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YR5 ID + GUM > Viral Hepatitis B + D > Flashcards

Viral Hepatitis B + D Flashcards

1
Q

4 etiological facts about hepatitis B

A

Enveloped, partially ds-DNA virus
Acute or chronic course
Chronic = viraemia + hepatic inflammation for > 6 months
Transmission: SI, blood + vertical (mother to baby)

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2
Q

What antigens may be released by hepatitis B?

A 
Core antigen (HBcAg) 
Surface antigen (HBsAg) 
e antigen (HBeAg): marker of high infectivity
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3
Q

Describe hepatitis D

A

Single-stranded RNA virus coated with HBsAg

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4
Q

What may histology show in hepatitis infection?

A

mild/ severe inflammation + changes

to cirrhosis

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5
Q

List 6 risk factors for hepatitis B

A

IVDU
Unscreened blood + blood products
Antenatal exposure (more likely to become chronic carriers)
SI with HBV carriers
From endemic area (Asia, Africa)
Genetic factors associated with varying rates of viral clearance

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6
Q

What is the incubation period of hepatitis B? Describe the course of infection

A

1-6 months (~3)
+/- Prodromal pre-icteric period 1-2 weeks post infection
Subclinical 70%
Symptomatic 30%

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7
Q

4 features of prodromal Sx of hepatitis B

A

Serum-sickness type illness Fever
Arthralgia
Urticaria/ maculopapular rash

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8
Q

What occurs after the prodromal symptoms of hepatitis B

A

Recovery: 4-8 weeks
1% develop fulminant liver failure
Chronic carriage may be diagnosed after routine LFT testing or if cirrhosis or decompensation develops

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9
Q

List 6 Sx of of symptomatic acute hepatitis B

A 
Fever + arthralgia
Nausea + anorexia
Jaundice with dark urine + pale stools
RUQ pain
Hepatomegaly/ splenomegaly  
Occasionally: urticaria + maculopapular rash
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10
Q

Give 2 signs of chronic hepatitis B

A

May be no findings

May have signs of chronic liver disease or decompensation

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11
Q

List 3 investigations for hepatitis B

A

Viral serology
Bloods
Liver biopsy

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12
Q

What bloods are seen in hepatitis B?

A

High: AST, ALT, ALP, BR (ALT>AST)
Microcytic anaemia + Thrombocytopenia (indicative of portal HTN)
Clotting: High PT (in severe disease)

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13
Q

Describe the serology in acute hepatitis B

A

HBsAg +ve
HBeAG +ve
Anti-HBc IgM

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14
Q

Describe the serology in chronic hepatitis B

A

HBsAg +ve
HBeAg +ve or -ve (correlates with activity)
Anti-HBc IgG

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15
Q

Describe the serology in a patient with HBV cleared

A

Anti-HBs +ve

Anti-HBc IgG

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16
Q

How is hepatitis D detected?

A

IgM or IgG against HDV

PCR

17
Q

Give 3 preventatory measures against hepatitis B

A

Blood screening
Safe sex
Instrument sterilisation

18
Q

When is passive immunisation against hepatitis B utilised?

A

HBIG:
following acute exposure
to neonates born to HBeAg- +ve mothers (+ active immunisation)

19
Q

What is the active immunisation against hepatitis B? Who is this for?

A

Recombinant HBsAg vaccine:
Individuals at risk
Neonates born to HB

20
Q

Describe management of acute hepatitis B infection

A 
Symptomatic tx (antipyretics, antiemetics + cholestyramine) + bed rest  
NOTIFIABLE disease
21
Q

What drugs can be used in management of chronic hepatitis B infection?

A

Nucleoside/ nucleotide analogues (Tenofovir/ Entecavir)

22
Q

List complications of viral hepatitis B

A 
Cirrhosis 
Chronic HBV infection/ reactivation
<1% get fulminant hepatic failure  
HCC 
Extrahepatic immune complex disorders (e.g. glomerulonephritis, polyarteritis nodosa)
23
Q

What is the prognosis of patients with viral hepatitis B?

A

Infants: 90% become chronic
Adults: 10% become chronic
Of chronic infections, 20-30% develop cirrhosis

24
Q

How does hepatitis B present?

A

Most children have asymptomatic acute infection

50% of adults have an asymptomatic acute infection (esp if HIV+)

25
Q

2 facts about hepatitis D

A

defective virus
Can only co-infect with HBV or super-infect carriers of HBV
“D is Dependent”

26
Q

Describe the pathophysiology of hepatitis B

A

Antibody + cell-mediated immune response to viral replication leads to liver inflammation + hepatocyte necrosis

27
Q

Describe the serology of those vaccinated against HBV

A

Anti-HBs antibody +ve

28
Q

Advantages and disadvantages of standard/ pegylated Interferon alpha in chronicHepatitis B

A

+ve: shorter duration than Nucleoside/ Nucleotide analogues
SEs: flu-like sx: fever, chills, myalgia, headaches, BM suppression + depression
CI: Decompensated cirrhosis, Pregnant, AI or Psych conditions

YR5 ID + GUM (24 decks)

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