Viral hepatitis

Question 1

On a scan of the liver, what is usually big?

Answer 1

Right lobe is always bigger

Question 2

Describe the flow of blood in the liver vs bile secretion

Answer 2

Central vein

Portal vein travel into central vein, whereas bile secretions go in the opposite direction to the bile ducts

Question 3

Hypoxic injury is more likely to be in which zone?

Answer 3

Near central vein

Zone 1 - oxygenated well
Zone 3 - high in glucose

Question 4

What is Hep A&E

Answer 4

Hepatitis caused by RNA virus that follows an acute course without progression to chronic carriage

Question 5

Which virus causes Hep A

Answer 5

Picornavirus

Question 6

Transmission is via

Answer 6

Faecal oral route

Question 7

Pathophysiology

Answer 7

Replicate inside hepatocytes and are secreted into bile

Question 8

Prodromal phase

Answer 8

viral infection in blood, like flu - malaise, anrexia, fever, nause and vomiting, RUQ pain

Question 9

Hepatitis phase

Answer 9

Hepatic inflammation causes

Unconjugated bilirubin increases

Therefore:
dark urine

Damage to bile duct, therefore:
pale stool

Question 10

What signs are not present?

Answer 10

No signs of chronic liver disease e.g. asterixis or leuconychia

Question 11

Recovery

Answer 11

1-2 months

Question 12

What is the recovery like in children?

Answer 12

Less severe in children

Question 13

Investigations

Answer 13

LFTS -high AST< ALP, ALT, Bilirubin
High ESR 
Low albumin and high platelets 
Serology 
Urine - Increased urobilinogen and dark urine

Question 14

Serology

Answer 14

HAV / H

IgM (acute)
IgG (over 6 months ago)

Question 15

Management

Answer 15

Bed rest
Symptomatic 
Antipyretic 
antiemetic
Cholestyramine (for pruritis)

Question 16

Prevention and control

Answer 16

Notifiable disease
Safe water, sanitation, food hygiene
for HAV - passive or active vaccines

Question 17

Prognosis

Answer 17

Recovery after 1-2 months

If fulminant - hepatic failure, 80%

Question 18

Another name for acute hepatic failure and who is more likely to get this during HAV or HEV

Answer 18

Fulminant - more likely if patient is pregnant

Question 19

Complications

Answer 19

Fulminant hepatic failure 
Cholestatic hepatitis (inflammation of bile ducts, jaundice and pruritis)

Post hepatic syndrome (malaise)

Question 20

Transmission of Hep A/E

Answer 20

Faecal-oral route

Question 21

Hep E most common way of transmission

Answer 21

Undercooked pork

Question 22

Hep A most common way of transmission

Answer 22

Travel

Question 23

Symptoms of hepatitis

Answer 23

Dark urine (icteric phase - 3-10 days after the jaundice)
Pale clay coloured stools
Pruritis
Jaundice