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Viral Hepatitis Flashcards

1
Q

What causes hepatitis

Presentation

  • Asymptomatic
  • Abdo pain
  • Fatigue
  • Arthralgia
  • N+V
  • Fever
  • Jaundice if high bilirubin
  • Fever
  • Higher ALT / AST than ALP

Can lead to cholestasis which differentiates from normal flu

  • HSM - painful
  • Dark urine / pale stools
  • Pruritus
A 
Hep ABCDE
Autoimmune 
Drug induced
Alcohol and NAFLD 
CMV, EBV, HIV
Herpes
Enterovirus 
VZV
Rubella
Q-fever, Yellow fever, Psittacosis, Leptospirosis
Ischaemia
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2
Q

How is hep A spread

A

Foecal oral
Contaminated food or drink
Most common travel

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3
Q

What are the symptoms of hep A

A 
Short incubation - 28 days
Benign and self limiting 
Mild flu 
Period of fever / malaise
Anorexia 
N+V 
Abdominal pain 
Jaundice
Pruritus

Can lead to cholestasis
Dark urine / pale stool
HSM – painful

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4
Q

Who is at high risk and offered immunisation

A 
Travellers
CHronic liver
Occupational exposure
Haemophiliac
Homosexual 
PWID
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5
Q

How do you Dx Hep A

A

Abnormal LFT
IgM HAV
IgG shows past exposure
FOB

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6
Q

How do you treat hep A

A

No treatment as self limiting 1-3 months
Relieve pain / itching / nausea
Human Ig lasts 4 months
Vaccine to prevent if high risk

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7
Q

What are complications of hep A

A

Prolonged fatigue / jaundice

No chronic damage or HCC risk

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8
Q

How is hep B spread (DNA virus)

A 
Blood
Sexual 
Vertical to babies
Horizontal among children
Carrier states exist but less likely to be chronic than hep C
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9
Q

How infective is hep B

A

Very 100x more than HIV

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10
Q

What are the symptoms of hep B

A 
Long incubation - 6 weeks (need to wait 4 to test)
Flu prodrome
Fever
Headache
Fatigue
ANorexia 
N+V
Abdo pain
Arthralgia / myalgia 
DIarrhoea 
Skin lesion / urticaria

CHolestasis
Pruritus / dark urine / pale stool
Jaundice + HSM develop which DDX from other flu

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11
Q

What is suggestive of hep B

A

Non-specific Hx
Jaundice
ABnormal LFT

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12
Q

What is the risk of neonates / adults developing chronic infection

A

90% neonate if infected mother
70% children
Adults = 5-10%

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13
Q

Who is at risk of hep B

A 
Chronic liver
Travellers
MSM
Haemophiilac / dialysis
IVDU
Healthcare
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14
Q

What is fulminant hepatic encephalopathy

A

DIC
Encephalopathy
Hypoglycaemia
Prolonged PT

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15
Q

Hep B serology

A

HBsAg = surface antigen (first to appear in acute infection)
HBcAg = core antigen
HBeAg = released by core when active
HBV DNA = viral DNA

If antigen detect then you have infection
e = current and highly infectious
s = acute or chronic

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16
Q

What suggests highly infectious

A

HBeAg + HBV DNA

Consider infectious even if e antigen is -ve due to risk of mutation

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17
Q

What suggests chronic hep B

A

HBeAg or surface antigen >6 months

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18
Q

How do you interpret serology

A

Anti-HBs

  • Implies immunity, develop as lose surface antigen and infection clears
  • Either exposure or immunisation
  • -ve in chronic as not cleared

Anti-HBc

  • C = caught (previous or current)
  • -ve if vaccine

IgM HBc
- Acute and lasts 6 months

IgG HBc
- Persists forever and shows past infection NOT vaccine

Anti-IBe
- Inactive virus

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19
Q

What suggests previous immunisation

A

Anti-Hbs

All other -ve

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20
Q

What suggests hep B 6 months ago

A

Anti-Hbs
Anti-HBc
IgG HBc
HBsAg -ve

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21
Q

What suggest previous hep B but now carrier / chronic

A

HbsAg +ve = chronic

Anti-HBc

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22
Q

How do you dx hep B

A

Serology

Liver enzymes

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23
Q

What should you do if testing for hep B

A

Test for HIV and hep D

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24
Q

Who gets tested for hep B

A 
High endemic
IVDU
MSM
At risk heterosexual
HIV / HCV
Anti-TB / immunosuppressed / chemo
Persistent abnormal LFT - no cause
Pregnant
Babies born to +ve mother 
Needle stick
Household contact
Prisoners = BBV
Blood transfusion / long term dialysis
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25
Q

How do you Rx acute hep B

A

No Rx
Self limiting
Prevent with vaccine
Can give Ig if needle stick

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26
Q

What do you advice someone with hep B

A 
Public health
<5% become chronic
NO alcohol / sex
Household precaution
Vaccinate contacts
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27
Q

When do you test for HIV / HBV / HCV

A

6 months

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28
Q

What are complications of HBV

A 
10% chronic
Cirrhosis
HCC
Liver failure
Membranous GN
Polyarteritis nodosa
Cyroglobulinuria
Vasculitis rash
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29
Q

When do you consider treatment of chronic

A 
2+ of
Abnormal LFT
High viral load
Abnormal fibroscan / cirrhosis
HbeAg +ve (DNA / ALT raised)
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30
Q

