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Stage 2: Inflammation > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

What does IgM show?

A

Acute/recent infection, or from donated blood

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2
Q

What does IgG show?

A

Past infection, immunisation response, presence of passively acquired antibody after receiving blood products

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3
Q

What is hepatitis?

A

Inflammation of liver

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4
Q

What are differential diagnoses of viral hepatitis?

A
  • CMV and EBV (can cause a hepatitis)
  • Parvovirus, adenovirus, enterovirus (can present with hepatitis instead of normal rash e.g. due to adenoviraemia)
  • Yellow fever, dengue
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5
Q

Which Hep viruses don’t cause chronic infection?

A

Hep A and E (can in immunocompromised)

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6
Q

Which Hep viruses cause chronic infection and cirrhosis?

A

B (± D) and C

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7
Q

What conditions are chronic Hep B and C infections associated with?

A
  • Persistent infection (carrier)
  • Chronic liver disease
  • Chronic active or persistent hepatitis
  • Cirrhosis
  • Hepatocellular carcinoma
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8
Q

What is cirrhosis?

A

When the liver is no longer functioning properly, small and shrunken

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9
Q

What investigations are done for viral hepatitis?

A

1) LFTs
2) Serology - antigen, IgM, IgG, alpha fetoprotein
3) Molecular - esp. when looking at prognosis and response to anti-viral agents
4) Imaging - fibroscan and ultrasound
5) Histopathology - liver biopsy (depending on other results)

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10
Q

What will LFTs show in hepatitis?

A

High aminotransferases (AST and ALT) in low 1000s and high BR

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11
Q

What does the presence of alpha fetoprotein indicate in chronic infection?

A

Hepatocellular carcinoma

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12
Q

What does imaging show in viral hepatitis?

A

Liver fibrosis, fatty deposits, general composition

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13
Q

What does a liver biopsy allow you to do?

A

Look at liver structure

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14
Q

What are the signs and symptoms of viral hepatitis?

A
  • Malaise, fever, headaches
  • GI symptoms (anorexia, N&V)
  • Right upper quadrant abdominal pain (liver capsule inflamed, liver enlarged and stretched)
  • Dark urine (can’t eradicate bilirubin) and clay coloured faeces (no bilirubin)
  • Jaundice
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15
Q

What are treatments for viral hepatitis?

A
  • Antiviral agents
  • Immunomodulation e.g. interferon
  • Supportive
  • Passive immunity through blood products containing IgG to virus to neutralise virus (temporary)
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16
Q

What are 3 similarities between Hep A and E?

A

1) Faecal-oral transmission
2) Similar incubation period
3) Same methods used for lab diagnosis

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17
Q

What is the incubation period of Hep A?

A

3-5 weeks

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18
Q

What is the transmission route of Hep A?

A

Faeco-oral transmission (source outbreaks, person to person)

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19
Q

How do you diagnose acute Hep A infection?

A

Hep A IgM detection in blood

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20
Q

When are people with Hep A considered infectious?

A

2 weeks before to 7 days after jaundice onset

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21
Q

What is the incubation period of Hep E?

A

6 weeks

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22
Q

How is Hep E transmitted?

A

Faeco-oral, also undercooked meat products

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23
Q

How do you diagnose Hep E infection?

A

Hep E IgM in blood and RNA detection

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24
Q

What are similarities between Hep B, D and C?

A

1) Persistent infection
2) Diagnostic tests similar - serology and molecular
3) Management of chronic infection - antivirals, immunomodulators

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25
Q

What is the incubation period of Hep B?

A

6 weeks-6 months

26
Q

How is Hep B similar to HIV?

A

It has a reverse transcriptase component

27
Q

How much Hep B do you need to be infectious?

A

Nano amount

28
Q

What does the soluble core of the virus contain that is associated with high infectivity?

A

e antigen (HBeAg)

29
Q

How is Hep B transmitted?

A

1) Sexual intercourse
2) Blood and blood products
3) Injecting drug use
4) Tattoos
5) Body piercing
6) Acupuncture

30
Q

What is a carrier of Hep B?

A

Someone who has had the virus for 6 months

31
Q

How long does Hep B surface antigen (HBsAg) persist in the circulation for?

A

> 6 months

32
Q

What are the two possible clinical states after acute infection?

