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Y4 - CCC & PC > Hepatitis > Flashcards

Hepatitis Flashcards

1
Q

What is hepatitis?

A

inflammation in the liver

  • this can be a chronic low level inflammation
  • or an acute, severe inflammation that results in large areas of necrosis + liver failure
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2
Q

What are the possible causes of hepatitis?

A
  • alcoholic hepatitis
  • non-alcoholic fatty liver disease
  • viral hepatitis
  • autoimmune hepatitis
  • drug-induced hepatitis (e.g. paracetamol overdose)
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3
Q

What is the presentation of hepatitis typically like?

A
  • it can be asymptomatic
  • or present with non-specific symptoms:
  1. fever (viral)
  2. jaundice
  3. abdominal pain
  4. pruritis
  5. fatigue
  6. muscle / joint aches
  7. N&V
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4
Q

What are the typical LFT findings in hepatitis?

A
  • there are high transaminases (AST / ALT)
  • there is a proportionally smaller raise in ALP
  • this is called a “hepatitic picture”
  • bilirubin may also be raised as a result of inflammation
  • high bilirubin causes jaundice

transaminases are liver cell enzymes that are released into the blood as a result of inflammation of the liver cells

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5
Q

How is hepatitis A transmitted?

A
  • it is a RNA virus
  • it is transmitted via the faecal-oral route through contaminated food / water

it is the most common viral hepatitis worldwide but relatively rare in the UK

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6
Q

What are the symptoms associated with hepatitis A?

A
  • N&V
  • anorexia
  • jaundice
  • it can cause cholestasis with dark urine and pale stools
    • moderate hepatomegaly

cholestasis = slowing of bile through the biliary system

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7
Q

What is involved in the management of Hepatitis A?

A
  • it will resolve without treatment in 1-3 months
  • basic analgesia is given
  • vaccination is available to reduce the chance of developing an infection
  • it is a notifiable disease so Public Health must be notified in all cases
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8
Q

In what ways can Hepatitis B be transmitted?

A
  • it is a DNA virus
  • transmitted through direct contact with blood or bodily fluids (sexual intercourse, sharing needles - IVDU / tattoos)
  • can be passed through sharing contaminated household products - e.g. toothbrushes
  • or between minor cuts / abrasions
  • can be passed from mother to child during pregnancy / delivery (vertical transmission)
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9
Q

What is the prognosis like following hepatitis B infection?

A
  • most people fully recover within 2 months
  • 10% will become chronic hepatitis B carriers
  • the viral DNA has integrated into their own DNA so they continue to produce viral proteins
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10
Q

What is meant by chronic hepatitis B?

A
  • hepatitis B that lasts for 6 months or more
  • it can potentially lead to cirrhosis or hepatocellular carcinoma
  • it may be asymptomatic
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11
Q

What are the 5 different viral markers that can be tested for in hep B?

A

surface antigen (HBsAg):

  • a marker of active infection

E antigen (HBeAg):

  • a marker of viral replication that implies high infectivity

core antibodies (HBcAb):

  • implies past or current infection

surface antibodies (HBsAb):

  • implies vaccination, past or current infection

Hep B virus DNA (HBV DNA):

  • direct count of the viral load
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12
Q

What does the presence of HBsAg indicate?

A

there is an active infection with Hep B

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13
Q

What does the presence of HBeAg indicate?

A
  • this indicates the patient is in the acute phase of the infection
  • the virus is actively replicating
  • a high level of HBeAg correlates with high infectivity
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14
Q

What does the presence of HBcAb indicate?

A

either a past or current Hep B infection

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15
Q

How can HBcAb be used to distinguish between an acute, chronic and past infection?

A

through measuring IgM and IgG versions of the HBcAb

  • IgM implies active infection
  • a high titre of IgM indicates acute infection
  • a low titre of IgM indicates chronic infection
  • IgG indicates a past infection when HBsAg is negative
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16
Q

What does the presence of HBsAb imply?

A
  • there has been an immune response to HBsAg
  • this could be due to vaccination, current or past infection
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17
Q

How can you tell if HBsAb is due to vaccination or infection?

A
  • HBsAg is given in the vaccine
  • a positive HBsAb could indicate an immune response to the vaccine
  • other viral markers are needed to distinguish between vaccination or infection
18
Q

What is the order of tests when screening for Hep B?

A
  • test for HBcAb for evidence of previous infection

AND

  • test for HBsAg for evidence of active infection
  • if these are positive, then test for HBeAg and viral load
19
Q

What does it mean if HBeAg is negative but HBeAb is positive?

A
  • the patient has been through a phase where the virus was replicating
  • now the virus has stopped replicating and they are less infectious
20
Q

What is involved in the vaccination for hep B?

