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GI > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

What is the causes of viral hepatitis?

A

Caused by 5 types of viruses:

A, B, C, D and E

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2
Q

Which viruses cause self limiting acute infections?

A

A and E

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3
Q

Which viruses cause chronic disease?

A

B, C and D

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4
Q

What type of viruses are A and E?

A

Enteric viruses: get through water
A: faecal-oral route or shellfish
E: water or undercooked pork

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5
Q

What type of viruses are B, C and D?

A

Parenteral viruses: blood

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6
Q

What do the viruses do to the liver?

A

Viruses cause inflammation of the liver

Liver cell damage and death of individual liver cells

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7
Q

What is the outcome of the acute inflammation they cause?

A

Resolution (liver returns to normal): hepatitis A, E
Acute liver failure if severe damage to liver: hepatitis A, B, E
Progression to chronic hepatitis and cirrhosis: hepatitis B, C

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8
Q

What can cirrhosis cause?

A

Liver failure (chronic liver failure)

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9
Q

What percentage of the Scottish population has hepatitis C?

A

1%

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10
Q

Does hepatitis C cause acute liver failure?

A

Rarely causes acute liver failure

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11
Q

What is the pathway of the disease?

A

After 6 months, 70-85% of those infected will have failed to clear the virus spontaneously, after this period the hepatitis C virus enters what is known as the chronic phase (85% chronic HCV infection)
It is now highly unlikely that the virus will be cleared without treatment
It is usually possible to cure the infection (90% = cured/cleared) with treatment

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12
Q

What happens in patients who develop chronic hepatitis C are not treated?

A

Disease varies: some people will have minimal liver damage with no scarring, while others can progress to cirrhosis (extensive scarring of the liver)
Cirrhosis can lead to hepatocellular carcinoma/liver failure

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13
Q

What type of virus is hepatitis C?

A

RNA virus

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14
Q

How is hepatitis C transmitted?

A 
IV drug abuse (contaminated needles)
Sexual contact (not as common)
Vertical transmission (occasionally)
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15
Q

What is the presentation of hepatitis C?

A

10% of patients report acute jaundice

Most asymptomatic until cirrhotic (i.e. significant damage)

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16
Q

What are the investigations?

A

May have normal LFTs

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17
Q

What is HBV?

A

Hepatitis B virus: DNA virus

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18
Q

How is hepatitis B transmitted?

A 
Vertical
Contaminated needles (IVDU)
Sexual intercourse (more common with hepatitis B than C)
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19
Q

What are some at risk groups for hepatitis B?

A 
IVDU and their sexual partners/carers
Health workers
Men who have sex with men
Staff or residents of prisons
Babies of HBsAg +ve mothers
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20
Q

What does HBsAg in the blood suggest?

A

Hepatitis surface antigen
Presence of virus: HBsAg (surface antigen) is present 1-6 months after exposure, HBsAg persisting for >6 months defines carrier status and occurs in 5-10% of infections

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21
Q

What percentage of adults recover and therefore do not become chronically infected with hepatitis B?

A

95%

After infection 5% of patients remain chronic carriers (HBsAg carrier) and are therefore infectious

22
Q

What does HBeAg in the blood mean?

A

Active replication

23
Q

What does HBV DNA in the blood mean?

A

Active replication

24
Q

What is HBcAg?

A

Hepatitis core antigen: active replication (not detected in blood)

25
Q

What does anti-HBs in the blood mean?

A

Protection: antibodies to HBsAg alone imply vaccination

26
Q

What does the presence of IgM anti-HBc mean?

A

Acute infection

27
Q

What does the presence of IgG anti-HBc mean?

A

Chronic infection

28
Q

What does the presence of anti-HBe mean?

A

Inactive virus

29
Q

How is hepatitis B treated/managed?

A

Treatment for HBV depends on how long you have been infected for:

  • If you have been exposed to the virus in the past few days, emergency treatment can help stop you becoming infected
  • If you have only had the infection for a few weeks or months (acute hepatitis B), you may only need treatment to relieve your symptoms while your body fights off the infection
  • If you have had the infection for more than 6 months (chronic hepatitis B), you may be offered treatment with medicines that can keep the virus under control and reduce the risk of liver damage - chronic hepatitis often requires long-term or lifelong treatment and regular monitoring to check for any further liver problems
30
Q

What are the 2 main treatments for chronic HBV?

A

Pegylated interferon

Oral antiviral medicines

31
Q

What are the complications of hepatitis B?

A

Chronic hepatitis B
Cirrhosis
Hepatocellular carcinoma
End-stage liver disease (liver failure)

32
Q

Do all patients with chronic hepatitis B develop liver cirrhosis?

A

No, some patients have no further progression (not all patients have progressive disease)
Approximately 15-40% of chronic hepatitis B patients will progress to cirrhosis, HCC or liver failure

33
Q

What is the treatment option for ESLD?

A

Liver transplant: HBV-related ESLD or HCC are responsible for 5-10% of cases of liver transplantation

34
Q

What do we give to at risk groups for hepatitis B?

A

Hepatitis B vaccination

35
Q

What is the presentation of hepatitis B patients?

A

Many people with hepatitis B will not experience any symptoms and may fight off the virus without realising they had it
If symptoms do develop, they tend to happen 2-3 months after exposure to the hepatitis B virus:
 Flu-like symptoms, including tiredness, a fever, and general aches and pains
 Loss of appetite
 Feeling + being sick
 Diarrhoea
 Abdominal pain
 Arthralgia
 Urticaria

36
Q

What is hepatitis A?

A

RNA virus

37
Q

What is the presentation of patients with hepatitis A?

A

Asymptomatic cases very common

38
Q

When does hepatitis A it occur?

A

Occurs sporadically or in epidemic form

Prevalence decreasing worldwide

39
Q

How is HAV transmitted?

A

Faecal-oral
Sexual
Blood

40
Q

What is the commonest age group that HAV affects?

A

5-14 years

41
Q

How is HAV diagnosed?

A

Acute disease diagnosed by IgM antibodies (recent infection)

IgG is detectable for life

42
Q

Who is the HAV immunisation given to?

A 
Travellers
Patients with chronic liver disease (e.g. IDU - especially with HCV or HBV)
Haemophiliacs
Occupational exposure e.g. lab workers
Men who have sex with men (MSM)
43
Q

What is HDV?

A

RNA virus: does not code for its own protein coat, enveloped by HBsAg

44
Q

What does HDV occur?

A

Only occurs in people with hepatitis B: co-infection or super-infection with HBV

45
Q

How is it HDV transmitted?

A

As for HBV

46
Q

How is HDV treated?

A

Very resistant to treatment

47
Q

What is HEV?

A

RNA virus

48
Q

What is the commonest cause of acute hepatitis in Grampian?

A

Hepatitis E

49
Q

What is the treatment of HEV?

A

No specific treatment

50
Q

Is there a HEV vaccine?

A

No effective vaccine currently available

51
Q

What are the complications of hepatitis E?

A

Fulminant hepatic failure in pregnancy

GI (54 decks)

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