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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
What is the incubation period of Hep B?
6 weeks-6 months
26
How is Hep B similar to HIV?
It has a reverse transcriptase component
27
How much Hep B do you need to be infectious?
Nano amount
28
What does the soluble core of the virus contain that is associated with high infectivity?
e antigen (HBeAg)
29
How is Hep B transmitted?
1) Sexual intercourse 2) Blood and blood products 3) Injecting drug use 4) Tattoos 5) Body piercing 6) Acupuncture
30
What is a carrier of Hep B?
Someone who has had the virus for 6 months
31
How long does Hep B surface antigen (HBsAg) persist in the circulation for?
> 6 months
32
What are the two possible clinical states after acute infection?
1) Icteric (infection resolves), develop jaundice | 2) Anicteric (carrier state) - don't develop jaundice, cirrhosis, hepatocellular carcinoma
33
What is the level of HBsAB in acute, resolving and chronic infection?
< 10 mIU/ml
34
What is the level of HBsAB in past infection or vaccine response?
> 10 mIU/ml
35
What do you find in serology tests in acute infection?
HBsAg, HB core antibody, HB core IgM, HB e antigen
36
What do you find in serology tests in chronic infection?
HBsAg, HB core antibody ± HB e antigen/antibody
37
Why do you look for HBsAg in Hep B infection?
Want to neutralise it, showing specificity
38
Why is molecular diagnosis of HBV DNA superior?
- Most direct measure of HBV replication - Clinical staging of chronic infection - Assessment of infectivity - Efficacy of antiviral agents
39
What are the 4 risk groups for chronic infection?
1) Infection early in life 2) Asymptomatic 3) Immune system defect 4) Male gender
40
How is Hep B prevented?
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
How is Hep B treated?
1) Antiviral therapy | 2) Immunomodulators (SC injection)
42
What type of virus is Hep D?
Satellite virus
43
Why does Hep D need Hep B to replicate and cause infection?
- ssRNA virus enveloped by HBsAg so needs it to multiply | - Can only infect people in HBsAg is around
44
What is Hep D infection?
- Superinfection of Hep B | - Acute infection is self limiting bc cannot survive without HBsAg
45
What else is Hep B immunisation protective against?
Hep D and arguably liver cancer bc Hep B is a big cause of liver cancer
46
What are the routes of transmission of Hep C?
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
What is the incubation period of Hep C?
6-12 weeks
48
What are the clinical features of Hep C?
- 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
Why is Hep C hard to diagnose?
Most of the time no jaundice and LFTs lower (so screening v important)
50
How is Hep C diagnosed?
- Serology - HCV antibody | - Molecular - HCV RNA detection and quantification, HCV genotype, antiviral resistance
51
Is there a vaccine for Hep C?
No (would need to be 6-valent bc 6 genotypes)
52
Describe treatment of Hep C with antivirals
- 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
Which is the only hepatitis virus which is not ssRNA?
Hep B (dsDNA)
54
Describe Hep A
- Self limiting in 99% | - No chronicity
55
Is there a vaccine available for Hep A?
Yes
56
What indicates previous exposure to Hep A?
Hep A IgG
57
Do you treat everyone with Hep B?
No - there are different phases
58
When do you treat Hep B?
If ALT and viral load is elevated
59
Why do you treat Hep B?
To prevent complications
60
What is the natural course of Hep C?
Acute Hep C → chronic Hep C → cirrhosis → liver cancer/hepatic failure
61
What drug can cure Hep C without interferon?
Sofosbuvir
62
What can chronic viral infections (e.g. Hep C) be treated with to stimulate the immune system?
IFN-alpha (interferon, cytokine)

Stage 2: Inflammation (39 decks)

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