Viral hepatitis

Question 1

What is unique about Hepatitis D?

Answer 1

It requires co-infection with HBV to replicate.

Question 2

Spectrum of clinical presentations

Answer 2

1. Asymptomatic
2. Symptomatic without jaundice (anicteric)
3. Symptomatic with jaundice + mild flu-like symptoms
4. Jaundice with abdominal pain
5. Liver failure

Question 3

What is the 1st line diagnostic test in viral hepatitis?

Answer 3

Serology

Question 4

Route of transmission of HepA

Answer 4

Faeco-oral route

Question 5

Sources of infection of HepA

Answer 5

Contaminated food and water

+ Person-to-person spread

Question 6

When is the most infectious period of HepA?

Answer 6

One week prior to onset of symptoms.

Question 7

Clinical presentation of children <4 yrs

Answer 7

Asymptomatic without jaundice

Question 8

Clinical presentation of children 4-6 yrs

Answer 8

Symptomatic without jaundice

Question 9

Clinical presentation of children >15 yrs and adults

Answer 9

Symptomatic + jaundice

Question 10

HAV: Risk factors for a poor outcome

Answer 10

Age >40

Previous liver disease

Question 11

Immunological response to acute HAV

Answer 11

Immune after first infection i.e. NO CHRONIC INFECTION or risk of liver Ca

Question 12

T/F: HAV is a benign disease

Answer 12

True- it is a mild-moderately severe disease with a low risk of liver failure

Question 13

HAV: Serological findings

Answer 13

Anti-HAV IgM= acute infection

Anti-HAV IgG= immune i.e. previous infection or vaccination

Question 14

HAV: Liver enzymes

Answer 14

AST and ALT are 10-100x the ULN

Question 15

Indications for HAV vaccine

Answer 15

Pre-exposure
HIV 
Chronic liver disease 
Travel to high-risk countries 
High-risk occupational exposure

Question 16

Which viral hepatitis is the leading cause of chronic liver damage worldwide?

Answer 16

Hepatitis B, followed by Hepatitis C

Question 17

HBV: Routes of transmission in developing countries

Answer 17

Perinatal

Child-to-child

Question 18

HBV: Routes of transmission in developed countries

Answer 18

Blood borne

Sexual transmission

Question 19

Spectrum of liver damage in chronic HBV

Answer 19

1. Inflammation
2. Fibrosis
3. Cirrhosis
4. Liver failure
5. HCC

Question 20

Will neonates predominantly be symptomatic or asymptomatic?

Answer 20

Asymptomatic

Question 21

Are children more likely to recover from acute HBV?

Answer 21

No, 70-95% of children develop chronic HBV/ become carriers

Question 22

What does + HBsAg mean?

Answer 22

Current infection (acute or chronic)

Question 23

HBeAg

Answer 23

Active DNA replication (+++ infectious)

Question 24

Anti-HBsAg

Answer 24

Immune due to previous infection/ vaccination

Question 25

Anti-HBcAb

Answer 25

Current infection (acute or chronic) or previous infection

Question 26

Anti-HBcAb IgM

Answer 26

Acute infection or flare

Question 27

Anti-HBeAb

Answer 27

Resolved infection (sAg neg) or less infectious chronic infection (sAg pos)

Question 28

Why should you do a viral load?

Answer 28

To quantify the severity of infection and decide on therapy

Question 29

What are the 3 effects of anti-HBV viral agents?

Answer 29

1. Delay progression of cirrhosis 2. Reduce incidence of HCC 3. Improve long-term survival

Question 30

What nucleotide analogues are used in HBV treatment?

Answer 30

Tenofovir | Entecavir (if tenofovir not tolerated)

Question 31

Which two classes of drugs are used in the treatment of HBV?

Answer 31

Nucleotide analogues | + Interferon

Question 32

What is meant by functional immunological cure?

Answer 32

Sustained DNA viral load suppression + loss of HBsAg

Question 33

Between INF and NA, which one is more likely to cure HBV infection?

Answer 33

INF

Question 34

Indications for HBV vaccination

Answer 34

Newborn babies Children Non-immune adults Babies born from mothers with untreated HBsAg infection

Question 35

What is the definition of fulminant hepatitis?

Answer 35

Fulminant hepatitis, or fulminant hepatic failure, is defined as a clinical syndrome of severe liver function impairment, which causes hepatic coma and the decrease in synthesizing capacity of liver, and develops within eight weeks of the onset of hepatitis.

Question 36

What are the other 3 viral co-infections with HBV?

Answer 36

1. HIV 2. HCV 3. HDV

Question 37

Transmission of HCV

Answer 37

Same as for HBV: Intravenous drug use >>> blood transfusions MSM Body piercings

Question 38

Is there a vaccine for HCV?

Answer 38

No vaccine, but there is a cure (expensive).

Question 39

Who is screened for HCV?

Answer 39

IV drug users MSM Unexplained elevated AST ad ALT

Question 40

What special investigations are used to diagnose HCV?

Answer 40

Serology (IgM) + confirm with PCR

Question 41

How is chronic HCV infection diagnosed with PCR?

Answer 41

If there is persistence of HCV RNA for 6 months after acute infection

Question 42

What is the most common cause of acute hepatitis and jaundice in the world, especially in East-Asia?

Answer 42

Hepatitis E virus

Question 43

What is the incubation period of HEV?

Answer 43

3-8 weeks?

Question 44

Which genotypes are the epidemic type?

Answer 44

Genotype 1+2

Question 45

Which genotypes are the sporadic type?

Answer 45

Genotype 3+4

Question 46

Route of transmission of HEV (genotype 1 and 2)

Answer 46

Faeco-oral contamination

Question 47

Route of transmission of HEV (genotype 3-4)

Answer 47

Exposure to infected animals + consumption of undercooked pork/ game

Question 48

What is acute-on-chronic hepatitis?

Answer 48

When a patient has pre-existing liver disease and now presents with sudden fulminant liver failure

Question 49

Which genotype of HEV is known to precipitate acute-on-chronic hepatitis?

Answer 49

Genotype 3

Question 50

Which genotype of HEV is associated with fulminant hepatitis and high mortality in PREGNANT woman?

Answer 50

Genotype 1

Question 51

T/F: The sporadic type f HEV does not cause severe disease?

Answer 51

True, unless acute-on-chronic phenomenon is seen