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Infection 2023 > 13 - Hepatitis > Flashcards

13 - Hepatitis Flashcards

1
Q

What is hepatitis?

A

- Hepatitis is the inflammation of the liver due to cell injury or viruses (hepatotropic) which can cause collateral liver damage e.g. EBV, CMV, VZV

  • Replicates in hepatocytes and destroys them
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2
Q

What are the different types of hepatitis and what are their modes of transmission and incubation periods?

A

Hep B and C cannot sort themselves out on their own

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3
Q

Outline the viral structure of Hep B and Hep C.

A

- Hepatitis B: dsDNA, enveloped

- Hepatitis C: ssRNA, positive, enveloped, icosahedral

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4
Q

How is bilirubin produced an excreted?

A
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5
Q

What are the different causes of jaundice and what causes each of these?

A

- Prehepatic – caused by haemolysis

- Intrahepatic – caused by viral hepatitis, drugs, alcohol hepatitis, cirrhosis

- Extrahepatic – caused by common duct stones and carcinoma

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6
Q

What are some liver function tests?

A

- Bilirubin

- ALT/AST (hepatocyte damage)

- ALP (biliary tract cell damage)

- Albumin

  • Tests of coagulation as clotting factors produced in liver (INR and PT)
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7
Q

A patient has the following liver function tests, what type of jaundice does he have?

A

Intrahepatic

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8
Q

How can Hep B be transmitted?

A
  • Vertical transmission
  • Sexual contact
  • Contaminateed needles (drug and needle stick injury)
  • Blood exposure
  • Close contacts, e.g sharing toothbrushes
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9
Q

What are the symptoms of acute Hep B?

A
  • Jaundice
  • Fatigue
  • Abdominal pain
  • Anorexia
  • Nausea
  • Vomiting
  • Arthralgia
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10
Q

What are the microbiological findings of Acute Hep B?

A
  • AST/ALT in 1000s
  • Incubation: 6 weeks to 6 months so may get missed
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11
Q

What are the complications of acute Hep B?

A
  • 50% no/vague symptoms and clears in 6 months
  • 1% sudden hepatic failure
  • Becomes chronic in 10% adults, 90% children
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12
Q

What are the different stages of serology for Hep B?

A
  • HBsAb produced in response to HBsAg
  • HBeAb produced in response to HBeAg
  • IgM and IgG in response to HBcAG

(can look at HBV DNA in PCR but not serology)

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13
Q

What is the definition of a chronic Hep B infection?

A

Persistance of HBsAg after 6 months

- 25% will develop cirrhosis and 5% will develop hepatocellular carcinoma

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14
Q

If you see IgG for HepB in a patients blood what can this mean?

A
  • May have had the infection and cleared it already or may be infected
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15
Q

What is the treatment for HepB?

A

- NO CURE

  • Life long antivirals
  • Not all people need antivirals as may be inactive carrier and have low viral load
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16
Q

What is the vaccination for Hep B?

A
  • The vaccination consists of a genetically engineered surface antigen (3 doses + boosters if required)
  • Produces surface antibody response:

I. >10 adequate

II. >100 long-term protection

17
Q

What would each of the following scenarios look like with a hepatitis B case? (indicate if present or absent)

A
18
Q

Who is at risk of Hep C transmission?

A
  • IVDU
  • Sexual contact (higher if HIV coinfected)
  • Vertical transmission
  • Blood transfusion before 1991
  • Needle stick injuries
19
Q

What is the disease progression of Hep C?

A

80% will become chronically infected

Of these some will develop chronic liver disease/cirrhosis, e.g HCC, decompensated liver disease

20
Q

What are the symptoms of a Hep C infection?

A

OFTEN GO UNOTICED SO DANGEROUS

21
Q

What are the complications of chronic liver disease/cirrhosis due to a chronic Hepatitis C infection?

A
  • Decompensated liver disease
  • Hepatocellular carcinoma (primary liver cancer)
  • Transplant
  • Death
22
Q

What are the blood tests involved in diagnosing Hep C?

A

- Serology – anti-Hep C antibody as it remains positive throughout life, even after clearance/cure (not protective, can get reinfected)

- Viral PCR – if positive, confirms on-going / chronic infection

23
Q

What is the treatment for Hep C?

A

- Cure but no vaccine

  • Directly acting antiviral drug combo:
  • 8-12 weeks, 90% chance of cure, £10,000 to £50,000 per couse and can get reinfected
24
Q

Discuss the risk of transmission of HIV, Hep B and C from needlestick injury.

A
25
Q

A medical student has a needle stick injury whilst taking blood from a known HIV positive man, what should be done?

A
  • First aid: bleed and wash wound
  • Collect blood from patient and med student
  • Inform occupational health
  • Check med students hep B vaccination status
  • Immediate PEP
26
Q

What should be done with HIV PEP?

A
  • Early administration of ARV within 72 hours
  • 3 a day for 28 days and then blood test at baseline, 1 month later, 3 months later
  • Counselling to discuss how to prevent transmission
27
Q

Distinguish between HIV, Hep B and Hep C in terms of:

  • Acute infection
  • Prevention
  • Outcome of untreated infection
  • Treatment
A

Infection 2023 (29 decks)

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