Viral Hepatitis Flashcards by James Reilly

What is hepatitis?

Inflammation of the liver

Viral hepatitis = inflammation of the liver as a result of direct viral infection

How well did you know this?

Not at all

Perfectly

Define acute hepatitis

Hepatitis within last 6 months

How well did you know this?

Not at all

Perfectly

Define chronic hepatitis

Any hepatitis lasting for longer than 6 months

How well did you know this?

Not at all

Perfectly

Possible symptoms of acute hepatitis

General malaise
Myalgia
GI upset
Abdominal pain (particularly in the right upper quadrant)
With/without cholestatic jaundice (pale stools, dark urine)
Tender hepatomegaly

How well did you know this?

Not at all

Perfectly

Infective causes of acute hepatitis

Viral - Hepatitis A and E
-Herpes viruses e.g. EBV (Epstein Barr Virus), CMV (Cytomegalovirus), VZV (Varicella Zoster Virus)

Non-viral - Leptospirosis

Toxoplasmosis
Coxiella (Q fever)

How well did you know this?

Not at all

Perfectly

*Non-Infective causes of acute hepatitis

Alcohol
Drugs
Toxins/poisoning
Pregnancy
Autoimmune
Hereditary metabolic

How well did you know this?

Not at all

Perfectly

Signs of Chronic liver disease

Clubbing
Palmar erythema
Dupuytren’s contracture (one or more fingers bending into palm of hand)
Spider naevi

How well did you know this?

Not at all

Perfectly

Infective causes of chronic liver disease

Hepatitis B (+/- D)
Hepatitis C

How well did you know this?

Not at all

Perfectly

Non-infective causes of chronic liver disease

Alcohol
Drugs
Autoimmune
Hereditary metabolic

How well did you know this?

Not at all

Perfectly

Describe genetic appearance of Hepatitis A

Small, undeveloped RNA virus

How well did you know this?

Not at all

Perfectly

Clinical presentation of Hepatitis A

Incubation period of 28 days.
Nausea, anorexia and distaste for cigarettes.
After 2 weeks, jaundice, with dark urine and pale stool.
Sometimes hepatomegaly

How well did you know this?

Not at all

Perfectly

Pathophysiology of Hepatitis A

Picornavirus
Viral replication occurs in infected hepatocytes
>Destruction of hepatocytes due to immune response and viral life cycle
>Hepatitis
>Hepatic symptoms
Virus particles shed through biliary tree into faeces. Most infectious just before jaundice

How well did you know this?

Not at all

Perfectly

How is Hepatitis A spread?

Faecal-oral route

Associated with shellfish

How well did you know this?

Not at all

Perfectly

Epidemiology of Hepatitis A

Most common viral hepatitis in the UK

How well did you know this?

Not at all

Perfectly

Diagnosis of Hepatitis A

Blood = ALT rises (Alanine transaminase)
IgM = Antibody to HAV

How well did you know this?

Not at all

Perfectly

Treatment of Hepatitis A

Prevention by vaccine

Treatment includes treating symptoms and avoiding alcohol

How well did you know this?

Not at all

Perfectly

Complications of Hep A

Cholestatic hepatitis

Rarely, liver failure and death

How well did you know this?

Not at all

Perfectly

Clinical presentation of Hep B (also D)

Flu like symptoms
Fever
Jaundice in 10% of younger and 50% of adults

How well did you know this?

Not at all

Perfectly

Pathophysiology of ACUTE Hep B

Study These Flashcards

Infected Hepatocyte
>Strong cellular immune response
>usually clearance of infection
>Still presents elevated liver enzymes and antibodies to HBV antigen
Possible to not be cleared -> fulminant liver failure (1% chance)

Pathophysiology of CHRONIC Hep B

Study These Flashcards

HBsAg (Hep B surface Antigen) levels persist for 6 months.
(Due to the virulence of the strain or the immunocompetence and age of the patient.)
In cases of vertical transmission there is an immune tolerance of HBV antigens that precedes a stage of immune clearance after 2-3 decades.
This is when hepatitis and cirrhosis present.

Spread of Hep B

Study These Flashcards

Parental route
Infected blood or bodily fluids
Mostly intercourse or vertical transmission

What is the most common viral hepatitis in the UK

Study These Flashcards

Hepatitis A

What is most common cause of hepatitis worldwide

Study These Flashcards

Infection by Hep B

Diagnosis of Hep B (also D)

Study These Flashcards

Blood - ALT rises
HBaAg, HBcAb, HBsAb, IgM HBcAb (antibodies)

HBsAg is present 1-6 months after exposure. Presence for me than 6 months implies carrier status

Treatment of Hep B

Avoid unprotected sex and alcohol Treatment - treat symptoms Fulminant hepatitis - antivirals

Complications of Hep B

Fulminant Hepatic failure (rare) | Chronic HBV infection and Cirrhosis can lead to hepatocellular carcinoma

Clinical presentation of Hep C

Incubation period of 6-9 weeks Often asymptomatic in acute infection Chronic infection may present with malaise, weakness and anorexia

What is Hepatitis B virus (what kind of genetic material is it)

Enveloped dsDNA reverse transcription virus

What is Hepatitis C virus (what kind of genetic material is it)

Enveloped RNA virus

Pathophysiology of Hep C

Acute infection: can resolve spontaneously, or progress to chronic. Chronic: sustained infection of hepatocytes -> damage to the cells -> cirrhosis and liver disease Blood borne virus

How is Hep C spread

Blood borne | Mostly transmitted by poorly sterilised instruments/shared needles

Hep C Epidemiology

Six numbered genotypes of which: 1 makes up 50% of cases 2 and 3 make up 40% of cases

Diagnosis of Hep C

Liver enzymes show rise Antibodies to HCV (or HCV RNA diagnoses acute infection) (antibodies present within 4-6 wks)

Treatment of Hep C

Antivirals - weekly subcut (SC) pegylated interferon alpha-2a and daily oral Ribavirin Information = advise on not sharing neddles

Complications of Hep C

Liver failure | If cirrhosis was found, could get hepatocellular carcinoma

Describe Hep E virus

RNA virus | similar to Hep A - acute only

How is Hep E spread and how is it prevented

Faeco-oral route usually spread by contaminated water, rodents, dogs and pigs Prevention by good sanitation and hygiene

True or False: | You can only get infected with Hep E once

True Once you've had Hep E then you cannot get infected again - 100% immunity

Treatment of Chronic Hepatitis B

SC Pegylated Interferon-Alpha 2a (immunodilatory treatment) - also for Hep D Nucleos(t)ide analogues (inhibit viral replication) e.g. Oral Tenofovir

What is Hep D

Incomplete RNA virus enclosed in a shell of Hep B surface antigen (HBsAg) Requires Hep B virus for assembly, allowing virus to replicate

Transmission of Hep D

Blood-borne

Epidemiology of Hep D

Common in Eastern Europe

Risk factors of Hep D

IV drug users | all same as HBV

Pathophysiology of Hep D

If acquired simultaneously with HBV (co-infection), causes increased severity of acute infection. Co-infection: Clinically indistinguishable from acute icteric (jaundice) HBV infection Serum IgM anti-HDV confirms co-infection Superinfection: When someone with chronic HBV gets HDV Results in secondary acute hep and increased rate of liver fibrosis progression

Hep C prevention

No vaccine available Previous infection DOES NOT confer immunity - can be re-infected Screen blood products Precaution with handling bodily fluids

Viral Hepatitis Flashcards

(45 cards)