Week 205 - Alocoholism and Hepatitis

Question 1

Name 9 types/causes of hepatitis.

Answer 1

Viral - A, B, C, D, E; Alcoholic hepatitis; Autoimmune; Epstein-Barr (EMV); Cytomegalovirus (CVM)

Question 2

Which types of hepatitis are common?

Answer 2

Hep A, B, C and alcoholic hepatitis

Question 3

Which viral forms of hepatitis are parenteral and which are oral/faecal?

Answer 3

Parenteral: Hep b, c and D

Oral/faecal: Hep A and E

Question 4

What is unique about hep D?

Answer 4

It can only be acquired by someone also infected with active Hep B - cannot replicate without it

Question 5

What are the 3 routes of transmission for viral hepatitis?

Answer 5

1) Oral/faecal
2) Parenteral
3) Blood Products (e.g. transfusion - parenteral also)

Question 6

What are the common symptoms of viral hepatitis in the prodromal phase?

Answer 6

Flu-like symptoms: nausea/vomiting, malaise, fatigue, anorexia, low-grade fever, myalgia, mild headache.

Question 7

What does icterus mean?

Answer 7

It is another term for jaundice and the associated symptoms

Question 8

What are the common signs & symptoms of viral hepatitis in the icteric phase?

Answer 8

• jaundice - itching (pruritis) - abdo pain - dark urine - pale faeces - arthralgia and skin rash

Question 9

List 3 other differeintials you ought to consider with the icteric picture.

Answer 9

1) Acute HIV infection
2) Acute drug-induced liver injury (e.g. paracetamol/ecstasy etc)
3) Drug-induced hypersensitivity reaction e.g. sulfasalazine hypersensitivity

Question 10

What are you likely to see/find on examination in someone presenting with viral hepatitis?

Answer 10

jaundice - sclera first then skin; hepatomegaly; temperature of up to 40; features of chronic liver disease; evidence of decompensation

Question 11

List some signs consistent with decompensated liver disease.

Answer 11

Encephalopathy - drowsiness, liver flap, hyperventilation
Excretory dysfunction - jaundice
Portal HTN / hypoalbuminaemia - ascites, peripheral oedema, leukonychia
Coagulopathy - bruising
Acid-base imbalance - respiratory acidosis

Question 12

List 7 investigatory tests you’d run with suspected viral hepatitis?

Answer 12

• FBC - U&Es - LFTs
• Clotting - Serology (liver antibodies, viral) - PCR (virus)
• USS

Question 13

What viral hepatitis types do we give have vaccines for in England and Wales?

Answer 13

Hep A, B and E

Question 14

What is genetically different about Hep B compared with A, C, D and E?

Answer 14

It is the only one that is composed of DNA rather than RNA

Question 15

Where is hep E more commonly found globally?

Answer 15

Mexico, North Africa, Asia

Question 16

What’s the average incubation period for Hep E?

Answer 16

40 days

Question 17

What is the cause of most outbreaks of Hep E?

Answer 17

Faecally contaminated water

Question 18

What should you ask any patient about of whom you suspect may Hep E?

Answer 18

Recent Foreign Travel

Question 19

Where is hep B more commonly found globally?

Answer 19

Central Africa and China & SE Asia

Globally a huge problem - approx. 2 deaths a min!

Question 20

What are the aims of Hep B (HBV) therapy?

Answer 20

1) Loss of: replication, e antigen, surface antigen
2) Normalisation of transaminases (ALT and AST)
3) Improve of liver histology