Viral hepatitis: A & E Flashcards
Define viral hepatitis A & E
Hepatitis caused by infection w/ the RNA viruses, hep A or E, that follow an acute course without progression to chronic carriage
Aetiology of viral hepatitis A & E
transmission, types, 3
Transmission by faecal-oral route
HAV = picornvirus HEV = calcivirus
Both viruses replicate within hepatocytes & are secreted into bile
Liver inflammation & hepatocyte necrosis is caused by the immune response
Infected cells targeted by CD8+ T cells & NK cells
Histological features of viral hepatitis A & E
3
inflammatory cell infiltration of portal tracts
zone 3 necrosis
bile duct proliferation
Epidemiology of viral hepatitis A & E
location x3, infection
HAV endemic in developing world
Infection often occurs sub clinically
Less common in developed world (sanitation), age of exposure higher & patients more likely to be symptomatic
HEV endemic in Asia, Africa & central America
Presenting symptoms of viral hepatitis A & E
general, 2
Incubation period 3-6 weeks
Prodromal period symptoms
Hepatitis symptoms
Presenting symptoms of viral hepatitis A & E - prodromal period
(4)
Malaise
Anorexia
Fever
N&V
Presenting symptoms of viral hepatitis A & E - hepatitis
4
Dark urine
Pale stools
Jaundice lasting around 3 weeks
Occasionally itching & jaundice lasts several weeks into HAV infection
Signs of viral hepatitis A & E on physical examination
5
Pyrexia Jaundice Tender hepatomegaly Spleen may be palpable ABSENCE of stigmata of chronic liver disease (maybe some spider naevi transiently)
Investigations for viral hepatitis A & E
3
Bloods
Viral serology
Urinalysis
Investigations for viral hepatitis A & E - bloods
3
LFTs - high AST, ALT, ALP & bilirubin
High ESR
Low albumin & high platelets
Investigations for viral hepatitis A & E - viral serology
2
Hep A - anti HAV IgM & IgG
Hep E - anti HEV IgM & IgG
Investigations for viral hepatitis A & E - urinalysis
2
Postive for bilirubin
Raised urobilinogen
Management of viral hepatitis A & E
2 + 3 prevention
No specific management
Bed rest & symptomatic treatments (e.g. antipyretics, antiemetics or cholestryramine for severe pruritus)
Prevention & control
Public health - safe water, sanitation & food hygiene
Notifiable disease
Immunisation available for HAV
Complications of viral hepatitis A & E
3
Fulminant hepatic failure
Cholestatic hepatitis w/ prolonged jaundice & pruritus can develop after HAV infection
Post hepatitis syndrome - continued mails for weeks/months
Prognosis of viral hepatitis A & E
time + 3
Recovery usually 3-6 weeks
Occasionally patients may relapse during recovery
No chronic sequelae
Fulminant hepatic failure has 80% mortality
