Viral Hepatitis C Flashcards

1
Q

def

A

hepatitis by infection with HCV

often follows a chronic course (80%)

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2
Q

what sort of virus is HCV

A

small, enveloped, ssRNA virus of flavivirus family

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3
Q

aetiology

A
1 transmission
-parenteral route
2 pathogenesis
-HCV not directly hepatotoxic
-humoral + cell-mediated response leads to hepatic inflammation + necrosis
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4
Q

what groups are at risk of HCV

A

1 IV drug users
2 tattooing
3 those on haemodialysis

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5
Q

what is a characteristic feature of HCV

A

lymphoid follicles in portal tracts

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6
Q

epi

A

common
prevalence is <2% in developed countries
prevalence is higher in developing countries (middle east)

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7
Q

history

A

1 asymptomatic (90%)
2 mild flu-like illness (<10%)
3 may be diagnosed incidentally with abnormal LFTs or in elderly with cirrhosis

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8
Q

examination

A

1 no signs/signs of CLD
2 extra-hepatic manifestations
-skin rash
-renal dysfunction

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9
Q

what is a skin rash caused by in HCV and what does it cause

A

mixed cryoglobulinaemia causing small-vessel vasculitis

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10
Q

what are cryglobulins

A

proteins which become insoluble at low temperature

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11
Q

what causes renal dysfunction

A

glomerulonephritis

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12
Q

investigations

A
1 bloods
-HCV serology
-reverse transcriptase PCR
-LFTs
2 liver biopsy
-assesses inflammation + liver damage
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13
Q

what would you look for in HCV serology for

A

acute: anti-HCV antibodies (igM)

past exposure/chronic: anti-HCV antibodies (igG)

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14
Q

why is reverse transcriptase PCR used

A

to confirm infection following serology

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15
Q

what would be found on LFTs with acute HCV

A

raised AST + ALT

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16
Q

what would be found on LFTs with chronic HCV

A

2-8fold elevation in AST +ALT

17
Q

what is the AST to ALT ratio

A

most causes of liver injury mean ALT>AST

however an AST to ALT ratio of greater than 2:1 suggests alcoholic liver disease

18
Q

management

A
1 acute
-no specific management
-antipyretics, antiemetics, cholestyramine
2 chronic
-combined interferon-alpha and ribavirin

3 regular USS with cirrhosis

19
Q

what is inteferon-alpha

A

a cytokine which enhances bodies antiviral response

20
Q

how long are HCV genotypes treated for

A

1+4: 24-48wks

2+3: 12-24wks

21
Q

complications

A

1 fulminant hepatic failure
2 chronic HCV carriage
3 cirrhosis
4 hepatocellular carcinoma

22
Q

prognosis

A

80% progress to chronic HCV infection

20-30% develop cirrhosis

23
Q

what is the chief reason for liver transplant in the west

A

HCV

24
Q

risk factors for progression

A

male
older
alcohol use