Viral Hepatitis A + E Flashcards
4 aetiological facts about viral hepatitis A +E
RNA viruses
Follow an acute course without progression to chronic carriage “Go to A+E with Hep A + E”
Faeco-oral transmission
Notifiable diseases
Describe the pathophysiology of hepatitis A and E
Replicate within hepatocytes + are secreted into bile
Liver inflammation + hepatocyte necrosis is caused by immune response
Infected cells are targeted by CD8+ T cells + NK cells
How do hepatitis A and E differ in type?
HAV = picornavirus HEV = calicivirus
Describe the epidemiology of hepatitis A
A more common than E
HAV: endemic in developing world
Infection often sub-clinical
Better sanitation in developed world means it’s less common, age of exposure is higher + hence pts are more likely to be symptomatic
Describe the epidemiology of hepatitis E
HEV is endemic in Asia, Africa + Central America
List 3 risk factors for hepatitis A and E
Travel to endemic region with poor sanitation
MSM
Close contact
What is the incubation period for hepatitis A and E?
3-6 weeks
5 prodromal Sx of hepatitis A and E
Malaise Anorexia + distaste for cigarettes in smokers Fever N+V RUQ pain
4 Sx of hepatitis A and E
Dark urine
Pale stools
Jaundice lasting ~ 3 weeks
Itching + jaundice may last several weeks in HAV infection
3 signs of hepatitis A and E
Tender hepatomegaly
Spleen may be palpable
ABSENCE of stigmata of chronic liver disease (some spider naevi may appear transiently)
Which bloods are taken in both hepatitis A and E?
LFTs: high AST, ALT + BR
High ESR
Viral Serology
Hep B + C serology for exclusion
Which antibodies are present in hepatitis A?
Anti-HAV IgM (acute illness, disappears after 3-5 months)
Anti- HAV IgG (recovery phase + lifelong persistence)
Which antibodies are present in hepatitis E?
Anti-HEV IgM (raised 1-4 weeks after onset)
Anti-HEV IgG
Describe the management of viral hepatitis
Bed rest + symptomatic tx (e.g. antipyretics, antiemetics or cholestyramine (for severe pruritus))
What measures are used for prevention and control of hepatitis?
Public Health: safe water, sanitation + food hygiene
When travelling, personal hygiene + dietary precautions
What is the prognosis in viral hepatitis?
Recovery is usually within 3-6 weeks
Occasionally pts relapse during recovery
No chronic sequelae
Fulminant hepatic failure has a mortality of 80%
Describe urinalysis in viral hepatitis
Positive for BR
Raised urobilinogen
What immunisation is available for viral hepatitis?
Available for HAV only
Passive immunisation with IM human immunoglobulin (effective for a short time)
Active immunisation with attenuated HAV vaccine offers safe + effective immunity for those travelling to endemic areas + high-risk individuals
Mx for acute exposure <2 weeks Hepatitis A in unvaccinated
Hep A vaccine
Normal human immunoglobulin in >40s
