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GI > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

How is Hep A transmitted?

A

Faecal oral spread.

Grows in the liver and is excreted down into the bile gut and enters the gut and faeces.

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2
Q

Where is Hep A common?

A

Humanitarian crisis, porr hygiene/overcrowding.

UK- rare. Some cases are imported and occasional clusters in gay men and PWID

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3
Q

What are the clinical features of Hep A?

A

Acute hepatitis (no chronic infection)

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4
Q

When is the peak incidence of Hep A?

A

Older children/young adults

Very young children will have no symptoms

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5
Q

How does the laboratory confirm Hep A infection?

A

Clotted blood for serology looking for hepatitis A IgM.

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6
Q

What colour bottle do you put hepatitis blood samples into?

A

Gold top vaccucontainer

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7
Q

There is a Hep A vaccine. Who gets it?

A

Targeted people at risk.
Travelers
Gay men
PWID

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8
Q

Where is Hep E common?

A

In the tropics but in the UK is more common than Hep A

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9
Q

What causes UK cases of Hep E without foreign travel?

A

Exposure to Pigs, Deer or Rabbit or their meats.

These antimals are chronically infected

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10
Q

What is the clinical presentation of Hep E?

A

Acute inflammation of the liver

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11
Q

How is Hep E transmitted?

A

Faecal oral in the tropics

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12
Q

Can you get chronic infection with hep E?

A

Only if you are immunocomprimised.

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13
Q

Pregnant lady recently returned from the tropics with Hep E. Are you worried?

A

Yes as the tropical genotype of Hep E has been associated with severe disease in pregnant women.

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14
Q

Is ther a Hep E vaccination?

A

Not yet

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15
Q

When can you get Hep D?

A

Only if you have Hep B. You can be co infected with Hep B and D at the same time or have Hep B and then later get Hep D.

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16
Q

What is the clinical importance of Hep D?

A

Exacerbates Hep B infection- rare in scotland

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17
Q

How is Hep B transmitted?

A

Sex
Mother to child (most significant worldwide)
Blood (acupuncture, tattoos, PWID healthcare)

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18
Q

When is chronic infection with Hep B more likely?

A

If the first exposure was in childhood.
Young children often assymptomatiic and then become chronically infected.
Older people get acute symptoms and are treated avoiding chronic infection

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19
Q

Who are the people at risk of Hep B in the UK?

A

PWID
People born in areas of intermediate or high prevalence.
Multiple sexual partners
Children of infected mother

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20
Q

What defines chronic hepatitis infection?

A

Infection for >6 months

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21
Q

How do you confirm Hep B infection in the laboratory?

A

Hepatitis B surface antigen (HBsAg) is present in the blood of all infectious individuals.
Hepatitis B e antigen (HBeAg) is usually present in the blood of highly infectious individuals
Hepatitis B viral DNA is always present in high titre in highly infectious individuals.
Hep B igM may be present in recently infected cases.
Anti Hep B antibody will be present in immunity

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22
Q

Hep B DNA tests are used in the diagnosis of Hep B. What else are they used for?

A

Predict risk of chronic liver disease and monitor therapy

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23
Q

What is ATL?

A

A biochemical marker of inflammation of the liver

24
Q

There are 4 phases of Hep B chronic infection and it is complex relationship between chronic infection and chronic liver disease. What does this mean in terms of monitoring chronically infected Hep B patients?

A

You need to monitor them every 6-12 months no matter what as they may become more infectious or develop more damage

25
Q

How can we reduce hepatitis B?

A

Safe blood transfusion, safe sex, needle exchange, prevent needlestick injuries, screen pregnant women to prevent mother child transmission.

26
Q

Who gets the Hep B vaccine?

A

All children born since August 2017

All older risk children and adults (healthcare workers)

27
Q

What is the post exposure prophylaxis of Hep B?

A

Vaccine and Hyperimmune Hep B immunoglobulin.

This works because the incubation of the virus is weeks long

28
Q

How is Hep C transmitted?

A

Similar to Hep B.

Blood, Sex, Mother to child (less common)

29
Q

Is there a Hep C vaccine?

A

No

30
Q

What percentage of Hep C infection will become chronic?

A

75%.

