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Viral hepatitis Flashcards

1
Q

what are the different types of hepatitis viruses?

A

= Hepatitis A-E

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2
Q

what is the chief or sole clinical manifestation of hepatitis virus?

A

= liver disease

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3
Q

how is hepatitis A transmitted?

A

= faecal-oral spread

  • poor hygiene/overcrowding
  • gay men and IV drug users
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4
Q

describe the clinical aspects of hepatitis A?

A
  • acute hepatitis, no chronic infection

- peak incidence of symptomatic disease in older children/young adults

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5
Q

how would you confirm hepatitis A?

A
  • clotted blood for serology (gold top vacutainer)
    = same sample for all causes of viral hepatitis

= hepatitis A IgM

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6
Q

how would you control the spread of hepatitis A?

A

= hygiene

= vaccine prophylaxis

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7
Q

where is hepatitis E common?

A

= in tropics

  • evidence of chronic infections in pigs, deer and rabbits.
  • severe disease in pregnant women
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8
Q

describe the clinical and transmission specs of hepatitis E?

A

= clinically like Hep A

transmission
= faecal-oral transmission

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9
Q

Who is at risk of getting a chronic hepatitis E infection?

A

= immunocompromised humans

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10
Q

when is hepatitis D ONLY found with?

A

= with hepatitis B

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11
Q

describe hepatitis D?

A

= parasite of a parasite

  • exacerbates hepatitis B infections
  • co-infections or superinfection

= rare in scotland

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12
Q

how is hepatitis B transmitted?

A

= sex
= mother to child
= blood
= chronic infections more likely to result if first exposure is in childhood

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13
Q

whoa are at higher risk for developing hepatitis B?

A
  • people born in areas of intermediate/high prevalence
  • mutual sexual partners
  • people who inject drugs
  • children of infected muscles
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14
Q

how would you confirm hepatitis B?

A
  • hepatitis B surface antigen (HBsAg) present in blood of all infections individuals
    = present for more than 6 months in chronic infections
    = Hep B e antigen usually present in highly infectious individuals
    = Hep B virus DNA always also present in high amounts in highly infected individuals
    = Hep B DNA TESTS used to predict risk of chronic liver disease and monitor therapy
  • hep B IgM
    = most likely to be present in recently infected vases
  • anti-has present in immunity
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15
Q

how would you control hepatitis B?

A 
- minimise exposure to;
= safe blood
= safe sex
= needle exchange 
= prevention of needle sticks 
= screening of pregnant women
  • 2 pre-exposure vaccines
  • posit-exposure pro-phylaxis
    = vaccine
    = Hyperimmune Hep B immunoglobulin
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16
Q

how is hepatitis C transmitted?

A

= similar to hep B

  • no vaccine available
17
Q

True or false.

Infection with hepatitis C results in chronic infection in about 75% of cases.

A

True

18
Q

what defines chronic infection ?

A

= 6 months of infection

19
Q

describe what happens once chronic infection of hepatits B and C has been acquired?

A

Hep B
= spontaneous cure not uncommon, even after many years of infection

Hep C
= once chronic infection established, spontaneous cure is NOT SEEN

20
Q

describe how you would diagnose Hep C?

A 
= patient at risk of Hep C, or with signs of chronic liver disease
= test for antibody to hep C virus 
= Negative NOT INFECTED
OR
= Positive PAST OR ACTIVE INFECTION 
= Test for Hep C virus RNA by PCR 
- negative = past infection 
- positive = active infection
21
Q

describe hep C virus control?

A

= no vaccine

= minimise exposure

22
Q

how do you manage acute viral hepatitis?

A 
= symptomatic 
= no anti-virals given 
= monitor for encephalopathy 
= monitor for resolution 
= immunisation contacts
= tests for other infections if at risk 
= vaccine against her infections if at risk
23
Q

how do you manage chronic viral hepatitis?

A

1) Antivirals

2) Vaccination
- other hepatitis viruses
- if cirrhotic: influenza, pneumococcal

3) Infection control
4) Alcohol↓

5) Hepatocellular carcinoma awareness/screening
- most important for patients with cirrhosis
- serum -alpha fetoprotein (AFP) and ultrasonography

24
Q

what people should get anti-virals?

A
  • Chronic infection
    = HCV RNA present and genotype known
    = HBsAg and Hep B DNA present
  • Risk of complications
    = evidence of inflammation / fibrosis sought, especially in Hep B
    = non-invasive tests of fibrosis
  • Fit for treatment
    = cirrhosis more difficult to treat, but cirrhotic patients are treated as a priority
    = liver cancer at presentation is a contraindication
    = HIV co-infection more difficult to trea
  • Patient may have other priorities
25
Q

what is interferon alfa?

A

= human protein

  • part of immune response to viral infection
  • made by genetic engineering
  • given by injection as pegylated interferon
26
Q

what are side effects of interferon alfa?

A 
minor 
= flue like symptoms 
- chills
- sore muscle
- malaise

major
= auto-immune disease
= psychosis
- thyroid disease

27
Q

what is an adverse affect of the anti-viral ribavirin?

A

= anaemia

28
Q

how do you treat chronic hep B?

A 
OPTION 1 
= Suppressive antiviral drug (5 licensed to date)
e.g. entecavir, tenofovir
\+ safer
\+ increasing range available
- suppression not cure
- resistance can develop
OPTION 2
= Peginterferon alone
\+ sustained cure possible from a few months of therapy
- side effects
- injections
- only minority gain benefit

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

29
Q

what are the aims of chronic hep B therapy?

A
  • reduction inf HBV DNA (suppression)
  • loss of HBeAg (enduring suppression)
  • loss of HBsAg (cure)

= improve liver and histopathology
= reduced infectivity
= reduced progression to cirrhosis and primary hepato-cellular carcinomas
= reduced mortality

30
Q

what are the aims/benefits of chronic hep C therapy?

A

= Response defined by loss of HCV RNA in blood sustained to 6 months after end of therapy

  • virological cure (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
31
Q

what are the principles of HCV therapy?

A 
Choice of anti-viral regime based on; 
= genotype virus 
= genotype of patients interferon response genes 
= stage of disease
= past treatment experience
= likelihood of side-effects
32
Q

give examples of current anti-virals?

A

= Simeprevir, Ledipasvir, Daclatasvir, Ombitasvir, Paritaprevir, Elbasvir, Grazoprevir

  • Used in certain genotypes in combinations of 2 or 3 drugs
  • Safe and well tolerated

= Sofosbuvir, Voxilaprevir, Velpatasvir

  • Active against all genotypes, used in combination
  • Safe and well tolerated

= Classes of HCV antiviral are called NS3-NS4A, NS5A and NS5B inhibitors depending on mode of action

Standard is now all oral, interferon free courses of 2 or 3 antivirals for up to 12 weeks with high Sustained Virological Responses

GI (43 decks)

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