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Gastroenterology > Viral Hepatitis COPY > Flashcards

Viral Hepatitis COPY Flashcards

1
Q

What are the causes of hepatitis?

A
  • Alcoholic hepatitis
  • NAFLD
  • Virus (Hep A,B,C,D,E)
  • Autoimmune
  • Paracetamol overodse
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2
Q

What is the transmission route for Hep A?

When does this infection mostly occur?

A
  • Faecal-oral
  • shellfish
  • Childhood
  • Travellers to e.africa and s.america
  • Higher risk sexual activity
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3
Q

What are the Sx for Hep A?

A
  • fever
  • malaise
  • anorexia, arthralgia, nausea
  • jaundice
  • hepatosplenomegaly
  • adenopathy
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4
Q

What are the RF for hep A?

A
  • Travel: those travelling to endemic areas
  • Sexual: high risk activities (e.g analingus, digital-rectal contact, chemsex), multiple partners
  • Haematological disorders: factor VIII and factor IX concentrates have been implicated in transmission
  • Occupational risks: for example laboratory or sewage workers
  • IVDU: known to be at increased risk.
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5
Q

What are the 4 clinical phases of Hep A?

A
  • Incubation:
    • ​Hepatitis A as a relatively long incubation period that may last from 2 - 6 weeks (mean 28-30 days).
  • Prodromal:
    • ​Early part of the disease, characterised by fever, joint pain and rash. Flu-like symptoms may be present
  • Icteric:
    • In addition to jaundice, the icteric phase is characterised by anorexia, abdominal pain and change in bowel habit.
  • Convalescent:
    • Recovery phase as the body returns to normal and symptoms subside. Symptoms like malaise may last months.
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6
Q

What will the test be like for Hep A?

A

Liver enzymes

  • AST and ALT raise - significant
  • Biilirubin raise - moderate
  • Prothrombin time - normal

Serology

  • +ve HAV-IgM, +ve HAV-IgG: Likely acute hepatitis A infection
  • +ve HAV-IgM, -ve HAV-IgG: May indicate acute infection or false positive IgM
  • -ve HAV-IgM, +ve HAV-IgG: Indicates previous infection or vaccine based immunity
  • -ve HAV-IgM, -ve HAV-IgG: No evidence of infection, may be very early or still in the incubation
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7
Q

How would you Mx hep A?

A
  • Self resolve 1-3months
  • Vaccination + booster in 6-12 months offerd to high risk
    • Travel (to endemic areas)
    • Chronic liver disease
    • Sexual (MSM, high risk activities e.g analingus, digital-rectal contact, chemsex)
    • Occupational risks
    • IVDU
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8
Q

What are the types of Hep B disease?

A
  • Acute
    • occur in any age
    • in adults and older children - self limiting
    • in younger children - chronic infection
  • Chronic
    • persistence of hepatitis B surface antigen (HBsAg) for >6 month
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9
Q

What are the 4 major genes within the HBV genome?

A
  • Surface (S) gene: encodes the small surface protein HBsAg
  • Core (C) gene: encodes the hepatitis B core antigen (HBcAg), which also helps form the e antigen (HBeAg)
  • Polymerase (P) gene: encodes DNA polymerase/reverse transcriptase
  • X gene: encodes the hepatitis B x (HBx) protein
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10
Q

What are the 5 proteins of HBV?

A
  • HBsAg: needed for construction of the outer HBV envelope
  • HBcAg: composed within the nucleocapsid that contains the viral DNA.
  • HBeAg: acts as an immune decoy to promote viral persistence. Presence is a marker of viral replication and infectivity.
  • DNA polymerase: involved in the synthesis of DNA molecules. Has reverse transcriptase activity, which means it can form DNA from RNA.
  • X protein: a transcriptional regulator that promotes cell cycle progression.
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11
Q

What is the transmission route of Hep B?

A
  • perinatally
  • parenterally (e.g. infected needles)
  • percutaneously
  • contact
  • close household contact (sharing toothbrush etc)
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12
Q

Which groups are at risk of Hep B?

A
  • IVDU and their sexual partners
  • Health workers
  • Haemophiliacs
  • homosexual men
  • haemodialysis
  • babies of HbSAg + mother
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13
Q

What are the Sx of Hep B?

A
  • Same as Hep A
  • Urticaria and arthralgia more common
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14
Q

What would the Ix look like for Hep B?

A
  • HBSAg present 1-6months post exposure
  • HBeAG present 1-3months post exposure - high infectivity
  • anti-HBC: past infection
  • anti-HBS alone: vaccination
    *
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15
Q

How would you Mx Hep B?

A
  • Self resolve within 2 months. 10% will go to become chronic hep B
  • Vaccination (3 doses at different intervals)
    *
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16
Q

What are the Cx of Hep B?

A
  • fulminant hepatic failure
  • cirrhosis
  • Hepatocellular carcinoma (HCC)
  • Cholangiocarcinoma
  • cryoglobinamea
  • membranous nephorpathy
  • polyarteritis nodosa
17
Q

What is the transmission route for Hep C?

A
  • same like Hep B
18
Q

What are the Sx of Hep C?

A
  • 85% asymptomatic
19
Q

What are the RF for progressionof Hep C?

A
  • male
  • old
  • high viral load
  • alcohol abuse
  • HIV
  • HBV
20
Q

What will the Ix look like for Hep C?

A
  • anti-HCV antibodies
  • HCV PCR
21
Q

How would you Mx Hep C?

A
  • Screening patients that are at risk of hepatitis C
  • Screen for other blood born viruses (hepatitis A and B and HIV) and other sexually transmitted diseases
  • Refer to gastroenterology, hepatology or infectious diseases for specialist management
  • Notify Public Health (it is a notifiable disease)
  • Stop smoking and alcohol
  • Education about reducing transmission and informing potential at risk contacts
  • Testing for complications: FibroScan for cirrhosis and ultrasound for hepatocellular carcinoma
  • Antiviral treatment with direct acting antivirals (DAAs) -typically taken for 8 to 12 weeks
  • Liver transplantation for end-stage liver disease
22
Q

What are the Cx of Hep C?

A
  • Glomerulonephritis
  • Cryoglobuminaemia
  • Thyroiditis
  • autoimmune hepatitis
  • polymyositis
23
Q

What is the weakness of Hep D?

A
  • Can only survive in pt c Hep B
  • Requires HBV for assembly
24
Q

What will the test be like for Hep D?

A
  • Anti HDV antibody
    • only ask if HBsAg present
25
Q

How does Hep E trasmit?

A
  • Faecal oral route
26
Q

What is the Mx for Hep E?

A
  • Self resolved within a month
27
Q

What is Hep E associated c?

28
Q

What are the clinical features of Hep A?

A

Symptoms

  • Abdominal discomfort
  • Nausea
  • Anorexia
  • Diarrhoea
  • Flu-like illness
  • Pruritus
  • Dark urine, pale stool
  • Rash

Signs

  • Jaundice
  • RUQ tenderness
  • Hepatomegaly (85%)
  • Splenomegaly (15%)
  • Lymphadenopathy (5%)
29
Q

What is the risk of chronic infection in Hep B?

A

Inverse relationship with age

  • Perinatal transmission: 90% risk of chronic infection
  • Early childhood transmission: 25-50% risk of chronic infection
  • Adult transmission: < 5% risk of chronic infection

Gastroenterology (18 decks)

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