Viral hepatitis

Question 1

Define Viral Hepatitis

Answer 1

viral infection of the liver by Hepatitis A-E, which, depending on organism, can cause either an acute or chronic inflamation of the liver

Hep A-RNA viral, faecal oral transmission
hep B-DNA virus, blood and sexually transmitted
Hep C-RNA vaccine, Blood exposure-

Question 2

Aetiology and risk factors of Viral hepatitis

Answer 2

All related to the viral infection
hep A-faecal oral transmission-Improper hygiene
hep B-DNA virus, blood and sexually transmitted-risk in healthcare and drug usage
Hep C-RNA vaccine, Blood exposure-risk in healthcare and drug usage

Risk factors
being/visiting endemic areas
bad hygene
Gay

IV drugs, healthcare worker, tattoos

Question 3

Epidiemology of viral hepatitis

Answer 3

HepA-depends on areas-
some are very endemic-africa, South Asia, and some less-europe/US

hepB-most common cause of liver disease in world-257million rn
Endemic in south east Asia, china, Africa

hep C-very common (71 mil rn)
Endemic to Europe and eastern meditaranean

Question 4

Signs and Sx of Viral Hepatitis

Answer 4

Hep B and C-often asymptomatic (70%-until cirrhosis)

Hep A-few weeks of infection
Fever, malaise, diarrhoea, nausea (before Jaundice)
Jaundice about 2 weeks after infection
Hepatomegaly + RUQ pain
Clay coloured stools

Hep B-
Chronic-asymtpo until liver cirrhosis (portal HTN, ascites, caput medusae, spider naevi, encelopathy, variceal bleeds, etc)

Acute-Urticarial rash
Fever/chills, malaise, nausea, arthritis

Hep C-asymptomatic, until liver problems (cirrhosis)

Question 5

Management of Viral Hepatitis

Answer 5

Hep A-if early in infection (<2w)-vaccine
also give immunoglobulin for immunocompromised patients, chronic liver disease pt, younger kids
and mainly supportive-(avoiding liver toxic substances)

Hep C-chronic and acute-same
Direct acting antiviral cocktails, e.g. Elbasvir/grazoprevir

Hep B-acute-will self terminate so supportive
Chronic-interferon B therapy, antivirals (nucleoside and nucleotide analogue),such as Entecavir, tenofovir disoproxil (1stline when no cirrhosis) for nearly 1 year -monitor rebound

Question 6

Complications of viral hepatitis

Answer 6

Hep A- rare:
acalculous cholecystitis, pancreatitis, aplastic crisis
Renal failure

Hep B-fulminant liver failure (1% of cases),
cirrhosis-common long term
Hepatocellular carcinoma
Reactivation

hep C-Hep B reactivation
Cirrhosis-common
Hepatocellular carcinoma
Rheum issues (like sjorgens)-common

Question 7

Investigations of Viral Hepatitis

Answer 7

LFT’s
in viral, AST/ALT ratio <1, but both raised (ast>alt)
Bilirubin raised

Hep A-urea can be very high in fulminant hep

IgM anti Hep A AB-positive

Hep B-
Surface hep B AB and antigen-active infection

Core Hep B-IgM (few weeks since infect) and igG (older infection/has had it)

Hep C-Hep C Antibody test ELISA-positive-indicates current infection
Hep C PCR test (can be neg if AB still positive-AB only says if has had it)

Question 8

Prognosis of viral hepatitis

Answer 8

HepA- 85% clear it within 3 months, and nearly 100% in 6
Some get symptoms continue for a few months
Fulminant-1%

hep B-lots of death per year
95% of immunocompetent people will neutralise it (not eliminate)
Drug good to induce relapse

Hep C-10 year survival of 79% when cirrhosis present
Mortality increasing