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Year Two - Gastroenterology System > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

What is hepatitis?

A

It is defined as a condition in which there is inflammation in the liver

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2
Q

What is hepatitis A?

A

It is defined as an acute infection of the liver caused by the hepatitis A virus

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3
Q

What type of virus is hepatitis A?

A

RNA picornavirus

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4
Q

What is the incubation period of hepatitis A?

A

2 - 4 weeks

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5
Q

How is hepatitis A transmitted?

A

Faecal oral route, usually in contaminated water or food

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6
Q

In exam questions, when does hepatitis A usually present?

A

2 - 4 weeks following travel to an at risk country (India, Thailand,

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7
Q

What are the eight clinical features associated with hepatitis A?

A

Flu-Like Prodrome

Right Upper Quadrant Pain

Nausea & Vomiting

Hepatomegaly

Dark Coloured Urine

Pale Stools

Jaundice

Anorexia

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8
Q

What investigation is used to diagnose hepatitis A?

A

Blood tests

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9
Q

What four blood test results indicate hepatitis A?

A

Increased AST Levels

Increased ALT Levels

Increased ALP Levels

Increased Bilirubin Levels

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10
Q

How do we manage hepatitis A? Why?

A

We provide conservative reassurance advice and basic analgesia

This is due to the fact that it is a self-limiting acute infection, which usually resolves without treatment in one to three months

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11
Q

Is there an immunisation available for hepatitis A?

A

Yes

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12
Q

What is the vaccine type used in hepatitis A?

A

Inactivated preparation

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13
Q

Who is administered the hepatitis A vaccine?

A

It It is not routinely offered and is instead administered to high risk groups

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14
Q

Which six patient groups receive the hepatitis A vaccine?

A

Travellers To High Prevalence Areas

Chronic Liver Disease Patients

Haemophilia Patients

Intravenous Drug Users

Men Who Have Sex With Men

Occupational Risk

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15
Q

What is hepatitis B?

A

It is defined as an infection of the liver caused by the hepatitis B virus

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16
Q

What type of virus is hepatitis B?

A

Double stranded DNA hepadnavirus

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17
Q

What is the incubation period of hepatitis B?

A

6 - 20 weeks

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18
Q

In what three ways is hepatitis B transmitted?

A

Parenterally via direct contact with infected blood or bodily fluids

Sexually via sexual intercourse

Vertically from mother to child, during pregnancy or delivery

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19
Q

What are the five clinical features associated with hepatitis B?

A

Fever

Right Upper Quadrant Pain

Nausea & Vomiting

Jaundice

Anorexia

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20
Q

What investigation is used to diagnose hepatitis B?

A

Blood tests

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21
Q

What seven blood tests are used to diagnose hepatitis B?

A

Hepatitis B Surface Antigen (HBsAg)

Hepatitis B Surface Antigen Antibody (Anti-HBs)

Hepatitis B Core Antigen (HBcAg)

Hepatitis B Core Antigen Antibody (Anti-HBc)

Hepatitis B Envelope Antigen (HBeAg)

Hepatitis B Envelope Antibody (Anti-HBe)

Hepatitis B Virus DNA (HBV-DNA)

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22
Q

What is the hepatitis B surface antigen (HBsAg)?

A

It is a protein found on the surface of HBV

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23
Q

What does a positive HBsAg result indicate?

A

Infection

In cases where there is persistence of HBsAg for a period greater than six months, chronic infection is indicated

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24
Q

What is the hepatitis B surface antigen antibody (anti-HBs)?

A

It is the antibody produced by the host in response to HbsAg exposure

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25
Q

What does anti-HBs demonstrate?

A

It indicates the clearance of HbsAg, and therefore resolution and immunity to hepatitis B infection

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26
Q

What does a positive anti-HBs result indicate?

A

Immunity

No current infection

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27
Q

What is the hepatitis B core antigen (HBcAg)?

A

It is a component of the nucleocapsid within HBV

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28
Q

What does a positive HBcAg result indicate? What is important to note?

A

Infection

It is not routinely measured in clinical practice

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29
Q

What is the hepatitis B core antigen antibody (anti-HBc)?

A

It is the antibody produced by the host in response to HbcAg

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30
Q

What does anti-HBc demonstrate?

