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Gastroenetrology > Viral hepatitis > Flashcards

Viral hepatitis Flashcards

1
Q

How many types of hepatitis are there and what are their names?

A 
5
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E
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2
Q

How is Hepatitis A spread?

A

Faecal to Oral spread
Poor Hygiene/Overcrowding
No carrier state
Can be present in urine

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3
Q

Is Hepatitis A chronic or acute?

A

Acute

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4
Q

What group of people have peak incidence of symptomatic disease?

A

Older children/Young Adults

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5
Q

How is Hep A diagnosed?

A

Clotted blood for serology
(Gold top vacutainer)
Hepatitis A IgM

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6
Q

How is Hep A controlled?

A

Hygiene

Vancine Prophylaxis

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7
Q

Where is Hep E most common?

A

Tropics

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8
Q

What is Hep E’s transmission route?

A

Faecal-oral

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9
Q

What are Hep E cases in the UK classified as?

A

Zoonoses

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10
Q

Is there a Hep E vaccine?

A

No :(

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11
Q

Can patients get chronic infection from Hep E?

A

Only those who are immunosuppressed

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12
Q

What other Hep is Hep D always found with?

A

Hep B

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13
Q

Is Hepatitis D parasitic?

A

Yeas

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14
Q

What does Hep D do to a Hep B infection?

A

Exacerbates it

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15
Q

How is hep B transmitted?

A

Sexually
Mother to child
Blood

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16
Q

Who is at high risk of Hepatitis B?

A

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

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17
Q

How is Hep B confirmed?

A

HBsAg is present in the blood of all infectious hep b individuls

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18
Q

When is HBsAg present in chronic Hep B infections?

A

For more than 6 months

19
Q

What are Hep B DNA tests also used to predict the risk of?

A

Chronic liver disease

20
Q

When is Hep B IgM most likely to be present?

A

Recently infected cases

21
Q

When are Anti-Hb’s present?

A

In immunity cases

22
Q

How can Hep B be controlled?

A 
Minimising exposure
Safe blood
Safe sex
Needle exchange
Prevention of needlestick injury
Screening of pregnant women
23
Q

Is there a Hep B Vaccine?

A

Yes,
Two actually
One for all children
One for at risk children and adults

24
Q

Is there such think as post exposure prophylaxis in Hep B cases?

A

Yes
Vaccine
HBIG (Hyperimmune Hep B immunoglobin)

25
Q

Is there a vaccine for hepatitis C?

A

No :(

26
Q

How often does a Hep C virus result in a chronic infection?

A

75% of cases

27
Q

How many months of infection means chronic?

A

6 months

28
Q

Can Hep B be spontaneously cured?

A

Yes

29
Q

Can Hep C be spontaneously cured?

A

No

30
Q

What is the typical time period from infection to cirrhosis?

A

> 20 years

31
Q

What is the typical time period from infection to hepatocellular carcinoma?

A

> 30 years

32
Q

What is more common Heb B or Hep C?

A

B

33
Q

What is the management of acute viral hepatitis?

A 
NO Antivirals
Monitor for encephalopathy
Mintor for resolution
Notify Public Health (Ellie Hothersall bae)
Immunisation of contacts
Test for other infections
Vaccinate against other infections
34
Q

What is the management of chronic viral hepatitis?

A 
ANTIVIRALS:
-Adefovir
-Entecavir
-Tenofovir etc
VACCINATIONS
-Other hepatitis viruses
-If cirrhotic: Influenza, pneumococcal
Infection control
Decreasing alcohol
Heapatocellular carcinoma screening
35
Q

What must we consider when deciding who to treat with Antivirals?

A 
Chronic infections
Risks of complications : evidence of inflammation
Fibrosis
Fitness for treatment
Patient's priorities
36
Q

What should we consider when deciding when to treat a patient?

A

Before the complications
When evidence of inflammation is present
When the patient is ready

37
Q

What is Interferon alfa?

A

A human protein that is part of the immune response to viral infection
It can be made by drug companies
In the form of peginterferon

38
Q

What are adverse side effects of peginterferon?

A 
Flu like symptoms
Chills sore muscles
Malaise
Thyroid disease
Autoimmune disease
Psychiatric disease
39
Q

What is an adverse effect of Ribavirin?

A

Anaemia

40
Q

When should peginterferon be used over entecavir?

A

In HBsAg and HBeAg pos patients with compensated disease and prediction of good chance of cure

41
Q

What are the benefits of chronic hepatitis B therapy?

A 
Virological
reduction in HBV DNA (suppression)
loss of HBeAg (more enduring suppression)
loss of HBsAg (cure)
Improved liver biochemistry
Improved histopathology
Reduced infectivity
Reduced progression to cirrhosis and primary hepatocellular carcinoma
Reduced mortality
42
Q

What are the benefits of chronic hepatitis C therapy?

A

Response defined by loss of HCV RNA in blood sustained to 6 months after end of therapy
virological cure
known as Sustained Virological Response or SVR
relapse after SVR is rare
reinfection can occur
After SVR patients have:
improved liver biochemistry
improved histopathology
reduced infectivity
reduced incidence of primary liver cancer
reduced mortality

43
Q

What are the principles of HCV therapy?

A

Choice of antiviral regime based on:
Genotype of virus, and viral load
Genotype of patient’s interferon response genes
This is less important as interferon used less
Stage of disease
Past treatment experience, genotypic resistance info
Likelihood of side-effects, inc Drug Drug Interactions
Cost effectiveness considerations
Responses of >90% SVR are now considered benchmark to aim for

Gastroenetrology (17 decks)

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