Viral hepatitis: C

Question 1

Define viral hepatitis C

Answer 1

Hepatitis caused by infection w/ hepatitis C virus (HCV), often following chronic course (in 80% cases)

Question 2

Aetiology of viral hepatitis C

type, 2, transmission

Answer 2

HCV is a small, enveloped, single stranded RNA virus

RNA viruses have poor fidelity of replication & mutation rates are high
So there’s lots of HCV genotypes (that can coexist in patient)

Transmission is parenteral
sexual or vertical

Question 3

Pathogenesis of viral hepatitis C

2 + 4 biopsy

Answer 3

Virus not thought to be directly hepatotoxic
Humoral & cell mediated responses to infection that lead to hepatic inflammation & necrosis
Liver biopsy shows:
chronic hepatitis
lymphoid follicles in portal tracts
fatty change
cirrhosis may be present

Question 4

Risk factors for viral hepatitis C

6

Answer 4

Receipts of blood & blood products
IV drug users
Non sterile acupuncture
Tattooing 
Haemodialysis 
Health care workers

Question 5

Epidemiology of viral hepatitis C

general, location

Answer 5

COMMON

Different genotypes of HCV have different geographical prevalence

Question 6

Presenting symptoms of viral hepatitis C

3

Answer 6

90% acute infections are ASYMPTOMATIC
10% become jaundiced w/ mild flu like symptoms
May be diagnosed after incidental abnormal LFT

Question 7

Signs of viral hepatitis C on physical examination

general, 1 + 2 rare

Answer 7

May be NO SIGNS
May be signs of chronic liver disease (if long standing infection)
Extra hepatic manifestations (rare):
skin rash
renal dysfunction (due to glomerulonephritis)

Question 8

Investigations for viral hepatitis C

2

Answer 8

Bloods

Liver biopsy

Question 9

Investigations for viral hepatitis C - bloods

3

Answer 9

HCV serology
anti HCV antibodies: IgM (acute) or IgG (past exposer or chronic)
Reverse transcriptase PCR
allows detection & genotyping
LFT
acute infection: high ALT, AST, bilirubin
chronic infection: 2-8x elevation of AST & ALP (often fluctuates oner time)

Question 10

Investigations for viral hepatitis C - liver biopsy

3

Answer 10

Assess degree of inflammation & liver damage
Transaminase (AST & ALT) levels have little correlation to histological changes
Useful for diagnosing cirrhosis

Question 11

Management of viral hepatitis C

2

Answer 11

Prevention

Medical

Question 12

Management of viral hepatitis C - prevention

4

Answer 12

Screen blood, blood products & organ donors
Needle exchange schemes for IV drug users
Instrument sterilisation
No vaccine available

Question 13

Management of viral hepatitis C - medical

acute + 2 chronic +1

Answer 13

Acute
Mainly supportive (antipyretic, antiemetics, cholestyramine)

Chronic
Pegylated interferon-α
Ribavirin (guanosine nucleotide analogue)
Duration of HCV genotype 1/4 are 24-48 weeks & 2/3 are 12-24 weeks

Regular US of liver may be needed if patient has cirrhosis

Question 14

Complications of viral hepatitis C

4

Answer 14

Fulminant hepatic failure
Chronic carriage of HCV
Hepatocellular carcinoma
Less common: porphyria cutanea tarda, cryoglobulinaemia, glomerulonephritis

Question 15

Prognosis of viral hepatitis C

2

Answer 15

80% of exposed will progress to chronic carriage

Of these 20-30% develop cirrhosis over 10-20 yrs