A

It indicates current/past hepatitis B infection

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31
Q

In clinical practice, how do we use anti-HBc results?

A

It can be used to determine whether the infection is acute or chronic by identification of the immunoglobulin type present

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32
Q

What two immunoglobulin types are present in anti-HBc?

A

IgM

IgG

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33
Q

What immunoglobulin is present at the start of hepatitis B infection?

A

Anti-HBc IgG

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34
Q

Over time, what is anti-HBc IgM gradually replaced with?

A

Anti-HBc IgG

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35
Q

What does a positive anti-HBc IgM result indicate?

A

Acute infection

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36
Q

What does a positive anti-HBc IgG result indicate?

A

Chronic infection

OR

Acquired natural immunity

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37
Q

What is acquired natural immunity?

A

It is immunity obtained from a previous infection

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38
Q

What is the hepatitis B envelope antigen (HBeAg)?

A

It is the antigen located between the core and lipid envelope within HBV

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39
Q

What does a HBeAg demonstrate?

A

It indicates that the virus is actively replicating

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40
Q

What does a positive HBeAg result indicate?

A

Active infection, with a higher risk of transmissibility

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41
Q

In clinical practice, how do we use HBeAg results?

A

It is used to distinguish between active chronic infection and inactive chronic infection

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42
Q

What is hepatitis B envelope antibody (anti-HBe)?

A

It is the antibody produced by the host in response to HbeAg

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43
Q

What does a positive anti-HBe result indicate?

A

Inactive chronic infection

OR

Acquired natural immunity

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44
Q

What does the hepatitis B virus DNA (HBV-DNA) determine?

A

The viral load of hepatitis B infection

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45
Q

In which individuals do we conduct a hepatitis B virus DNA (HBV-DNA)?

A

In individuals with positive hepatitis B infection serological markers

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46
Q

What does a high HBV-DNA viral load indicate?

A

Active chronic infection - with an increased risk of complication development

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47
Q

What does a low HBV-DNA viral load indicate?

A

Acute infection

OR

Inactive chronic infection

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48
Q

What are the two initial serology markers used to diagnose hepatitis B? What is each serology marker used to identify?

A

Anti-HBs = to identify previous infection

HbsAg = to identify active infection

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49
Q

What two further serology markers are used to diagnose hepatitis B - following initial positive results?

A

HbeAg

HBV DNA

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50
Q

What does a positive HBsAg result indicate?

A

Acute infection

Active chronic infection

Inactive chronic infection

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51
Q

What does a positive anti-HBs result indicate?

A

Natural immunity

Passive immunity

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52
Q

What does a positive anti-HBc IgM result indicate?

A

Acute infection

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53
Q

What does a positive anti-HBc IgG result indicate?

A

Active chronic infection

Inactive chronic infection

Natural immunity

54
Q

What does a positive HBeAg result indicate?

A

Acute infection

Active chronic infection

55
Q

What does a positive anti-HBe result indicate?

A

Inactive chronic infection

Natural immunity

56
Q

What does a high HBV-DNA result indicate?

A

Inactive chronic infection

57
Q

What does a low HBV-DNA result indicate?

A

Active chronic infection

58
Q

What other blood test can be used to diagnose hepatitis B?

A

LFTs

59
Q

What are transaminases?

A

ALT

AST

60
Q

What is the transaminase level in acute hepatitis B infection?

A

Increased

61
Q

What is the transaminase level in active chronic hepatitis B infection?

A

Increased

62
Q

What is the transaminase level in inactive chronic hepatitis B infection?

A

Normal

63
Q

What is the transaminase level in hepatitis B natural immunity?

A

Increased/normal

64
Q

What is the transaminase level in hepatitis B passive immunity?

A

Normal

65
Q

In what four ways do we manage hepatitis B conservatively?

A

Smoking Cessation Advice

Alcohol Cessation Advice

Blood Born Virus Screening

Public Health Notification

66
Q

What three blood born viruses do we screen for in hepatitis B positive patients?

A

Hep A

HIV

STIs

67
Q

How do we pharmacologically manage hepatitis B?

A

Anti-viral drugs

68
Q

Name four anti-viral drugs

A

Pegylated (PEG) interferon alpha-21

Tenofovir

Entecavir

Telbivudine

69
Q

In which hepatitis B patients, do we administer anti-virals to?