A
  • it involves injection of HBsAg
  • individuals are then tested for HBsAb to confirm response to the vaccine
  • there are 3 doses at different intervals

it is part of the UK routine vaccination schedule

21
Q

Who should be screened for Hep B?

A
  • there should be a low threshold for screening patients at risk of Hep B
  • other bloodborne viruses (hep A / HIV) and other STDs should also be screened for
22
Q

What advice is given to a patient with hepatitis B?

A
  • stop smoking and drinking alcohol
  • education about reducing transmission and informing potential at risk contacts
23
Q

What is involved in the management of hepatitis B?

A
  • PHE must be informed as it is a notifiable disease
  • FibroScan to check for cirrhosis
  • USS to check for hepatocellular carcinoma
  • antiviral medication can be given to slow progression of disease + reduce infectivity
  • liver transplantation for end-stage liver disease

the patient is referred to gastroenterology, hepatology or infectious diseases for specialist management

24
Q

What is hepatitis C and how is it spread?

A
  • it is an RNA virus
  • it is spread via blood and bodily fluids
25
Q

What is the prognosis of Hepatitis C like?

A
  • 1 in 4 will make a full recovery
  • 3 in 4 will develop chronic Hep C infection
  • chronic infection is associated with liver cirrhosis + hepatocellular carcinoma
26
Q

How can Hepatitis C be tested for?

A
  • the screening test looks for Hepatitis C antibody
  • if this is positive, Hepatitis C RNA testing is used to confirm the diagnosis, calculate viral load and assess individual genotype
27
Q

What is involved in the management of Hep C?

A
  • it is the SAME as hepatitis B except for:
  • no vaccine is available
  • direct acting antivirals (DAAs) tailored to the specific viral genotype can cure the infection in 90% patients when taken for 8-12 weeks
28
Q

What is Hepatitis D and which individuals can contract this infection?

A
  • it is an RNA virus
  • it can only survive in patients with a concurrent Hep B infection
  • it attaches to the HBsAg to survive and cannot survive without this protein

there are very low rates in the UK

29
Q

What are the consequences of hepatitis D?

How is it managed?

A
  • it increases the complications and severity of hep B infection
  • there is no specific treatment for hep D
  • PHE must be notified as it is a notifiable disease
30
Q

What is hepatitis E and how is it transmitted?

A
  • it is an RNA virus
  • it is transmitted via the faecal-oral route

it is very rare in the UK

31
Q

What type of illness is typically produced by Hep E?

A
  • it usually produces a mild illness
  • this clears within 1 month and no treatment is required
  • rarely it can progress to chronic hepatitis and liver failure in immunocompromised patients

it is a notifiable disease + no vaccine is available

32
Q

What is thought to be the cause of autoimmune hepatitis?

A
  • there is a genetic predisposition and it is triggered by environmental factors
  • a viral infection causes a T-cell mediated response against liver cells
  • the T cells recognise the liver cells as being harmful
  • they alert the rest of the immune system to attack these cells

the exact cause is unknown

33
Q

What are the 2 different types of autoimmune hepatitis?

A
  • Type 1 tends to occur in adults
  • Type 2 tends to occur in children
34
Q

Who tends to be affected by Type 1 autoimmune hepatitis?

A
  • women in their late 40s or 50s
  • it presents around or after the menopause
  • it presents with fatigue and features of liver disease on examination
  • the course is less acute than T2
35
Q

Who is typically affected by Type 2 autoimmune hepatitis?

A
  • it typically affects teenagers / individuals in their early 20s
  • they have an acute picture with high transaminases and jaundice
36
Q

What will investigations for autoimmune hepatitis show?

A
  • raised transaminases (ALT / AST)
  • raised IgG
  • it is associated with many autoantibodies
37
Q

What autoantibodies are associated with Type 1 autoimmune hepatitis?

A
  • anti-nuclear antibodies (ANA)
  • anti-smooth muscle antibodies (anti-actin)
  • anti-soluble liver antigen (anti-SLA/LP)
38
Q

What autoantibodies are associated with Type 2 autoimmune hepatitis?

A
  • anti-liver kidney microsomes-1 (anti-LKM1)
  • anti-liver cytosol antigen type 1 (anti-LC1)
39
Q

How is autoimmune hepatitis diagnosed?

A

liver biopsy

40
Q

What is involved in the treatment for autoimmune hepatitis?

A
  • high dose steroids - typically prednisolone
  • prednisolone is tapered over time as other immunosuppressants (typically azathioprine) are introduced
  • immunosuppressant treatment induces remission but is usually required life-long
  • liver transplant may be required in end-stage disease but autoimmune hepatitis can recur in transplanted livers

Y4 - CCC & PC (34 decks)

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