Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

GI > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

Define hepatitis?

A

6 viruses known to infect humans- A, ,C,D,E nd G other viruses that inect liver= CMV, EBV, yellow fever, herpes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the six different viruses known to infect

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the typical presentation for hepatitis?

A

fever, jaundice, raised ALT, AST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the typical presentation for hep A?

A

Travel, faecal-oral (contaminated water is a major source/ poor hygiene), acute, usually asymptomatic, supportive management , 2 weeks incubation - Asia and Africa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the typical presentation for hep B?

A

acute, MSM, unprotected sex, blood transfusion/ IVDU, causes high ALP as well, most clear the infection, 4-12wks, health care workers, likely in children, Africa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the typical presentation for Hep C?

A

chronic, rf for hepatocellular carcinoma, TRANSFUSIONS, blood to blood transmission/IVDU, 2wks-6mnths, Eastern Mediterranean

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the typical presentation for Hep D?

A

only with Hep B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the typical presentation for Hep E?

A

Enteric, faecal oral (water), Pregnancy, immunocompromised, supportive management, acute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Define hepatitis A and E?

A

hepatitis caused by infection with RNA viruses, hepatitis A or hepatitis E that follow an acute course with progression to chronic carriage

go to A and E with Hep A and E

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what type of viruses are Hep A and E?

A

small non-enveloped single stranded linear RNA viruses of roughly 7500 nucleotides-> with transmission via faeco-oral route

HAV- picornavirus

HEV - calcivirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

describe the aetiology of hepatitis A and E?

A 
HAV = picornavirus
HEV = calicivirus

Transmission = faecal-oral route

Both viruses replicate within hepatocytes and are secreted into bile

Liver inflammation and hepatocyte necrosis is caused by the immune response

Infected cells are targeted by CD8+ T cells and NK cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the transmission of hepatitis A and E?

A

faecal -oral route

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

describe the histological features of hepatitis A and E

A

Inflammatory cell infiltration of portal tracts (neutrophils, macrophages, eosinophils, lymphocytes)

Zone 3 necrosis

Bile duct proliferation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the risk factors for hepatits A and E?

A

endemic region with poor sanitation

homosexual men

close contact with infected person

think went on hols and had some shellfish

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

summarise the epidemiology of viral hepatitis?

A

Hep A – more common than Hep E

HAV is endemic in the developing world

Infection often occurs sub-clinically (no clinical findings)

Better sanitation in the developed world means that it is less common, age of exposure is higher and, hence, patients are more likely to be symptomatic

Annual UK incidence: 5000

HEV is endemic in Asia, Africa and Central America

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is the incubation period of HAV and HEV?

A

3-6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are the prodromal period symptoms ( early symptoms) of Hepatitis A and Hep E?

A

malaise

anorexia- distaste in cigarettes in smokers

fever

nausea and vomiting

RUQ pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are the symptoms of hepatitis?

A

dark urine

pale stools

jaundice lasting around 3 weeks

ocassionally, itching and jaundice may last several weeks in HAV infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are the signs of hep A and Hep E?

A

pyrexia

jaundice

tender hepatomegaly

spleen may be palpable

ABSENCE of stigmata of chronic liver disease (although some spider naevi may appear transiently)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are the appropriate investigations for Hep A and Hep E and interpret the results?

A

Bloods

- LFTs - high AST, ALT, ALP and bilirubin

  • High ESR
  • Low albumin + high platelets (if severe)

Vital Serology

  • Hep B and C serology must be done to rule them out
  • Hepatitis A:
  • Anti-HAV IgM (during acute illness, disappears after 3-5 months)
  • Anti- HAV IgG (recovery phase and lifelong persistence)
  • Hepatitis E:
  • Anti-HEV IgM (raised 1-4 weeks after onset)
  • Anti-HEV IgG

Urinalysis

  • Positive for bilirubin
  • Raised urobilinogen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

outline the management plan for viral hepatitis?

A

There is no specific management other than bed rest and symptomatic treatment (e.g. antipyretics, antiemetics or cholestyramine (for severe pruritus))

Prevention and Control

  • Public Health - safe water, sanitation and food hygiene
  • These are notifiable diseases
  • When travelling, personal hygiene and dietary precautions
  • Immunisation is available for HAV only

Passive immunisation with IM human immunoglobulin (effective for a short time)

Active immunisation with attenuated HAV vaccine offers safe and effective immunity for those travelling to endemic areas and high-risk individuals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are the possible complications of Hep A and Hep E?

A

Fulminant hepatic failure (in a very small proportion of patients but is more common in pregnant women)

Cholestatic hepatitis with prolonged jaundice and pruritus can develop after HAV infection

Post-hepatitis syndrome: continued malaise for weeks to months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

summarise the prognosis of viral hepatitis?