A

In individuals with a viral load count > 20,000 IU/mL

70
Q

How do anti-virals manage hepatitis B?

A

They are used to slow disease progression and reduce infectivity

71
Q

Is there an immunisation against hepatitis B?

A

Yes

72
Q

What vaccine type is used in hepatitis B?

A

Conjugate

73
Q

What does the hepatitis B vaccine consist of?

A

It involves injection of the hepatitis B surface antigen (HbsAg) prepared from yeast cells using recombinant DNA technology

74
Q

How many doses of the hepatitis B vaccine are administered?

A

3 doses

75
Q

What serology marker is produced as a result of hepatitis B immunisation?

A

anti-HBs

76
Q

Which seven patient groups are offered the hepatitis B vaccine?

A

Children Immunisation Programme

Chronic Liver Disease Patients

Chronic Kidney Disease Patients

Regular Blood Transfusion Patients

Intravenous Drug Users

Healthcare Workers

Sex Workers

77
Q

At what three ages do children receive the hepatitis B vaccine?

A

2 months old

3 months old

4 months old

78
Q

How do we confirm response to the hepatitis B vaccine?

A

We conduct anti-HBs serology testing 1 to 4 months after primary immunisation

79
Q

What does an anti-HBs level of > 100 indicate about response to the hepatitis B vaccine? What is the further management option?

A

There is an adequate response

These individuals only require a roster at 5 years

80
Q

What does an anti-HBs level of 10 - 100 indicate about response to the hepatitis B vaccine? What is the further management option?

A

There is a suboptimal response

These individuals require one additional vaccine dose

81
Q

What does an anti-HBs level of <10 indicate about response to the hepatitis B vaccine? What is the further management option?

A

There has been no response

These individuals need tested for infection and require a further vaccine course (3 doses)

82
Q

What are the six complications of hepatitis B?

A

Chronic Hepatitis

Liver Failure

Hepatocellular Carcinoma

Membranous Glomerulonephritis

Polyarteritis Nodosa

Cryoglobulinemia

83
Q

What is a feature of chronic hepatitis B on light microscopy?

A

Ground glass hepatocytes

84
Q

What is hepatitis C?

A

It is defined as an infection of the liver caused by the hepatitis C virus

85
Q

What type of virus is hepatitis C?

A

RNA flavivirus

86
Q

What is the incubation period of hepatitis C?

A

6 – 9 weeks

87
Q

How many strains are there of hepatitis C?

A

Six

88
Q

What are the two most common strains of hepatitis C?

A

Genotype one

Genotype three

89
Q

In what three ways is hepatitis C transmitted?

A

Parenterally via direct contact with infected blood or bodily fluids

Sexually via sexual intercourse

Vertically from mother to child, during pregnancy or delivery

90
Q

Is breastfeeding contraindicated in mothers with hepatitis C?

A

No

91
Q

What are the nine clinical features associated with hepatitis C?

A

Fever

Right Upper Quadrant Pain

Nausea & Vomiting

Pruritis

Jaundice

Purpura

Arthralgia

Ascites

Anorexia

92
Q

What investigation is used to diagnose hepatitis C?

A

Blood tests

93
Q

What two blood tests are used to diagnose hepatitis C?

A

Hepatitis C Antibody

Hepatitis C RNA

94
Q

What is the hepatitis C antibody blood test?

A

It determines whether an individual has been exposed to the virus by testing for the presence of antibodies

95
Q

How is the hepatitis C antibody blood test used to investigate hepatitis C?

A

It is used to screen for infection

96
Q

What does a positive hepatitis C antibody blood test result mean?

A

It indicates that an individual has been infected with hepatitis C, however it is undetermined whether this infection is currently present or has been cleared

97
Q

What is the hepatitis C RNA blood test?

A

It determines whether there is replication of the virus, and therefore whether there is current infection within the body

In addition, this blood test can be used to determine the virus genotype, which allows the most appropriate management to be administered

98
Q

How is the hepatitis C RNA blood test used to investigate hepatitis C?

A

It is used to diagnose current hepatitis C infection

99
Q

In what four ways do we conservatively manage hepatitis C?

