Viral Hepatitis A&E

Question 1

def

Answer 1

hepatitis caused by RNA viruses (hepA or hepE)

follow an acute course without progression to chronic carriage

Question 2

aetiology

Answer 2

1 RNA viruses with faecal-oral transmission
2 replicate in hepatocytes and secreted into bile
3 liver inflammation + hepatocyte necrosis caused by immune response
4 CD8+Tcells + NKcells attack infected cells

Question 3

what sort of virus is HAV

Answer 3

picornavirus

SS linear RNA virus

Question 4

what sort of virus is HEV

Answer 4

calcivirus

SS linear RNA virus

Question 5

epi of HAV

Answer 5

common in developing world

Question 6

epi of HEV

Answer 6

common in asia, africa, central america

Question 7

history

Answer 7

incubation period (time between exposure to infection and symptoms) is 3-6wks for HAV + HEV

1 prodromal period
-malaise
-fever
-nausea + vomiting
-distaste for cigarettes in smokers
2 (followed by) hepatitis
-dark urine, pale stools

Question 8

examination

Answer 8

1 pyrexia
2 jaundice
3 tender hepatomegaly

Question 9

what should be absent in examination of HAV or HEV

Answer 9

stigmata of CLD

Question 10

investigations

Answer 10

1 bloods
-LFTs (very high AST+ALT, high bilirubin, high alkphos)
-raised inflammatory markers
2 viral serology
-HAV: anti-HAV Ig
-HEV: anti-HEV Ig

Question 11

what would anti-HAV IgM suggest

Answer 11

current/recent hep A infection

Question 12

what would anti-HAV IgG suggest

Answer 12

past hep A infection

Question 13

what would anti-HEV IgM suggest

Answer 13

current/recent hep E infection

Question 14

what would anti-HEV IgG suggest

Answer 14

past hep E infection

Question 15

management

Answer 15

1 no specific management
-bed rest
-symptomatic treatment
2 prevention + control
-public health (safe, clean water and food) (both are notifiable diseases)
-immunisation (active) (HAV only)

Question 16

complications

Answer 16

1 fulminant hepatic failure
2 cholestatic hepatitis (after HAV infection)
3 post hepatitis syndrome

Question 17

how common is fulminant hepatic failure in HAV and HEV

Answer 17

HAV 0.1%

HEV 1-2% but as high as 20% in pregnant women

Question 18

prognosis

Answer 18

recovery in usually 3-6wks

fulminant hepatic failure has 80% mortality

Question 19

which hep virus is associated with pigs

Answer 19

HEV