What do you do otherwise

A

Monitor

Some stages of chronic are highly infectious

31
Q

How would you treat

A

Anti-viral (nucleoside analogue) = 1st line
Pegylated interferon (anti-viral + immune)
Liver transplant if cirrhotic
Monitor renal function
Interferon less successful in chronic

32
Q

What is prophylaxis in hep B if exposed

A

Vaccine to newborn at birth, 4 weeks and 12 months as well as normal 3
HBIG if HbeAg at birth
If on chemo / immunosuppressed / contact = vaccine and Ig

33
Q

What do you do after vaccine

A

Check Anti-Hbs levels at 3 months

If chronic liver / healthcare

34
Q

How do you monitor and follow up hep B

A

Clinic
LFT
Fibroscan
Advise if become immunocompromised

35
Q

When can you not perform invasive procedure

A

HbeAg or HbsAg +Ve
High HBV DNA
Hep C

36
Q

Who is at risk of no response to vaccine

A 
Obesity
Alcohol
SMoking
>40
Immunocompromsie
37
Q

How do you treat hep B in pregnancy

A 
Tenofavir safe
Obstetric team
Advise delivery
Passive and active to newborn
Can breast feed
Test baby at 1 year
38
Q

How is hep C. spread (RNA)

A

Blood - IVDU / snort - more common hep C
Little sexual / placental
Can breast feed

39
Q

Can you become immune to hep C

A

No so can get reinfected

No vaccine

40
Q

What are the symptoms of hep C

A 
Short incubation 
Flu like symptoms 
Malaise
Anorexia
Fatigue
Arthralgia
10% jaundice
41
Q

What are complications of hep C

A 
85% = chronic
Cirrhosis
HCC
Sjogren
Cryoglobulinuria
Membranous GN
42
Q

What is chronic defined as

A

HCV RNA >6 months

43
Q

Who is more likely to het fulminant hepatitis

A

Pregnancy
Elderly
Immunocompromised

44
Q

What suggests cirrhosis

A

ALT up
Platelet down
Test other BBV
HCC surveillance

45
Q

Who is at risk of hep C

A 
Alcohol accelerates
HIV accelerates 
IVDU
Haemophiliac
Transfusion pre screen
Dialysis
Tattoo / piercing
46
Q

How do you Dx hep C

A 
Increased LFT
No IgM
IgG not detected for months
HCV antigen detection or HCV RNA - PCR
HCV Ab if chronic or previous exposure 
If Ab +ve but RNA -ve = cleared or treated
47
Q

When do you retest for hep C

A

3-6 months to make sure

48
Q

When do you treat hep C

A

If Ab and antigen +ve

49
Q

How do you treat hep C

A 
Now curable 
Anti-viral 3 months
Protease inhibitor - interferon and ribavirin = 1st line
Interferon no longer 
NO PEP or VACCINE
50
Q

How do you prevent hep C

A

Don’t share needles
Donor screen
Cover wounds
Do monthly PCR if on PEP and Rx if seroconversion

51
Q

What are SE of ribavirin

A

Teratogenic so don’t get pregnant 6 months
Haemolytic anaemia
Cough

52
Q

What are the SE of interferon

A 
Thrombocytopenia
Leukapenia
Fatigue
Depression
Flu
53
Q

What does response to Rx of hep C depend on

A

Age
Gender
Liver disease
Amount of virus

54
Q

What are types of response to hep C Rx

A

Non Responder
Viral Breakthrough
Relapse - when Rx stopped
Sustained viral after 6 months = 95%

55
Q

How is hep D transmitted

A

Same as hep B

But requires hep B surface antigen

56
Q

What are the symptoms of hep D

A

More severe hep B and rapid progression if co-infection

Suspect if acute flare up

57
Q

How do you Dx hep D

A

IgM and IgG

PCR = Dx

58
Q

How do you treat hep D

A

NO vaccine
Pegylated interferon
Transplant
Prevent hep B

59
Q

What are the complications of hep D

A

Chronic B
Cirrhosis
HCC
Fulimant hepatitis

60
Q

How is hep E spread

A

Foecal oral

61
Q

What is the most common hepatitis

A

E

Screen in any acute liver injury

62
Q

What are the symptoms of hep E

A

Short incubation = 40 days
Mild
Like HAV
Jaundice <1%

63
Q

When is hep E dangerous

A

Pregnancy = high infant mortality (diff hep A) due to fulminant
Elderly men

64
Q

What are extra hepatic complications of hep E

A 
AKI - think if no cause
Pancreatitis
Bell's Palsy
GBS
Neuralgic arthropathy - brachial plexus pain
Arthtiris
Anaemia
65
Q

Who is at risk of hep E

A

Occupational - farm

Blood transfusion due to short viraemia phase

66
Q

When do you suspect hep E

A

Deranged LFT for alcohol consumption

67
Q

How do you Dx hep E

A

IgG and IgM
HEV PCR serology
Abnormal LFT

68
Q

What is chronic hep E

A

> 3 months

No dip in HEV RNA 6 months

69
Q

How do you treat hep E

A

No specific Rx or vaccine

Clean water and avoid undercooked meat

70
Q

What are complications of hep E

A

Persistent in immunocompromsied

Liver failure if CLD

71
Q

Do you notify government

A

YES

72
Q

What vaccines do chronic liver patients get

A

Pneumococcal one off

Influenza annual

73
Q

What is the window period

A

Point in infection where surface antigen and antibody = zero
Not actually zero just in equilibrium
Core Ab only thing that is +Ve

GI (29 decks)

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