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YR6: GASTRO > Viral Hepatitis B + D > Flashcards

Viral Hepatitis B + D Flashcards

1
Q

What is viral hepatitis B?

A

Infection caused by hepatitis B virus, which may follow an acute or chronic course
Chronic = viraemia + hepatic inflammation continuing for > 6 months

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2
Q

Describe hepatitis B and give routes of transmission

A

Enveloped, partially ds-DNA virus

Transmission: sexual contact, blood + vertical transmission (from mother to baby)

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3
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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4
Q

Describe hepatitis D

A

Single-stranded RNA virus coated with HBsAg

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5
Q

What may histology show in hepatitis infection?

A

mild to severe inflammation + changes to cirrhosis

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6
Q

List 6 risk factors for hepatitis B

A

IV drug use
Unscreened blood + blood products
Infants of HBeAg-positive mothers
Sexual contact with HBV carriers
Younger individuals (esp. babies) are more likely to become chronic carriers
Genetic factors associated with varying rates of viral clearance

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7
Q

Describe the epidemiology of hepatitis B and D

A

Common
1-2 million deaths annually
Common in Southeast Asia, Africa+ Mediterranean countries
HDV is also found worldwide

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8
Q

What is the incubation period of hepatitis B?

A

3-6 months

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9
Q

List 8 prodromal symptoms of hepatitis B

A 
Malaise  
Headache  
Anorexia  
Nausea + vomiting  
Diarrhoea  
RUQ pain  
Serum-sickness type illness (e.g. fever, arthralgia, polyarthritis, urticaria, maculopapular rash)  
Jaundice develops with dark urine + pale stools
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10
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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11
Q

List 6 signs of acute hepatitis B

A 
Jaundice  
Pyrexia 
Tender hepatomegaly 
Splenomegaly  
Cervical lymphadneopathy (in 10-20%) 
Occasionally: urticaria + maculopapular rash
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12
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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13
Q

List 3 investigations for hepatitis B

A

Viral serology
Bloods
Liver biopsy

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14
Q

What bloods are seen in hepatitis B?

A

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

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15
Q

Describe the serology in acute hepatitis B

A

HBsAg +ve

IgM anti-HBcAg

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16
Q

Describe the serology in chronic hepatitis B

A

HBsAg +ve
IgG anti-HBcAg
HBeAg +ve or -ve (correlates with activity)

17
Q

Describe the serology in a patient with HBV cleared

A

Anti-HBsAg +ve

IgG anti-HBcAg

18
Q

How is hepatitis D detected?

A

IgM or IgG against HDV

PCR

19
Q

Give 3 preventatory measures against hepatitis B

A

Blood screening
Safe sex
Instrument sterilisation

20
Q

When is passive immunisation against hepatitis B utilised?

A

HBIG:
following acute exposure
to neonates born to HBeAg-positive mothers (in addition to active immunisation)

21
Q

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

A

Recombinant HBsAg vaccine:
Individuals at risk
Neonates born to HB

22
Q

Describe management of acute hepatitis B infection

A 
Symptomatic tx (antipyretics, antiemetics + cholestyramine) + bed rest  
Notifiable disease
23
Q

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

A 
Interferon alpha (standard or pegylated)  
SEs: flu-like sx: fever, chills, myalgia, headaches, bone marrow suppression + depression 
Nucleoside/ nucleotide analogues (adefovir, entecavir, telbivudine, tenofovir)
24
Q

List complications of viral hepatitis B

A

1% get fulminant hepatic failure
Chronic HBV infection (10% of adults, much higher in neonates)
Cirrhosis
HCC
Extrahepatic immune complex disorders (e.g. glomerulonephritis, polyarteritis nodosa)
Superinfection with HDV may lead to acute liver failure or more rapidly progressive disease

25
Q

What is the prognosis of patients with viral hepatitis?

A

Adults: 10% of infections become chronic

Of the chronic infections, 20-30% develop cirrhosis

26
Q

How does hepatitis B present?

A

Most children have an asymptomatic acute infection

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

27
Q

What is hepatitis D?

A

defective virus, may only co-infect with HBV or superinfect people who are already carriers of HBV
“D is Dependent”

28
Q

Describe the pathophysiology of hepatitis B

A

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

29
Q

Describe the serology of those vaccinated against HBV

A

Anti-HBsAg antibody +ve

YR6: GASTRO (61 decks)

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