A

Recovery is usually within 3-6 weeks

Occasionally patients may relapse during recovery

There are no chronic sequelae

Fulminant hepatic failure has a mortality of 80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Define Hep B?

A

Hepatitis caused by infection with hepatitis B virus (HBV), which may follow an acute or chronic course

Chronic is defined as viraemia and hepatic inflammation continuing for > 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what
26
Define Hep D?
a defective virus, that may only co-infect with HBV or superinfect people who are already carriers of HBV – D is Dependent
27
describe the transmission of hep B and hep D?
sexual contact, blood and vertical transmission (from mother to baby)
28
what are the risk factors for Hep B and Hep D?:
IV drug use Unscreened blood and blood products inc haemodialysis Infants of HBeAg/HBsAg-positive mothers Sexual contact with HBV carriers Younger individuals (particularly babies) are more likely to become chronic carriers Genetic factors are associated with varying rates of viral clearance
29
what type of virus is HBV?
enveloped, partially double stranded DNA virus
30
What type of virus if HDV
HDV is a single-stranded RNA virus coated with HBsAg
31
What are the various viral proteins produced by Hep B?
Core antigen (HBcAg) Surface antigen (HBsAg) e antigen (HBeAg)
32
describe the histology of Hep B?
mild to severe inflammation and changes to cirrhosis
33
outline the aetiology of Hep B and Hep D?
HBV is an enveloped, partially double-stranded DNA virus Transmission: sexual contact, blood and vertical transmission (from mother to baby) Various viral proteins are produced such as: Core antigen (HBcAg) Surface antigen (HBsAg) e antigen (HBeAg) This is a marker of high infectivity HDV is a single-stranded RNA virus coated with HBsAg Antibody and cell-mediated immune response to viral replication leads to liver inflammation and hepatocyte necrosis
34
what are the risk factors for Hep B and Hep D?
**IV drug use** Unscreened blood and blood products inc haemodialysis Infants of HBeAg/HBsAg-**positive mothers** **Sexual contact** with HBV carriers Younger individuals (particularly babies) are more likely to become chronic carriers Genetic factors are associated with varying rates of viral clearance
35
summarise the epidemiology of viral hepatitis?
Common 1-2 million deaths annually Common in Southeast Asia, Africa and Mediterranean countries HDV is also found worldwide
36
what is the incubation period of viral hepatitis?
3-6 months 6 months in chronic carriers
37
what are the presenting symptoms of Hep B and Hep D?
Most children have an asymptomatic acute infection and 50% of adults have an asymptomatic acute infection (esp if they have HIV) 1-2 week prodrome consisting of: * Malaise * Headache * Anorexia * Nausea and vomiting * Diarrhoea * RUQ pain * Serum-sickness type illness may develop (e.g. fever, arthralgia, polyarthritis, urticaria, maculopapular rash) Jaundice then develops with dark urine and pale stools Recovery usually within 4-8 weeks 1% develop fulminant liver failure Chronic carriage may be diagnosed after routine LFT testing or if cirrhosis or decompensation develops
38
what are the signs of chronic Hep B infection?
Jaundice Pyrexia Tender hepatomegaly Splenomegaly Cervical lymphadneopathy (in 10-20% of patients) Occasionally: urticaria and maculopapular rash
39
what are the signs of chronic Hep B?
May be no findings May have signs of chronic liver disease or decompensation
40
describe the viral serology?
41
describe the viral serology of acute HBV?
HBsAg positive IgM anti-HBcAg +/- HbEAg - if this is negative it reduces the likelyhood of transmission from mum to baby
42
what is the viral serology for chronic Hep B?
HBsAg positive IgG anti-HBcAg +/- HBeAg (correlates with severity)
43
describe serology for HBV cleared?
Anti-HBsAg antibody positive IgG anti-HBcAg
44
describe the serology of HBV that has been vaccinated against?
Anti-HBsAg antibody positive
45
Describe the serology of HDV infection?
Detected by IgM or IgG against HDV PCR is used for detection of HDV
46
summarise serology for Hep B infection?
47
what are the appropriate investigations for Hep B and what are the results?
viral serology **LFTs** * High: AST, ALT, ALP, bilirubin * Also do a coag screen with baseline liver USS **FBC** * Microcytic anaemia (indicative of portal HT) * Thrombocytopenia (indicative of portal HT) **Clotting** * High PT (in severe disease) TO CONSIDER: Liver Biopsy – percutaneous or transjugular if clotting is deranged or ascites peresent
48
describe the prevention of Hep B?
blood screening, safe sex, instrument sterilisation
49
what are the possible complications of Hep B?
1% get fulminant hepatic failure Chronic HBV infection (10% of adults, much higher in neonates) Cirrhosis HCC **Extrahepatic immune complex disorders (e.g. glomerulonephritis, polyarteritis nodosa)** Superinfection with HDV may lead to acute liver failure or more rapidly progressive disease
