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MD3002 - GI Disease/Pathology > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

What are the main causes of hepatitis?

A
  • Viral
  • Non-viral; e.g. Toxoplasma gondii
  • Drugs; e.g. paracetamol
  • Alcohol
  • Poisons; e.g. Aflatoxins, Amanita phalloides (mushrooms)
  • Other; e.g. pregnancy, circulatory insufficiency
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2
Q

What are the classifications of hepatitis?

A

Hepatitis A-E
Hepatitis F - ‘delisted’
Hepatitis G - ‘orphan’

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3
Q

Describe hepatitis A-E

A
  • All are hepatotropic - All demonstrate an ability to infect hepatocytes (liver cells)
  • All belong to different virus families - All possess entirely different properties
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4
Q

What are the 6 stages of viral replication?

A
  • Adsorption
  • Penetration
  • Uncoating
  • Replication of nucleic acid
  • Maturation/assembly
  • Release
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5
Q

What is meant by the term hepatitis?

A

inflammation of the liver

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6
Q

What are the viral features of HAV?

A
  • Picornaviridae family
  • Single-stranded RNA virus
  • Non-enveloped virus (naked)
  • Only 1 serotype
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7
Q

How is HAV spread?

A

o Faecal-oral route
o Poor hand hygiene
o Contaminated food or water

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8
Q

What are the main clinical features of HAV?

A
  • Fever, anorexia
  • Nausea, vomiting
  • Jaundice
  • Dark urine, pale stools
  • Liver moderately enlarged
  • Spleen palpable in 10% patients
  • No chronic carriage
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9
Q

How many viruses can be present in one gram of faeces?

A

100 million

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10
Q

What are the stages of infection of HAV?

A
  • Incubation period of 2-4 weeks (prodromal phase)
  • Virus excreted in faeces for 1-2 weeks before symptoms
  • Translocation from FI tract to blood
  • Infection of liver cells
  • Passage of biliary tract and back to GI tract
  • Excretion in faeces
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11
Q

What is the prognosis of HAV?

A

Prognosis excellent (mortality 0.1%) in young adults

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12
Q

How could HAV cause death?

A
  • Death if fulminant hepatic necrosis occurs
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13
Q

How is HAV diagnosed?

A
  • Diagnosed by presence of anti-HAV IgM
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14
Q

What is the main treatment of HAV?

A
  • No specific treatment
  • Maintain comfort and nutritional balance
  • Fluid and electrolyte replacement
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15
Q

What is the main methods for prevention of HAV?

A
  • Vaccine
  • Good hygiene
  • Resistant to chlorination
  • Killed by boiling for 10mins
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16
Q

What type of virus is HAV?

A
  • Picornaviridae family
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17
Q

Describe the viral features of HBV

A
  • Hepadnaviridae
  • Double-stranded DNA virus
  • Enveloped virus
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18
Q

What is the transmission method of HBV?

A
  • Sexual intercourse
  • Intra-uterine, peri- and post-natal infection
  • Blood or blood products
  • Contaminated needles and equipment used by intravenous drug users
  • In association with tattooing, body piercing and acupuncture
  • Contaminated haemodialysis
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19
Q

Describe the antigens of hepatitis B

A 
-	HBsAg – surface antigen
o	Indicates high transmissibility
o	HBsAb provides immunity and appears late (not in carriers)
-	HBcAg – core antigen
o	HBcAb appears early in infection
-	HBeAg – envelope antigen
o	Derived from core
o	Indicates high infectivity
20
Q

Who is at risk HBV?

A

Anyone coming into contact with blood/body fluids from someone infected with HBV
e.g. sexual transmission, vertical transmission (mother - baby), living with a person with chronic HBV, drug users etc.)

21
Q

What are the stages of infection go HBV?

A
  • Incubation period of 2-4 months
  • 50% patients develop chronic active hepatitis
    o 20% of these proceed cirrhosis
  • 1-4% of these risk developing liver cancer
22
Q

Describe the stages of acute infection of HBV

A
  • Incubation period of 45-120 days
  • Pre-icteric period of 1-7 days
  • Icteric period 1-2 months
  • Convalescent period of 2-3 months in 80-90% of adult cases
23
Q

How to distinguish between acute infection and chronic infection in Hep B?

