Viral Hepatitis

Question 1

What is hepatitis and what are some of its causes?

Answer 1

Liver inflammation and it can be caused by; Infections such as Hepatitis A-E, cytomegalovirus and epstein barr virus. Drugs, 1 autoimmune and ischaemia

Question 2

What are the main symptoms of hepatitis?

Answer 2

• Asymptomatic,
• Fever,
• Jaundice,
• Malaise,
• Diarrhoea/vomiting,
• Acute liver failure

Question 3

What is the most common cause of hepatocellular carcinoma?

Answer 3

Worldwide - Hepatitis B,

Europe - Hepatitis C

Question 4

Describe the epidemiology of hepatitis A?

Answer 4

Spread via faecal-oral route. Has an incubation period of 2-6weeks. Water borne epidemics with sporadic infections from shellfish.

Question 5

Describe how hepatitis A presents?

Answer 5

• Hepatomegally,
• Jaundice,
• Fatigue,
• Arthralgia,
• Poor appetite
  PJHAF

Question 6

Describe the serology/investigations for hepatitis A?

Answer 6

• Hep A IgM - positive in acute infection.

- Hep A IgG - indicates immunity

Question 7

Vaccinations for what types of hepatitis virus exist?

Answer 7

A and B worldwide and E in china

Question 8

What is the management of hepatitis A?

Answer 8

Self-resolving infection so just supportive treatment. No cases of chronic hep A, lifelong immunity and less than 0.5% will develop acute liver failure

Question 9

Describe the transmission of Hepatitis B

Answer 9

Horizontal - Unprotected sex, contaminated needles, breaks in mucous membranes, blood transfusion.
Vertical - From mother to baby in child birth

Question 10

Describe the presentation of Hepatitis B

Answer 10

Jaundice,
Poor appetite,
Myalgia,
Fever,
Tender hepatomegaly
JPMFT

Question 11

What markers are present when vaccinated against Hepatitis B

Answer 11

Anti-HBs

Question 12

What markers are present in an acute hepatitis B infection

Answer 12

HBsAg, HBeAg, anti-HBc IgM

Question 13

What markers are present in a chronic hepatitis B infection

Answer 13

HBsAg, Anti-HBc IgG

Question 14

What markers are present when recovering from a hepatitis B infection?

Answer 14

Anti-HBs, Anti-HBc IgG

Question 15

What are some treatment options for hepatitis B?

Answer 15

Nucleotide analogues,eg, tenofovir which are lifelong treaments.
Pegylated alpha interferon - 48 weeks long

Question 16

Describe the presentation of Hepatitis C

Answer 16

• Asyptomatic,
• Poor appetite,
• Myalgia,
• Fever,
• Jaundice,
• Tender hepatomegaly

Question 17

What are the investigations for Hep C?

Answer 17

Blood tests;
If hepatitis C RNA is present then there is an active infection.
If Anti-Hepatitis C antibody present then recovery or chronic infection

Question 18

What are the modes of transmission for hepatitis C?

Answer 18

Horizontal - Contaminated needles, blood transfusion, breaks in mucous membranes, unprotected sex.
Vertical - Mum to baby in childbirth

Question 19

What are some extrahepatic manifestations of chronic hepatitis C?

Answer 19

Autoimmune - Thyroid disease,
Haematological - Lymphoma,
Pulmonary - Fibrosis,
Renal - Membraneoproliferative glomerulonephritis,
Skin - Lichen planus and porphyria cunea tardia

Question 20

What is the treatment for hepatitis C?

Answer 20

Direct acting antivirals which take 12-24 weeks and cure is achieved in 95% cases;
Protease inhibitors - Paritaprevir,
NS5A inhibitors - Ledipasvir,
RNA polymerase inhibitors - Sofosbuvir

Question 21

What is specific about the epidemiology of hepatitis D?

Answer 21

Only possible to be infected if you already have hepatitis B

Question 22

Describe the clinical presentation of hepatitis D

Answer 22

It cannot be distinguished from hepatitis B

Question 23

Describe the hepatitis D serology

Answer 23

Hepatitis D IgM - acute infection,

Hepatitis D IgG - indicates immunity

Question 24

What are some of the complications of hepatitis D

Answer 24

The co-infection of hepatitis B and D represents the most severe form of hepatitis due to rapid progression and development of hepatocellular carcinoma

Question 25

Describe the treatment for hepatitis D

Answer 25

The antivirals for hep B don’t work for hep D so pegylated interferons are the only treatment option

Question 26

Describe the presentation of Hepatitis E?

Answer 26

95% are asymptomatic but those who do have symptoms have;

• Diarrhoea,
• Vomiting,
• Fevers,
• Neurological symptoms

Question 27

What are the treatments and complications for hepatitis E?

Answer 27

It is a self limiting disease so only supportive care. However it is the most common cause of acute hepatitis in the uk and 25% of pregnant women die