Week 3.3 - Hepatitis (Liver Symposium)

Question 1

what are the types of hepatitis and their causes?

Answer 1

A and E are enteric - acute self limiting
BCD are parenteral and cause chronic disease

Question 2

What is the clinical course of HepA?

Answer 2

infection, asymptomatic until 2-4 weeks. children usually stay asymptomatic but may develop jaundice

Question 3

What is the transmission of HepA?

Answer 3

feco-oral but may be by blood

Question 4

How do you diagnose HepA and what antigens?

Answer 4

HepA antigen specific IgM in the blood

Question 5

What is the prevelance of HepA? how do we battle it?

Answer 5

decreasing. we give vaccines to:
- hepB/C patients
- chronic liver disease
- travellers
- lab workers
- gay men,

Question 6

What is the structure of HepB given its antigens?

Answer 6

• surface gene HBsAg suggests presence of virus
• core antigen HBcAg in tissue sugegests active replication
• hep e antigen HBeAg suggests active replication
• inner shell with DNA polymerase helps replication

Question 7

What are the antibodies against HBV?

Answer 7

Anti-HBs - protection
IgM anti-HBc - acute infection
IgG anti-HbC - chronic infection
Anti-HBe - against e antigen

Question 8

What is the go to therapy for HBV?

Answer 8

we only treat those with a very high viral load. oral antiviral drug tenofir and pegylated interferon

Question 9

How do we approach HBV?

Answer 9

• check if virus present by checking surface antigen HBsAg
• check if its active by looking at HBcAg or HBeAg
• check for IgM - if present its acute, if not worry it is chronic (and 6 months)

Question 10

What occurs in most people with acute HBV?

Answer 10

it clears and we can see IgM anti HBc antibodies

Question 11

What occurs in individuals with chronic HBV?

Answer 11

• some have no progression,
• some cirrhosis,
• may lead to end stage liver failure or HCC (hepatocellular carcinoma)

Question 12

What is the natural history/ outcome of HepC?

Answer 12

• 15% resolve, 85% chronic.
• of those 80% stable and 20% go to cirrhosis.
• of that 75% progress slowly and 25% get HCC and transplant/die

Question 13

What are symptoms of HCV?

Answer 13

90% asymptomatic, 10% jaundice. most asymptomatic until cirrhosis. most have normal LFT’s. challenging to pick out.

Question 14

How do we diagnose and treat HCV?

Answer 14

diagnose with anti HCV antibodies. treatment used to be aggressive interferon but now direct antivirals - 90% success rate.

Question 15

what is HepD?

Answer 15

also known as delta virua. usually co-occurs with HBV and makes treatment difficult

Question 16

what is HepE?

Answer 16

self limiting in majority of people except pregnant women. no treatment or vaccine.

Question 17

What is the genome of hepatitis?

Answer 17

all RNA except HBV - DNA