A

Smoking Cessation Advice

Alcohol Cessation Advice

Blood Born Virus Screening (Hep A, HIV, STIs)

Public Health Notification

100
Q

What is the pharmacological management option for hepatitis C?

A

Direct Acting Anti-Virals (DAAs)

101
Q

What are direct acting anti-virals (DAAs)?

A

They are drugs that target the specific viral genotype

102
Q

Name four direct acting anti-virals (DAAs) used to manage hepatitis C

A

Sofosbuvir

Ledipasvir

Ombitasvir

Ribavirin

103
Q

What is the aim of direct acting anti-virals (DAAs) management of hepatitis C?

A

Sustained virological response (SVR)

This is defined as undetectable serum HCV RNA six months after the end of therapy

104
Q

Is there an immunisation available for hepatitis C?

A

No

105
Q

What are the eight complications associated with hepatitis C?

A

Chronic Hepatitis C

Liver Failure

Hepatocellular Carcinoma

Arthritis

Sjogren’s Syndrome

Cryoglobulinemia

Porphyria Cutanea Tarda

Membranoproliferative Glomerulonephritis

106
Q

What is hepatitis D?

A

It is defined as an infection of the liver caused by the hepatitis D virus

107
Q

What type of virus is hepatitis D?

A

A single stranded RNA virus

108
Q

What is the incubation period of hepatitis D?

A

2 - 8 weeks

109
Q

How is hepatitis D transmitted?

A

Parenterally via direct contact with infected blood or bodily fluids

110
Q

What is required for hepatitis D infection to occur?

A

It requires hepatitis B surface antigens (HbsAg)

111
Q

What is co-infection - in terms of hepatitis D?

A

It is the infection of both hepatitis B and D

112
Q

What is superinfection - in terms of hepatitis D?

A

It when HBsAg positive patients develop hepatitis D

113
Q

What are the five clinical features of hepatitis D?

A

Fever

Right Upper Quadrant Pain

Nausea & Vomiting

Jaundice

Anorexia

114
Q

What investigation is used to diagnose hepatitis D?

A

Blood tests

115
Q

What blood test is used to diagnose hepatitis D?

A

Reverse PCR Hepatitis D RNA

116
Q

What is reverse PCR hepatitis D RNA?

A

This test involves the synthesis of DNA from RNA by using an RNA-dependent DNA polymerase

117
Q

In what four ways do we conservatively manage hepatitis D?

A

Smoking Cessation Advice

Alcohol Cessation Advice

Blood Born Virus Screening (Hep A, HIV, STIs)

Public Health Notification

118
Q

What is the pharmacological option for hepatitis D?

A

Anti-Viral Drugs

119
Q

Name an anti-viral drug used to manage hepatitis D?

A

Pegylated (PEG) interferon alpha-21

120
Q

Is there a cure for hepatitis D?

A

No

The management options are therefore used to slow down the progression of disease only

121
Q

Is there an immunisation available for hepatitis D?

A

Yes

The hepatitis B vaccine can be used to prevent hepatitis D infection, due to the requirement of co-infection

122
Q

What is hepatitis E?

A

It is defined as an infection of the liver caused by the hepatitis E virus

123
Q

What type of virus is hepatitis E?

A

RNA hepevirus

124
Q

What is the incubation period of hepatitis E?

A

3 – 8 weeks

125
Q

How is hepatitis E transmitted?

A

Faecal-oral route, usually in contaminated water or food

126
Q

In exam questions, how does hepatitis E infection tend to transmit?

A

Undercooked pork

127
Q

What are the five clinical features of hepatitis E?

A

Fever

Right Upper Quadrant Pain

Nausea & Vomiting

Jaundice

Anorexia

128
Q

What investigation is used to diagnose hepatitis E?

A

Blood tests

129
Q

What four blood test results indicate hepatitis E?

A

Increased AST Levels

Increased ALT Levels

Increased ALP Levels

Increased Bilirubin Levels

130
Q

How do we manage hepatitis E? Why?

A

We provide conservative reassurance advice and basic analgesia

This is due to the fact that it is a self-limiting acute infection, which usually resolves without treatment in one to three months

131
Q

In which patient group does hepatitis E carry a high mortality in?

A

Pregnant patients

132
Q

Is there an immunisation available for hepatitis E?

A

No

Year Two - Gastroenterology System (33 decks)

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