A

1) Icteric (infection resolves), develop jaundice

2) Anicteric (carrier state) - don’t develop jaundice, cirrhosis, hepatocellular carcinoma

33
Q

What is the level of HBsAB in acute, resolving and chronic infection?

A

< 10 mIU/ml

34
Q

What is the level of HBsAB in past infection or vaccine response?

A

> 10 mIU/ml

35
Q

What do you find in serology tests in acute infection?

A

HBsAg, HB core antibody, HB core IgM, HB e antigen

36
Q

What do you find in serology tests in chronic infection?

A

HBsAg, HB core antibody ± HB e antigen/antibody

37
Q

Why do you look for HBsAg in Hep B infection?

A

Want to neutralise it, showing specificity

38
Q

Why is molecular diagnosis of HBV DNA superior?

A
  • Most direct measure of HBV replication
  • Clinical staging of chronic infection
  • Assessment of infectivity
  • Efficacy of antiviral agents
39
Q

What are the 4 risk groups for chronic infection?

A

1) Infection early in life
2) Asymptomatic
3) Immune system defect
4) Male gender

40
Q

How is Hep B prevented?

A

1) Passive immunisation - Hep B immunoglobulin given to babies at birth whose mothers have Hep B on top of vaccine
2) Active immunisation - recombinant vaccine

41
Q

How is Hep B treated?

A

1) Antiviral therapy

2) Immunomodulators (SC injection)

42
Q

What type of virus is Hep D?

A

Satellite virus

43
Q

Why does Hep D need Hep B to replicate and cause infection?

A
  • ssRNA virus enveloped by HBsAg so needs it to multiply

- Can only infect people in HBsAg is around

44
Q

What is Hep D infection?

A
  • Superinfection of Hep B

- Acute infection is self limiting bc cannot survive without HBsAg

45
Q

What else is Hep B immunisation protective against?

A

Hep D and arguably liver cancer bc Hep B is a big cause of liver cancer

46
Q

What are the routes of transmission of Hep C?

A

1) Injecting drug users sharing equipment
2) Blood and blood products
3) Contaminated needles e.g. tattoos, acupuncture, body piercing
(sex and MTC lower risk of transmission)

47
Q

What is the incubation period of Hep C?

A

6-12 weeks

48
Q

What are the clinical features of Hep C?

A
  • Anicteric (75%), carrier state, 40-50% chronic liver damage
  • 25% icteric (jaundiced)
  • LFTs may be much lower than Hep B
  • 20% cirrhosis
  • Hepatocellular carcinoma
49
Q

Why is Hep C hard to diagnose?

A

Most of the time no jaundice and LFTs lower (so screening v important)

50
Q

How is Hep C diagnosed?

A
  • Serology - HCV antibody

- Molecular - HCV RNA detection and quantification, HCV genotype, antiviral resistance

51
Q

Is there a vaccine for Hep C?

A

No (would need to be 6-valent bc 6 genotypes)

52
Q

Describe treatment of Hep C with antivirals

A
  • Goal is to cure infection and prevent complications (can eradicate bc not in chromosome like Hep B)
  • Aim is undetectable HCV RNA in blood by 12 weeks
  • Cure rates > 90%
  • Directly acting antivirals (DAA)
  • Target HCV protease and other viral proteins
53
Q

Which is the only hepatitis virus which is not ssRNA?

A

Hep B (dsDNA)

54
Q

Describe Hep A

A
  • Self limiting in 99%

- No chronicity

55
Q

Is there a vaccine available for Hep A?

A

Yes

56
Q

What indicates previous exposure to Hep A?

A

Hep A IgG

57
Q

Do you treat everyone with Hep B?

A

No - there are different phases

58
Q

When do you treat Hep B?

A

If ALT and viral load is elevated

59
Q

Why do you treat Hep B?

A

To prevent complications

60
Q

What is the natural course of Hep C?

A

Acute Hep C → chronic Hep C → cirrhosis → liver cancer/hepatic failure

61
Q

What drug can cure Hep C without interferon?

A

Sofosbuvir

62
Q

What can chronic viral infections (e.g. Hep C) be treated with to stimulate the immune system?

A

IFN-alpha (interferon, cytokine)

Stage 2: Inflammation (39 decks)

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