 20 years

patient usually asymptomatic

27
Q

Time from infection to hepatocellular carcinoma

A

> 30 years

patient usually asymptomatic

28
Q

What happens after a hep C infection

A

Most people asymptomatic which leads to resolution (25%) or chronic infection (75%)

29
Q

What happens after Hep B infection

A

mostly asymptomatic
mainly leads to resolution
less than 5% get chronic infection

30
Q

Which hepatitis is ‘mild’

A

Hep E

31
Q

Tests for Hep C

A

Antibody test
If positive either past or active infection of Hep C
If positive test for Hep C RNA by PCR - positive is active infection

32
Q

How to control hepatitis C

A

Minimise exposure

No vaccine

33
Q

How to manage acute viral hepatitis

A

Symptomatic
No antivirals given
Monitor for encephalopathy
Monitor for resolution
Notify public health
Immunise contacts if a vaccine (hep A & B)
Test and vaccinate against other infections

34
Q

Management of chronic viral hepatitis

A

Antivirals
-12 for C
-6 for B
-Genotype of hep C us important in deciding which antiviral
Vaccination
-against other hep
-influenza and pneumococcal in cirrhotic
Infection control
Reduce alcohol intake
Hepatocellular carcinoma awareness/screening
-AFP

35
Q

Issues with antiviral treatment of chronic viral hepatitis

A

For hep C must know genotype of virus
For hep B must know hep B DNA and surface antigen present
Prioritise patients at greatest risk of complications
-evidence of inflammation/fibrosis
-do non-invasive tests of fibrosis (fbroscan)
-biochem evidence of inflammation (increase ALT)

36
Q

Higher HBV DNA starting load the lower the risk of developing cancer true/false

A

false

higher risk of developing cancer

37
Q

What is interferon alfa and what hep is it still used for

A 
Used for B 
Protein produced by human cells- part of innate response 
Given by injection as peg interferon 
Complex mode of action - immune adjacent - helps along the immune system 
Many side effects 
-flu like symptoms 
-thyroid disease 
-autoimmune disease 
-psychiatric disease
38
Q

Therapy for chronic Hep B

A

option 1 - suppressive antiviral - safer but suppression not cure
option 2 - peg interferon alone - cure but bad side effects

39
Q

What are the aims/benefits of chronic hep B therapy

A

reduction in HBV DNA (suppression)
loss of HBeAg (more suppression)
loss of HBsAg(cure)

40
Q

aims/benefits of chronic Hep C therapy

A

Loss of HCV RNA in blood sustained to 6 months after end of therapy
virological cure
Sustained virological response

41
Q

Benchmark aim for Hep C therapy

A

> 90% sustained virological response

42
Q

How long to you treat chronic hep C to cure it

A

12 weeks

Y1 GI (41 decks)

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