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Pathology by week > W29 - Viral hepatitis > Flashcards

W29 - Viral hepatitis Flashcards

1
Q

hepatitis A virus (HAV)

  • type of virus?
  • transmission?
  • incubation period?
A

hepatitis A virus (HAV)

  • type of virus = ss, + sense RNA genome, quasi-enveloped virus
  • transmission = faeco-oral
  • incubation period = 15-50 days
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2
Q

% of children infected with hepatitis A by the age of 10 in developing countries with poor sanitary conditions and hygienic practices?

A

90%

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3
Q

In which 2 population groups in the UK has their been hepatitis A outbreaks?

A

MSM (2016-2017)

IVDU (2001, 2017)

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4
Q

Hepatitis A - % that will be symptomatic in:

  • children
  • adults
A

Hepatitis A:

  • children = <10% symptomatic
  • adults = 70% symptomatic
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5
Q

Heptitis A - symptoms (7)

A
  1. Fever
  2. malaise
  3. anorexia/nausea
  4. diarrhoea
  5. abdominal discomfort
  6. jaundice
  7. extra-hepatic manifestations
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6
Q

Hepatitis A treatment?

A

Self-limiting; 99% resolves spontaneously; no chronic hep A cases

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7
Q

For how long do we get a) viraemia and b) HAV in stool with hepatitis A infection?

marker for acute infection?

marker for clearance?

A

a) viraemia = 0-5 weeks
b) HAV in stool = 1-2 to 5 weeks

acute infection = IgM

clearance = IgG+, IgM-

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8
Q

If you get someone with suspected acute HAV infection, in addition to IgM and IgG serology, what do you need to check and why?

A

Bilirubin - if bilirubin level <30umol/L, acute HAV infection is less likely

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9
Q

Hepatitis A - what is the infectious period?

A

2 weeks before onset of 1st symptoms

1 week after onset of jaundice

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10
Q

PREP and PEP treatments for hepatitis A?

A

PREP = for people at risk (endemic travellers)

PEP :

1) within 14 days of exposure => HV vaccine +/- HNIG (for >60y.o., chronic liver disease incl. CHB/CHC, immunocompromised)
2) over 14 days of exposure => HV vaccine +/- HNIG (for chronic liver disease incl. CHB/CHC, immunsompromised)

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11
Q

What diagnosis is suggested by the following blood test:

anti-HAV IgG negtive, anti-HAV IgM positive?

A) Previous HAV vaccination

B) Never exposed

C) Acute HAV infection

A

C) Acute HAV infection

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12
Q

Hepatitis B:

  • type of virus?
  • Transmission?
  • Incubation periods?
A

Hepatitis B:

  • type of virus = ds DNA with RT, enveloped virus
  • Transmission = blood-borne, horizontal & vertical
  • Incubation periods = 40-160 days
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13
Q

Hepatitis B - outcome in:

  • neonates & children:
  • adults:
A

Hepatitis B - outcome in:

  • neonates & children:
  • mostly asymptomatic
  • 90% HBV-infected neonates develop CHB
  • 30% of children <5y.o. will go on to develop CHB
  • adults:
  • 30-50% icteric hepatitis
  • 10% develop CHB
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14
Q

Hepatitis B:

risk of fulminant hepatitis?

A

0.1-0.5% risk of fulminant hepatits, esp if co-infection with HCV/HDV

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15
Q

What 3 factors are important for predicting vertical transmission of hepatitis B?

A
  1. Maternal HbE Ag (most imp predictor)
  2. Maternal ab status
  3. Maternal HBV viral load
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16
Q

Definition of chronic hepatitis B?

A

•persistence of HBsAg for 6 months or more after acute HBV infection

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17
Q

Complications of chronic hepatitis B?

A
  1. Cirrhosis (8-20% untreated CHB in 5 years)
  2. Hepatocellular carcinoma (2-5% of CHB cirrhotic patients)
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18
Q

Interpretation of HBV serology

HbsAg - / HbsAb - / Hbc IgM - / Hbc Ab -

A

Susceptible

19
Q

Interpretation of HBV serology

HbsAg - / HbsAb + / Hbc IgM - / Hbc Ab +

A

immune due to past infection

20
Q

Interpretation of HBV serology

HbsAg - / HbsAb + / Hbc IgM - / Hbc Ab -

A

Immune due to immunisation

21
Q

Interpretation of HBV serology

HbsAg + / HbsAb - / Hbc IgM + / Hbc Ab -

A

Acute hepatitis B

22
Q

Interpretation of HBV serology

HbsAg + / HbsAb - / Hbc IgM - / Hbc Ab -

A

Acute hepatitis B

23
Q

Interpretation of HBV serology

HbsAg + / HbsAb - / Hbc IgM - / Hbc Ab +

A

Chronic hepatitis B

  • here they will have core ab, but IgM MUST BE NEGATIVE!
24
Q

Name 2 treatment options available for CHB

A
  1. Peg-IFN alpha
  2. ETV/TDF/TAF (antivirals)