50
summarise the prognosis of Hep B?
51
describe the management of acute hep B?
Symptomatic treatment (antipyretics, antiemetics and cholestyramine) and bed rest Nucleoside/nucleotide analogues (entecavir OR tenofovir) Notifiable disease - trace sexual and needle sharing contacts and offer a vaccination against HBV
52
outline the management of chronic Hep B?
1st Line: Nucleoside/nucleotide analogues (entecavir OR tenofovir) 2nd Line OR + if coninfected by HepD: Interferon alpha (standard or pegylated – pegylated has inc half life) * Cytokine which augments natural antiviral mechanisms * Side-effects: flu-like symptoms such as fever, chills, myalgia, headaches, bone marrow suppression and depression – 5-10% discontinue * Signs of good response to interferon: high serum transminases, low HBV DNA, active histological changes, absence of complicating disease * Usually on these for life
53
describe the passive immunisation of Hep B?
Hepatitis B immunoglobulin following acute exposure and to neonates born to HBeAg-positive mothers (in addition to active immunisation)
54
Describe the active immunisation of Hep B?
Recombinant HBsAg vaccine for individuals at risk and neonates born to HBV +ve mothers Immunisation against HBV protects against HDV
55
define Hep C?
Hepatitis caused by infection with hepatitis C virus (HCV), often following a chronic course (in 80% of cases)
56
describe the transmission of HCV?
**PARENTERAL** Sexual transmission Vertical transmission
57
What type of virus of Hep C?
HCV is a small, enveloped, single-stranded RNA virus ## Footnote **RNA viruses have poor fidelity of replication and mutation rates are high - so, there are lots of HCV genotypes**
58
what are the risk factors for Hep C?
Recipients of blood and blood products IV drug users Non-sterile acupuncture Tattooing Haemodialysis Health care workers
59
describe the pathogenesis of Hep C?
The virus is not thought to be directly hepatotoxic It is the humoral and cell-mediated responses to the viral infection that leads to hepatic inflammation and necrosis
60
describe liver biospy of hep C?
Chronic hepatitis Lymphoid follicles in portal tracts Fatty change Cirrhosis may be present
61
Summarise the epidemiology of Hep C?
COMMON Different genotypes of HCV have different geographical prevalence
62
what are the presenting symptoms of Hep C?
90% of acute infections are ASYMPTOMATIC 10% become jaundiced with mild flu-like illness May be diagnosed after incidental abnormal LFT or in older patients with complications of cirrhosis
63
what are the signs of Hep C on physical examination?
May be NO SIGNS There may be signs of chronic liver disease (if long-standing HCV infection) e.g. jaundice, ascites May be signs of hepatic encephalopathy if advanced CLD Extra-hepatic manifestations (rare) include: * Skin rash * Renal dysfunction (due to glomerulonephritis)
64
what are the appropriate investigations for Hep C and describe the results?
HCV Serology * **Anti-HCV antibodies - IgM (acute) or IgG (past exposure or chronic)** Reverse-transcriptase PCR * Allows detection and genotyping of HCV * Used to confirm antibody testing or if suspected in pt but serology negative LFT * Acute infection: High ALT, AST and bilirubin * Chronic infection: 2-8 x elevation of AST + ALT (often fluctuates over time)
65
what investigations would you consider for Hep C?
**Liver Biopsy** * Assess the degree of inflammation and liver damage (NOT for diagnosis) * NOTE: transaminase (AST and ALT) levels bear little correlation to histological changes * Useful for diagnosing cirrhosis – as these pts require monitoring for HCC
66
describe the prevention management for Hep C?
Screen blood, blood products and organ donors Needle exchange schemes for IV drug users Instrument sterilisation NO VACCINE AVAILABLE
67
describe the medical management for Hep C?
**Acute - mainly supportive (antipyretics, antiemetics, cholestyramine)** **Chronic** * Antivirals are now curative: NS5A inhibitors * Pegylated interferon-a * AND * Ribavarin Monitor HCV viral load after 12 weeks to determine treatment efficacy HCV RNA level measured by polymerase chain reaction on EDTA blood sample is used to monitor response to treatment. Undetectable HCV RNA at 48 weeks after completion of treatment defines cure (known as ‘sustained virological response’ or SVR) **Regular US of the liver may be needed if the patient has cirrhosis** There is no post exposure prophylaxis available for hepatitis C, unlike HIV.
68
what are the possible complications of Hep C?
Fulminant hepatic failure Chronic carriage of HCV **Hepatocellular carcinoma** Less common: porphyria cutanea tarda, cryoglobulinaemia, glomerulonephritis
69
summarise the prognosis of Hep C?
80% of exposed will progress to chronic carriage Of these, 20-30% will develop cirrhosis over 10-20 years

GI (51 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions