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Path - Microbiology > Viral hepatitis > Flashcards

Viral hepatitis Flashcards

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1
Q

which of the hepatitis viruses are rna and which are DNA?

A

All are RNA apart from hep B

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2
Q

hep a virus is of which family?

A

Picornaviridae

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3
Q

which hep viruses are of feace-oral contact?

A

Hep A and E

the first and the last

an image of a table is very helpful

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4
Q

patient comes back from India, 6 weeks later they develop, jaundice, RUQ discomfort.

diagnosis?

A

hep a

come from an endemic area
Incubation period: 2-6 weeks

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5
Q

which hepatitis produce chronic infection and which don’t?

A

Chronic: B, C, E

No chronicity: Hep A

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6
Q

Which liver marker do we look at with hepatitis serology?

how does it change?

A

ALT - usually raised

2-3x normal - not in thousands!

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7
Q

patient has Anti-HAV IgM in serology. meaning?

A

acute infection

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8
Q

patient has Anti-HAV IgG in serology. meaning?

A

past infection OR vaccination

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9
Q

what advice would you give to hep A patient regards to work?

A

Advice for patient: stay off work for 7 days from onset symptoms

BECAUSE are infectious 2 wks before symptoms start

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10
Q

when are people given a hep A vaccine?:

A

for pre-exposure prophylaxis or recent exposure:

Travel to high risk country
Chronic liver disease
Haemophilia
People who inject drugs ‘PWID’
MSM - men who have sex with men
Occupational risk: lab, residential facilities, sewage work
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11
Q

treatment for some1 with confirmed hep A?

A

no cure

supportive care

liver transplant if deteriorate

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12
Q

in those with hep a, which group are most likely to present with jaundice

A

adults / over 14s

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13
Q

which virus is of the hepadnavirus family?

A

Hep B

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14
Q

which hep viruses are transmitted via:

sexual, parenteral, vertical

A

Hep B

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15
Q

characterise chronic infection in

  1. Hep B
  2. Hep E
A

B: HBsAg positive > 6 months

E: HEV RNA positive > 3 months

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16
Q

which hep virus has the longest incubation period?

A

Hep B - 2-6 months

hep c can also be 6 months but can start in weeks too

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17
Q

how many under 5s develop hep B?

A

90%

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18
Q

how many adults develop hep b?

A

10%

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19
Q

kids with acute hepatitis infection present how?

A

no symptoms

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20
Q

what part of the hep b drug structure is a target?

A

dna polymerase

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21
Q

what is the order of hep b structural components from outside to in?

A

surface antigen
e antigen
core antigen
ds DNA and dna polymerase

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22
Q

HBsAb: marker of _____ ?

A

IMMUNITY

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23
Q

core+envelope Ab positive denotes?

A

past infection

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24
Q

core+envelope Ab negative, SAb + denotes?

A

vaccination

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25
Q

SAg-
EAg -
Core Ab-
Sab +

denotes?

A

vaccination

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26
Q

mnemonic of decreasing order of abundance igs?

A

GAMED

g most abundant because for long term immunity

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27
Q

Anti-HBc IgM (core IgM) means?

A

acute infection

28
Q

what components of the hep b can’t you have in vaccine?

A

e and core antigen

29
Q

which is the marker of active replication i.e. infectiousness

A

e antigen

HBeAg

30
Q

Anti-HBe means?

A

past/chronic

31
Q

HBV DNA means?

A

active replication

32
Q

SAg+ EAg+ Core Ab +

denotes?

A

Acute infection - if IgM

Chronic infection - if IgG. high risk

33
Q

SAg+ EAg- Core Ab +

A

Resolving acute

chronic low risk

34
Q

SAg- EAg-

Core Ab +

A

resolved infection

reactivation risk - latency

NOT a vaccine because its CORE antibody not surface

35
Q

SAg- EAg-
Core Ab -
SAb -

A

no exposure - not immune

vaccinate risk groups

36
Q

how long after infection are Anti-HBs (HBsAb positive)

made? in acute infection

A

8 months / 32 weeks

37
Q

what does serology look like in acute hep b with recovery?