Just 25% will manage to keep the virus out of their blood and liver.

31
Q

Is the chance of chronic infection with Hep C depend on age?

A

No- it’s independent of age

32
Q

How can infection with Hep B or C lead to primary hepatocellular carcinoma?

A

Chronic infection => chronic hepatitis => Cirrhosis => primary hepatocarcinoma or chronic liver failure => death

33
Q

Can you get a spontaneous cure from Hep B after years of infection?

A

Yes- its not uncommon

34
Q

Can you get a spontaneous cure of chronic Hep C infection?

A

No- spontaneous cures are not seen

35
Q

How long does it take for chronic hepatitis infection to cause cirrosis and hepatocellular carcinoma?

A 
Cirrhosis = 20 years
Cancer = 30 years
36
Q

Why is chronic hepatitis quite a large problem?

A

Most people are asymptomatic when infected and later get chronic infection and hepatitis cirrhosis etc, before it is diagnosed

37
Q

What percentage of Hep B infection in adults will lead to a chronic infection?

A

<5%

NB: This is much greater in children as they are often asymptomatic

38
Q

How is Hep C diagnosed in at risk individuals?

A

1) Test for the antibody for Hep C virus.
=> Negative- not infected/ discharge. Postitive- past or active infection.
2) Then Test for Hep C virus RNA by PCR.
=> Negative- past infection/discharge. Positive- active infection

39
Q

How is acute viral hepatitis managed?

A

No antivirals if acute.
Monitor for encephalopathy and resolution of Hep B, C or E if immunocomprimised.
Notify public health
Immunise all contacts.
Test for other infections if at risk- HIV, syphilis etc and vaccinate against other infections if at risk

40
Q

If hepatitis a notifiable disease?

A

YES- to public health

41
Q

What is important when choosing antivirals for chronic hep C infection?

A

Genotype of the virus (1-6).
This can be determined by sequencing the virus.
NB: genotype is not important in Hep B.

42
Q

If you diagnose chronic hepatitis, which vaccinations should the patient receive?

A

Other Hepatitis viruses to prevent furtehr insult to the liver
If cirrhotic: influenza and pneumococcal viruses

43
Q

What advice do you give to chronic hepatitis patients?

A

Try to control the infection. Sex etc
Decrease alcohol consumption as much as possible
Hepatocellular carcinoma screening : important in cirrhosis.

44
Q

WHat is the hepatocellular carcinoma screening?

A

AFP- serum- alpha fetoprotein and USS

45
Q

Who should be treated for hepatitis?

A

Those with chronic Hep C infection or chronic Hep B infection with HepB DNA above a cirtain threshold
Cirrhotic patients are treated as a priority

46
Q

What are the contra indications for treatment of hepatitis?

A

Liver cancer at presentation

HIV co infection- treat the HIV first

47
Q

How can you test for fibrosis and inflammation of the liver?

A

Fibrosis- fibroscan measures elasticity of the liver

Inflammation = Raised ALT

48
Q

When should you treat hepatitis?

A

Before complications and when there is evidence of inflamation

49
Q

What is the injectable drug occasionally used to treat hepatitis and what are the side effects?

A

Interferon alpha (peginterferon)

Side effects: flu like symptoms
Thyroid disease, autoimmune disease and psychiatric disease. (Aviod if already has these diseases)

50
Q

Ribavin is used to treat hepatitis. What is the common side effect?

A

Anaemia

51
Q

What is the most common therapy for hepatitis B?

A

Life long oral therapy.

Suppression of hep B DNA to undetectable levels.

52
Q

If you can remove HBsAg from the blood of a Hep B patient is this a cure?

A

YES

Reduction of Hep B DNA is suppression and loss of HBeAg is more enduring supression

53
Q

What is a Sustained Virological Response (SVR)?

A

RNA negative 6 moths after the end of therapy.
Virological cure from hepatitis C.
Relapse is rare but reinfection can occur

54
Q

What are the current antivirals used in Hepatitis C therapy?

A 
Simeprevir
Ledipasvir
Daclastavir
Ombitasvir
Elbasvir
Grazoprevir
Called NS3, NS4A etc
55
Q

How long is Hep C therapy for?

A

Up to 12 weeks

GI (48 decks)

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