Viral Hepatitis A + E

Question 1

What is viral hepatitis?

Answer 1

Infection with RNA viruses hepatitis A or E, that follow an acute course without progression to chronic carriage
Go to A+E with Hep A + E

Question 2

Describe the aetiology of hepatitis A and E

Answer 2

Both small non-enveloped ss-linear RNA viruses with transmission via faeco-oral route.
Both 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

Question 3

How do hepatitis A and E differ in type?

Answer 3

HAV = picornavirus 
HEV = calicivirus

Question 4

Describe the epidemiology of hepatitis A

Answer 4

Hep A is more common than Hep E  
HAV: endemic in developing world 
Infection often occurs sub-clinically  
Better sanitation in developed world means it's less common, age of exposure is higher + hence pts are more likely to be symptomatic  
Annual UK incidence: 5000

Question 5

Describe the epidemiology of hepatitis E

Answer 5

HEV is endemic in Asia, Africa + Central America

Question 6

List 3 risk factors for hepatitis A and E

Answer 6

Endemic region with poor sanitation
Homo men sex
Close contact with infected person

Question 7

What is the incubation period for hepatitis A and E?

Answer 7

3-6 weeks

Question 8

List 5 prodromal symptoms of hepatitis A and E

Answer 8

Malaise  
Anorexia + distaste for cigarettes in smokers 
Fever  
N+V  
RUQ pain

Question 9

List 4 symptoms of hepatitis A and E

Answer 9

Dark urine
Pale stools
Jaundice lasting ~ 3 weeks
Itching + jaundice may last several weeks in HAV infection

Question 10

List 5 signs of hepatitis A and E

Answer 10

Pyrexia  
Jaundice  
Tender hepatomegaly  
Spleen may be palpable  
ABSENCE of stigmata of chronic liver disease (some spider naevi may appear transiently)

Question 11

Which bloods are taken in both hepatitis A and E?

Answer 11

LFTs: high AST, ALT, ALP + BR
High ESR
Low albumin + high platelets (if severe)
Viral Serology
Hep B + C serology must be done to rule them out

Question 12

Which antibodies are present in hepatitis A?

Answer 12

Anti-HAV IgM (during acute illness, disappears after 3-5 months)
Anti- HAV IgG (recovery phase + lifelong persistence)

Question 13

Which antibodies are present in hepatitis E?

Answer 13

Anti-HEV IgM (raised 1-4 weeks after onset)

Anti-HEV IgG

Question 14

Describe the management of viral hepatitis

Answer 14

Bed rest + symptomatic tx (e.g. antipyretics, antiemetics or cholestyramine (for severe pruritus))

Question 15

What measures are used for prevention and control of hepatitis?

Answer 15

Public Health: safe water, sanitation + food hygiene
These are notifiable diseases
When travelling, personal hygiene + dietary precautions

Question 16

What is the prognosis in viral hepatitis?

Answer 16

Recovery is usually within 3-6 weeks
Occasionally patients may relapse during recovery
There are no chronic sequelae
Fulminant hepatic failure has a mortality of 80%

Question 17

Describe urinalysis in viral hepatitis

Answer 17

Positive for BR

Raised urobilinogen

Question 18

What immunisation is available for viral hepatitis?

Answer 18

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