Viral Hepatitis C Flashcards

1
Q

What is hepatitis C?

A

Infection caused by hepatitis C virus (HCV), often following a chronic course (in 80% of cases)

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2
Q

Describe hepatitis C

A

Small, enveloped, ss-RNA virus
RNA viruses have poor fidelity of replication + mutation rates are high - so, there are lots of HCV genotypes (which can co-exist in a single pt)

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3
Q

How is hepatitis C transmitted?

A

PARENTERAL
Sexual transmission
Vertical transmission

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4
Q

List 6 risk factors for hepatitis C

A
Recipients of blood + blood products  
IV drug users  
Non-sterile acupuncture  
Tattooing  
Haemodialysis  
HCPs
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5
Q

Describe the pathogenesis of hepatitis C

A

Virus NOT thought to be directly hepatotoxic

Humoral + cell-mediated responses to the viral infection that leads to hepatic inflammation + necrosis

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6
Q

Describe the epidemiology of hepatitis C

A

COMMON

Different genotypes of HCV have different geographical prevalence

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7
Q

How does hepatitis C usually present?

A

90% of acute infections are ASYMPTOMATIC
May be diagnosed after incidental abnormal LFT or in older patients with complications of cirrhosis
May be NO SIGNS

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8
Q

List symptoms of hepatitis C

A

10% become jaundiced with mild flu-like illness

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9
Q

List 3 categories of signs of hepatitis C

A

May be signs of chronic liver disease (if long-standing HCV infection) e.g. jaundice, ascites
May be signs of hepatic encephalopathy if advanced CLD
Extra-hepatic manifestations (rare): Skin rash + Renal dysfunction (due to glomerulonephritis)

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10
Q

Describe the serology of hepatitis C

A

Anti-HCV antibodies: IgM (acute) or IgG (past exposure or chronic)

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11
Q

Describe LFTs seen in hepatitis C

A

Acute: High ALT, AST + BR
Chronic: 2-8 x elevation of AST + ALT (often fluctuates over time)
Transaminase (AST + ALT) levels bear little correlation to histological changes

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12
Q

Why may you perform a liver biopsy in hepatitis C?

A

Assess degree of inflammation + liver damage (NOT for dx)

Useful for diagnosing cirrhosis

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13
Q

List 3 preventative measures against hepatitis C?

A

Screen blood, blood products + organ donors
Needle exchange schemes for IV drug users
Instrument sterilisation

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14
Q

Can you be completely protected from hepatitis C?

A

NO VACCINE AVAILABLE

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15
Q

Describe management of acute hepatitis C

A

Mainly supportive (antipyretics, antiemetics, cholestyramine)

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16
Q

Describe medical management of chronic hepatitis C

A

Antivirals are now curative: NS5A inhibitors
Pegylated interferon-a
+
Ribavarin

17
Q

List 3 complications of hepatitis C

A

Fulminant hepatic failure
Chronic carriage of HCV
Hepatocellular carcinoma

18
Q

List 3 rarer complications of hepatitis C

A

Porphyria cutanea tarda
Cryoglobulinaemia
Glomerulonephritis

19
Q

What is the prognosis of hepatitis C?

A

80% of exposed progress to chronic carriage

Of these, 20-30% will develop cirrhosis over 10-20 years

20
Q

What may be seen on liver biopsy in chronic hepatitis C?

A

Lymphoid follicles in portal tracts
Fatty change
Cirrhosis may be present

21
Q

Why is reverse transcriptase PCR used in hepatitis C?

A

Allows detection + genotyping of HCV

Used to confirm antibody testing or if suspected in pt but serology negative

22
Q

Describe the long term management in chronic hepatitis C

A

Monitor HCV viral load after 12 weeks to determine tx efficacy
HCV RNA level measured by PCR on EDTA blood sample is used to monitor response to tx.
Regular US of the liver may be needed if the patient has cirrhosis

23
Q

What defines cure of chronic hepatitis C?

A

Undetectable HCV RNA at 48 weeks after completion of tx (AKA ‘sustained virological response’ or SVR)