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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
How do you Rx acute hep B
No Rx Self limiting Prevent with vaccine Can give Ig if needle stick
26
What do you advice someone with hep B
``` Public health <5% become chronic NO alcohol / sex Household precaution Vaccinate contacts ```
27
When do you test for HIV / HBV / HCV
6 months
28
What are complications of HBV
``` 10% chronic Cirrhosis HCC Liver failure Membranous GN Polyarteritis nodosa Cyroglobulinuria Vasculitis rash ```
29
When do you consider treatment of chronic
``` 2+ of Abnormal LFT High viral load Abnormal fibroscan / cirrhosis HbeAg +ve (DNA / ALT raised) ```
30
What do you do otherwise
Monitor | Some stages of chronic are highly infectious
31
How would you treat
Anti-viral (nucleoside analogue) = 1st line Pegylated interferon (anti-viral + immune) Liver transplant if cirrhotic Monitor renal function Interferon less successful in chronic
32
What is prophylaxis in hep B if exposed
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
What do you do after vaccine
Check Anti-Hbs levels at 3 months | If chronic liver / healthcare
34
How do you monitor and follow up hep B
Clinic LFT Fibroscan Advise if become immunocompromised
35
When can you not perform invasive procedure
HbeAg or HbsAg +Ve High HBV DNA Hep C
36
Who is at risk of no response to vaccine
``` Obesity Alcohol SMoking >40 Immunocompromsie ```
37
How do you treat hep B in pregnancy
``` Tenofavir safe Obstetric team Advise delivery Passive and active to newborn Can breast feed Test baby at 1 year ```
38
How is hep C. spread (RNA)
Blood - IVDU / snort - more common hep C Little sexual / placental Can breast feed
39
Can you become immune to hep C
No so can get reinfected | No vaccine
40
What are the symptoms of hep C
``` Short incubation Flu like symptoms Malaise Anorexia Fatigue Arthralgia 10% jaundice ```
41
What are complications of hep C
``` 85% = chronic Cirrhosis HCC Sjogren Cryoglobulinuria Membranous GN ```
42
What is chronic defined as
HCV RNA >6 months
43
Who is more likely to het fulminant hepatitis
Pregnancy Elderly Immunocompromised
44
What suggests cirrhosis
ALT up Platelet down Test other BBV HCC surveillance
45
Who is at risk of hep C
``` Alcohol accelerates HIV accelerates IVDU Haemophiliac Transfusion pre screen Dialysis Tattoo / piercing ```
46
How do you Dx hep C
``` 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
When do you retest for hep C
3-6 months to make sure
48
When do you treat hep C
If Ab and antigen +ve
49
How do you treat hep C
``` Now curable Anti-viral 3 months Protease inhibitor - interferon and ribavirin = 1st line Interferon no longer NO PEP or VACCINE ```
50
How do you prevent hep C
Don't share needles Donor screen Cover wounds Do monthly PCR if on PEP and Rx if seroconversion
51
What are SE of ribavirin
Teratogenic so don't get pregnant 6 months Haemolytic anaemia Cough
52
What are the SE of interferon
``` Thrombocytopenia Leukapenia Fatigue Depression Flu ```
53
What does response to Rx of hep C depend on
Age Gender Liver disease Amount of virus
54
What are types of response to hep C Rx
Non Responder Viral Breakthrough Relapse - when Rx stopped Sustained viral after 6 months = 95%
55
How is hep D transmitted
Same as hep B | But requires hep B surface antigen
56
What are the symptoms of hep D
More severe hep B and rapid progression if co-infection | Suspect if acute flare up
57
How do you Dx hep D
IgM and IgG | PCR = Dx
58
How do you treat hep D
NO vaccine Pegylated interferon Transplant Prevent hep B
59
What are the complications of hep D
Chronic B Cirrhosis HCC Fulimant hepatitis
60
How is hep E spread
Foecal oral
61
What is the most common hepatitis
E | Screen in any acute liver injury
62
What are the symptoms of hep E
Short incubation = 40 days Mild Like HAV Jaundice <1%
63
When is hep E dangerous
Pregnancy = high infant mortality (diff hep A) due to fulminant Elderly men
64
What are extra hepatic complications of hep E
``` AKI - think if no cause Pancreatitis Bell's Palsy GBS Neuralgic arthropathy - brachial plexus pain Arthtiris Anaemia ```
65
Who is at risk of hep E
Occupational - farm | Blood transfusion due to short viraemia phase
66
When do you suspect hep E
Deranged LFT for alcohol consumption
67
How do you Dx hep E
IgG and IgM HEV PCR serology Abnormal LFT
68
What is chronic hep E
>3 months | No dip in HEV RNA 6 months
69
How do you treat hep E
No specific Rx or vaccine | Clean water and avoid undercooked meat
70
What are complications of hep E
Persistent in immunocompromsied | Liver failure if CLD
71
Do you notify government
YES
72
What vaccines do chronic liver patients get
Pneumococcal one off | Influenza annual
73
What is the window period
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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