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MD3002 Pathology > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

What are the causes of hepatitis?

A
  • Viral
  • Non-viral (e.g toxoplasma gondil)
  • Drugs (e.g paracetomol)
  • Alcohol
  • Poisons (e.g aflatoxins, amanita phalloides ‘mushrooms)
  • Other (pregnancy, circulatory insufficiency)
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2
Q

What is common amongst Hepatitis viruses (A-E)?

A
  • All are hepatotropic

i. e all demonstrate an ability to infect hepatocytes (liver cells)

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3
Q

What are the stages of viral replication?

A
  • Adsorption
  • Penetration
  • Uncoating
  • Replication of nucleic acid
  • Maturation / assembly
  • Release
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4
Q

What are the features of HAV?

A
  • Picornaviridae family
  • Single-stranded RNA virus
  • Non-enveloped virus (naked)
  • Only 1 serotype
  • Notifiable disease
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5
Q

How is HAV transmitted?

A
  • Faecal-oral route (100m viruses present / gram faeces)
  • Poor hand hygiene
  • Contaminated food or water
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6
Q

Where are anti-HAV numbers usually high?

A

Usually developing countries with poor sanitation

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7
Q

What virus can be contained within shellfish?

A

HAV

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8
Q

What is the incubation period of HAV?

A

2 - 4 weeks (prodromal phase)

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9
Q

When is HAV excreted in faeces?

A

1 - 2 weeks before symptoms

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10
Q

How does HAV reach the liver cells?

A
  • Translocation from GI tract to blood
  • Infection of liver cells
  • Passage to biliary tract to GI tract
  • Excretion in faeces
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11
Q

What are the clinical features of HAV?

A
  • Fever, anorexia
  • Nausea, vomiting
  • Jaundice
  • Dark urine, pale stools
  • Liver moderately enlarged
  • Spleen palpable in 10% patients
  • Prognosis excellent (0.1%)
  • Death if fulminant hepatic necrosis occurs
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12
Q

How is HAV diagnosed?

A

Presence of anti-HAV IgM

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13
Q

How is HAV treated?

A
  • No specific treatment
  • maintain comfort and nutritional balance
  • Fluid and electrolyte replacement
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14
Q

How is HAV prevented?

A
  • Vaccine
  • Good hygiene
  • Resistant to chlorination
  • Killed by boiling for 10 mins
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15
Q

What are the main features of HBV?

A
  • Hepadnaviridae
  • Double-stranded DNA virus
  • Enveloped virus
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16
Q

What are the HBV antigens?

A
  • HBsAg - surface antigen
  • HBcAg - core antigen
  • HBeAg - envelope antigen
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17
Q

What antigen indicates high transmissibility?

A

HBsAg - surface antigen (appears late and provides immunity)

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18
Q

What antigen appears early in infection?

A

HBcAg - core antigen

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19
Q

What antigen indicates high infectivity?

A

HBeAg - envelope antigen (derived from core)

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20
Q

How is HBV transmitted?

A
  • Sexual intercourse
  • Intra-uterine, peri- and post-natal infection
  • Blood or blood products
  • Contaminated needles and equipment used by IV drug users
  • In association with tattooing, body piercing and acupuncture
  • Contaminated haemodialysis equipment
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21
Q

How long is the incubation period for HBV?

A

2 - 4 months

22
Q

What percentage of patients with HBV develop liver conditions?

A
  • 50% develop chronic active hepatitis
  • 20% of these proceed to cirrhosis
  • 1-4% of these risk developing liver cancer
23
Q

What are the stages of HBV infection?

A
  • Incubation period of 45 - 120 days
  • Pre-icteric period of 1 - 7 days
  • Icteric period of 1 - 2 months
  • Convalescent period of 2 - 3 months in 80-90% of adult cases
24
Q

What does icteric mean?

A

Jaundiced

25
Q

What antibodies are protective against HBV?

A
  • anti-HBs (high HBsAg is what causes chronic infection)
26
Q

What indicates that HBV infection has become chronic?

A

Continued presnce of HBsAg and absence of antibodies to it

27
Q

What do antibodies to core antigen (HBcAg) appear concomitantly with?

A

Rise in liver transaminases

28
Q

When do antibodies HBeAg and HBsAg appear?

A

Only during convalescence

29
Q

What are the clinical features of the HBV pre-icteric period?

A
  • Malaise
  • Anorexia
  • Nausea
  • Pain in RUQ (tender liver)
30
Q

What is fulminant hepatitis?

A

Massive necrosis of liver parenchyma and a decrease in liver size (acute yellow atrophy)

31
Q

What are the outcomes of acute HBV infection?

A
  • Fulminant hepatitis
  • Chronic hepatitis or asymptomatic carrier state
  • Resolution of infection
32
Q

What does the treatment of HBV involve?

A
  • Pegylated interferon (peginterferon): superior compared to alph-interferon alone
  • Nucleoside analogues such as oral lamivudine
33
Q

How is HBV prevented?

A
  • Vaccination: 3 injections over 6 months
  • HBV immunoglobulin
  • Blood screening
  • Needle exchange programmes
  • Sexual health education
34
Q

What are the features of HCV?

A
  • Flaviiviridae
  • Single-stranded RNA
  • Enveloped virus
35
Q

How many HCV virus types are there?

A

6 (from nucleotide sequences)

36
Q

What are the clinical features of HCV?

A
  • Usually asymptomatic
  • Fatigue
  • Nausea
  • Weight loss
  • May rarely progress to cirrhosis
  • Small proportion of patients may develop hepatocellular carcinoma many years after primary infection
37
Q

How is HCV transmitted?

A
  • Blood and blood products
  • Blood cantaminated needles
  • tatooing, body piercing, acupuncture
  • Haemodialysis
38
Q

Where does HCV replicate?

A

Mainly in hepatocytes

39
Q

How long is the HCV incubation period?

A

2 weeks to 6 months

40
Q

How is HCV screened?

A
  • Blood test available for HCV based on NAAT

- Current incidence of transfusion-associated HCV is low

41
Q

How is HCV treated?

A
  • Ribavirin + pegylated alph-interferon
  • Combination therapy
  • Sofosbuvir (nucleotide analogue)
  • Boceprevir (protease inhibitor)
  • Telaprivir (nucleotide analogue)
  • Daclatasvir (inhibits NS5A)
  • No vaccine currently available
42
Q

What are the features of HDV?

A
  • Small (35nm) circular ss RNA virus
  • Defective virus
  • HDV picks up HBsAg as it buds from liver cell
  • Needs HBV to be dangerous
43
Q

What specific treatment is available for HDV?

A

None

44
Q

What are the features of HEV?

A
  • Caliciviridae
  • SS RNA
  • Non-enveloped virus
45
Q

How many cases of HEV are there per year?

A

20 million

46
Q

How is HEV spread?

A

Waterborne disease

47
Q

Wha is the incubation period of HEV?

A

3 - 8 weeks

48
Q

What group are especially at risk of HEV infection?

A
  • Peak incidence in young adults
  • Can be life-threatening in pregnant women
  • Usually self-limiting in normal patients
49
Q

What are the 2 types of HEV?

A

Genotyoe 1 and 2
1 - devloping countries
2 - developed

50
Q

How is HEV prevented?

A
  • Good sanitation adn hygiene

- Vaccine (Hecolin)

51
Q

What are the other causes of viral hepatitis?

A
  • Epstein-BArr virus
  • Cytomegalovirus
  • Yellow fever virus
  • Adenoviruses
  • Bunyaviruses
  • Flaviviruses

MD3002 Pathology (19 decks)

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