A

RECOVERY:
HBsAg loss
Anti-HBs (HBsAb positive)

38
Q

what does serology look ini in chronic hep b?

A

NO surface antibody

BUT you get core antibody: Igm + igg

LOTS of HBsAg

39
Q

what’s the gold standard card in cirrhosis diagnostics?

A

histopath

40
Q

ivx for hcc : hepatocellular carcinoma?

A

AFP - also high in pregnancy

imaging : ULTRASOUND

41
Q

patient with test signs:

Radiology:
coarse echotexture, nodularity,

portal HTN – splenomegaly

which condition?

A

cirrhosis

42
Q

who with Hep B should be treated?

A

HBeAg +

HBV DNA > 20k & ALT x2

Cirrhosis + HBV DNA detectable

  • the greater the load of hbv dna, the gr8er risk of cirrhosis and HCC
43
Q

what do you want from hbv treatment?

A

REDUCE HBV DNA load!!

also SAg , eAg too.

ALT normalization

44
Q

mmemonic for HEP B treatment?

A

TILE

T- Tenofovir*

I - pegylated interferon alpha

L- lamivudine

E- Entacavir*

*NRTI

45
Q

what is the MOA of NRTIs?

A

inhibit DNA polymerase

high genetic barrier to resistance - tenfovir and entecavir

46
Q

which hep b drugs indue eAg, sAg loss

A

pegylated interferon alpha

sc injections

bad side effects

47
Q

how long to take tenfovir and entecavir for?

A

until HBsAg loss

48
Q

how is hep b prevented in UK?

A

Routine Vaccination:

2 months, 3 months, 4 months

49
Q

is baby is HBsAg positive, eAg negative how to treat?

A

vaccine at birth + routine schedule

50
Q

HBsAg positive, eAg positive how to treat?

A

vaccine at birth PLUS HBIG within 48 hours

51
Q

what does the hep b vaccine consist of?

A

Recombinant vaccine (HBsAg)

52
Q

can you get hep c from sex?

A

NO

53
Q

when can one get hep e?

A

range but

chronic infection - post transplant and immunosuppresed

54
Q

which is the only non-vaccine preventable hep virus?

A

hep c

55
Q

hep c is acquired from?

A

blood products

56
Q

what marker is used to diagnose hep c?

problems?
what to measure instead ?

A

Anti-HCV antibody

rises after 4 weeks. -ALT rises first!

measure - HCV RNA

57
Q

treatment for hep c?

A

everyone who has it gets treatment with:

Direct acting antivirals - NS3,4,5 inhibitors

(serine) Protease inhibitors

58
Q

which hep virus can you get only if you have hep b?

A

hep d

59
Q

if one has hep b and d co-infection, can this become chronic?

A

no

60
Q

if one has hep b and d SUPER infection, can this become chronic?

A

yes

happens in people who already have hep b

61
Q

how to prevent hep d?

A

hep b vaccine + post exposure prophylaxis

62
Q

which hep b genotypes affect humans?

A

GT 1 and 2 directly

3 and 4 only IF humans eat undercooked meat

63
Q

which hep virus are pregnanct women at risk of death from?

A

hep e

64
Q

how to diagnose hep e in

  1. immunocompetent
  2. immunocompromised
    ?
A
  1. immunocompetent : anti-hep e antibodies

2. immunocompromised: hep e RNA

65
Q

which hep virus is associated with extra hepatic manifestation of which neurological signs most important?

A

hep e

66
Q

treatment/prevention for hep e?

A

supportive

RIBAVIRIN

67
Q

RARE COMPLICATIONS:
CNS disease – Bell’s palsy, Guillain Barre, other neuropathy

are found in?

A

hep e

Path - Microbiology (27 decks)

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