(ETV = entecavir, TDF = tenofovir, TAF = prodrug of tenofovir)

25
Q

Hepatitis B:

  • PREP
  • PEP
A

Hepatitis B:

- PREP:

  • routine childhood immunisation
  • high risk populations

- PEP:

  • neonate born to mom with hep B => HBV vaccine +/- HBIG
  • sexual partner => HBV vaccine +/- HBIG (within 1 week of contact)
  • needlestick injury
26
Q

What diagnosis is suggested by the following blood test:

HBsAg negative

Anti-HBc IgG negative

anti-Hbs >1000iu/ml

A

Previous vaccination

27
Q

What diagnosis is suggested by the following blood test:

HBsAg positive

Anti-HBc IgM positive

Anti-HBc IgG negative

A

Acute infection

28
Q

What proportion of hepatitis B infected adults go on to develop CHB?

A

10%

29
Q

A patient with CHB presents with a mass in the liver. the Alfa-feto protein (AFP) is more than 200 iu/ml (normal <6). What is the most likely diagnosis?

A) Hepatocellular carcinoma

B) Secondary liver metastasis

C) Cirrhosis

A

A) Hepatocellular carcinoma

30
Q

Hepatitis D (delta) virus:

  • type of virus?
  • transmission?
  • incubation period?
A

Hepatitis D (delta) virus:

  • type of virus = ss, circular RNA, enveloped virus that relies on HBV for propagation
  • transmission = blood-borne
  • incubation period = 3-6 weeks
31
Q

Who should you check hepatitis D serology in?

A

Someone with hepatitis B => always check their hep D status!

32
Q

HBV/HDV co-infection:

  • presentation?
  • % proceeding to chronic infection?
A

HBV/HDV co-infection:

  • presentation = similar to acute hep B; mostly self-limiting
  • % proceeding to chronic infection = <5%
33
Q

When does HDV become troublesome? why?

A

Not with co-infection occurs with HBV, but when there is HDV super-infection in CHB, b/c:

1) 80% that HDV will also become chronic
2) increased risk of cirrhosis and HCC (than CHB alone)

34
Q

Hepatitis C virus:

  • type of virus?
  • transmission?
  • incubation period?
A

Hepatitis C virus:

  • type of virus = ss, + sense RNA
  • transmission = blood-borne
  • incubation period = 2-6 weeks
35
Q

What % of acute hepatitis C spontaneously clears? what % become chronic hepatitic C (CHC)?

A

30% spontaneous clearance

70% become chronic hepatitis C (CHC)

36
Q

Complications of chronic hepatitis C

A
  1. Cirrhosis (up to 30% in 20 years)
  2. HCC
37
Q

Treatment for hepatitis C

A

Any HCV (acute or chronic) should be considered for direct-acting antivirals (DAA is a combination of drugs) = 90% cure rate

- 8 or 12 weeks

  • single-tablet regimen
  • different types: protease inhibitor, NS5A inhibitor, NS5B inhibitor
  • at end of treatment, check viral load again
  • always check drug-drug interactions
38
Q

Hepatitis C

PREP?

PEP?

A

Hepatitis C

PREP = nil available

PEP = nil available

39
Q

Hepatitis E virus:

  • type of virus?
  • transmission?
  • incubation period?
A

Hepatitis E virus:

  • type of virus = ss, + sense RNA, quasi-enveloped virus
  • transmission = faeco-oral
  • incubation period = 15-60 days

(similar to hep A)

40
Q

Hepatitis E:

  • clinical course?
  • at risk populations?
A

Hepatitis E:

  • clinical course = self-limiting; advise against alcohol use during course of disease
  • at risk populations:
    1. pregnant women (25% maternal mortality & high perinatal infant mortality)
    2. chronic liver disease patients
    3. immunocompromised
41
Q

Name 3 organ systems affected by extra-hepatic manifestations of hepatitis E infection

A
  1. Neurological - GBS
  2. Hematological
  3. Renal
42
Q

Hepatitis E treatment

A

usually self-limiting disease

  1. HEV patient should avoid prepping food for 1st 2 weeks
43
Q

Hepatitis E prevention (2 measures)

A
  1. Immunocompromised and chronic liver disease patients => avoid eating undercooked meat (pork) and shellfish
    2) HEV vaccination (only licensed in China)

Pathology by week (70 decks)

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