Viral Hepatitis B + D

Question 1

What is viral hepatitis B?

Answer 1

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

Question 2

Describe hepatitis B and give routes of transmission

Answer 2

Enveloped, partially ds-DNA virus

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

Question 3

What antigens may be released by hepatitis B?

Answer 3

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

Question 4

Describe hepatitis D

Answer 4

Single-stranded RNA virus coated with HBsAg

Question 5

What may histology show in hepatitis infection?

Answer 5

mild to severe inflammation + changes to cirrhosis

Question 6

List 6 risk factors for hepatitis B

Answer 6

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

Question 7

Describe the epidemiology of hepatitis B and D

Answer 7

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

Question 8

What is the incubation period of hepatitis B?

Answer 8

3-6 months

Question 9

List 8 prodromal symptoms of hepatitis B

Answer 9

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

Question 10

What occurs after the prodromal symptoms of hepatitis B

Answer 10

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

Question 11

List 6 signs of acute hepatitis B

Answer 11

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

Question 12

Give 2 signs of chronic hepatitis B

Answer 12

May be no findings

May have signs of chronic liver disease or decompensation

Question 13

List 3 investigations for hepatitis B

Answer 13

Viral serology
Bloods
Liver biopsy

Question 14

What bloods are seen in hepatitis B?

Answer 14

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

Question 15

Describe the serology in acute hepatitis B

Answer 15

HBsAg +ve

IgM anti-HBcAg

Question 16

Describe the serology in chronic hepatitis B

Answer 16

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

Question 17

Describe the serology in a patient with HBV cleared

Answer 17

Anti-HBsAg +ve

IgG anti-HBcAg

Question 18

How is hepatitis D detected?

Answer 18

IgM or IgG against HDV

PCR

Question 19

Give 3 preventatory measures against hepatitis B

Answer 19

Blood screening
Safe sex
Instrument sterilisation

Question 20

When is passive immunisation against hepatitis B utilised?

Answer 20

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

Question 21

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

Answer 21

Recombinant HBsAg vaccine:
Individuals at risk
Neonates born to HB

Question 22

Describe management of acute hepatitis B infection

Answer 22

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

Question 23

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

Answer 23

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

Question 24

List complications of viral hepatitis B

Answer 24

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

Question 25

What is the prognosis of patients with viral hepatitis?

Answer 25

Adults: 10% of infections become chronic

Of the chronic infections, 20-30% develop cirrhosis

Question 26

How does hepatitis B present?

Answer 26

Most children have an asymptomatic acute infection

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

Question 27

What is hepatitis D?

Answer 27

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

Question 28

Describe the pathophysiology of hepatitis B

Answer 28

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

Question 29

Describe the serology of those vaccinated against HBV

Answer 29

Anti-HBsAg antibody +ve