A
  • HBsAg and HBeAg appear during incubation period
  • Viral DNA become detectable
  • Antibodies to core antigen (HBcAg) appear concomitantly with rise in liver transaminases
  • Antibodies to HBeAg and HBsAg only appear during convalescence
  • Continued presence of HBsAg and absence of antibodies to it indicate that infection has become chronic
24
Q

Clinical features of the pre-iteric period of HBV

A
  • Malaise
  • Anorexia
  • Nausea
  • Pain in right upper quadrant (tender liver)
25
Q

What are the clinical features of the steric period of HBV?

A 
-	Yellowish pigmentation
o	Skin
o	Sclerae
o	Other mucous membranes
-	Caused by hyperbilirubinemia
26
Q

What are the clinical outcomes of acute infection by HBV?

A
  • Fulminant hepatitis
  • Chronic hepatitis or asymptomatic carrier state
  • Resolution of infection
27
Q

What is the treatment for HBV?

A
  • Pegylated interferon (peginterferon): superior compared to -interferon alone
  • Nucleoside analogues such as oral lamivudine
28
Q

What are the methods used for prevention go HBV?

A
  • Vaccination: 3 injections over 6 months
  • HBV immunoglobulin
  • Blood screening
  • Needle exchange programmes
  • Sexual health education
29
Q

Describe the viral features of HCV

A
  • 6 virus types (from nucleotide sequences)
  • Flaviviridae
  • Single-stranded RNA
  • Enveloped virus
30
Q

What are the clinical features of HCV

A
  • Usually asymptomatic
  • Fatigue
  • Nausea
  • Weight loss
  • May rarely progress to cirrhosis
  • Small proportion to patients may develop hepatocellular carcinoma many years after primary infection
31
Q

What are the modes of transmission of HCV?

A
  • Blood borne products
  • Blood contaminated needles
  • Tattooing, body piercing, acupuncture
  • Haemodialysis
32
Q

What are the stages of infection of HCV?

A
  • Virus replicates mainly in hepatocytes

- Incubation period 2 weeks to 6 months

33
Q

What are the screening procedures for HCV?

A
  • Blood test available for HCV based on NAAT

- Current incidence of transfusion associated HCV is low

34
Q

What are the main treatments used for HCV?

A
  • Ribavirin + pegylated -interferon
  • Combination therapy
  • No vaccine currently available
35
Q

What are the viral features of HDV?

A
  • Small (35nm) circular single-stranded RNA virus
  • Defective virus
  • HDV picks up HBsAg as it buds from liver cell
36
Q

What is unique about Hep D?

A
  • Found as co-infection with HBV

- HBV severs as helper virus for infectious HDV production

37
Q

How is HDV transmitted?

A
  • Transmitted percutaneously, sexually, from infected blood
38
Q

Who is mainly at risk for HDV?

A
  • Chronic HBV carriers are at risk for infection with HDV
39
Q

What is the main treatment for HDV?

A
  • No specific treatment available
40
Q

What are the viral features of HEV?

A
  • Caliciviridae
  • Single-stranded RNA
  • Non-enveloped virus
41
Q

What is the peak incidence of HEV?

A
  • Peak incidence in young adults
42
Q

What type of disease is HEV?

A
  • Waterborne disease

- Usually self-limiting

43
Q

What is the incubation period of HEV?

A
  • Incubation period 3-8 weeks
44
Q

Who is HEV life threatening in?

A

pregnant woman

45
Q

What are the main methods for prevention of HEV?

A

Good sanitation and hygiene

Vaccine (Hecolin)

46
Q

What are the main other causes of Viral Hepatitis?

A
  • Epstein-Barr virus
  • Cytomegalovirus
  • Yellow fever virus
  • Adenovirus
  • Bunyaviruses
  • Flaviviruses

MD3002 - GI Disease/Pathology (11 decks)

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