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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
Hepatitis B: - PREP - PEP
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
What diagnosis is suggested by the following blood test: HBsAg negative Anti-HBc IgG negative anti-Hbs \>1000iu/ml
Previous vaccination
27
What diagnosis is suggested by the following blood test: HBsAg positive Anti-HBc IgM positive Anti-HBc IgG negative
Acute infection
28
What proportion of hepatitis B infected adults go on to develop CHB?
10%
29
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) Hepatocellular carcinoma
30
Hepatitis D (delta) virus: - type of virus? - transmission? - incubation period?
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
Who should you check hepatitis D serology in?
Someone with hepatitis B =\> always check their hep D status!
32
HBV/HDV co-infection: - presentation? - % proceeding to chronic infection?
HBV/HDV co-infection: - presentation = similar to acute hep B; mostly self-limiting - % proceeding to chronic infection = \<5%
33
When does HDV become troublesome? why?
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
Hepatitis C virus: - type of virus? - transmission? - incubation period?
Hepatitis C virus: - type of virus = **ss, + sense RNA** - transmission = **blood-borne** - incubation period = **2-6 weeks**
35
What % of acute hepatitis C spontaneously clears? what % become chronic hepatitic C (CHC)?
30% spontaneous clearance 70% become chronic hepatitis C (CHC)
36
Complications of chronic hepatitis C
1. Cirrhosis (up to 30% in 20 years) 2. HCC
37
Treatment for hepatitis C
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
Hepatitis C PREP? PEP?
Hepatitis C PREP = nil available PEP = nil available
39
Hepatitis E virus: - type of virus? - transmission? - incubation period?
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
Hepatitis E: - clinical course? - at risk populations?
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
Name 3 organ systems affected by extra-hepatic manifestations of hepatitis E infection
1. Neurological - GBS 2. Hematological 3. Renal
42
Hepatitis E treatment
usually self-limiting disease 1. HEV patient should avoid prepping food for 1st 2 weeks
43
Hepatitis E prevention (2 measures)
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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