Hepatitis Flashcards
What is the definition of hepatitis?
- Inflammation in the liver
- Ranges from chronic low-level to acute and severe (which causes necrosis and failure)
What are the causes of hepatitis?
- Viral
- Autoimmune
- NAFLD
- Alcoholic hepatitis
- Drug induced (e.g. paracetamol)
What are the clinical features of hepatitis?
- May be asymptomatic (particularly hep C)
- Fatigue
- Pruritis
- Muscle and joint aches
- Nausea and vomiting
- Jaundice
- Fever (in viral hepatitis)
What are the typical blood findings in hepatitis?
- Deranged LFTs: increased transaminases with a proportionally lower rise in ALP (hepatic picture)
- Bilirubin is also increased due to inflammation (thus causing jaundice and pruritus)
Which of the viral hepatitises are notifiable diseases?
All of them
How are the viral hepatitises transmitted?
- A and E are faeco-oral (A particularly from shellfish and associated with travellers; E particularly from undercooked pork, think BBQs)
- B, C and D are with direct contact with blood and bodily fluids (including vertical transmission)
Hepatitis A commonality, transmission, management, and availability of vaccine?
- Most common hepatitis worldwide but rare in UK
- Transmission is faeco-oral
- Management: self limiting over 1-3 months, give basic analgesia, notifiable disease
- Vaccine available
Hepatitis B transmission, investigations, management, prognosis, complications and availability of vaccine?
- Transmission is by direct contact with bodily fluids (including vertical transmission)
- Investigations: hepatitis B viral markers, have low threshold for screening
- management: refer to gastro/hepatology/infectious diseases, notifiable disease, management may be conservative or medical/surgical
- prognosis: most fully recover in 2 months, 10-15% become chronic hep B carriers
- Complications: cirrhosis and hepatocellular carcinoma
- Vaccination is routine as part of 6 in1
What is the conservative management of hep B and C?
- Smoking cessation
- Decrease alcohol
- Education about reducing transmission
- Inform at risk contacts
What is the medical management of hep B and C?
- Antiviral medication (can slow progression)
- Test and treat complications (fibroscan for cirrhosis, USS for hepatocellular carcinoma)
What is the surgical management of hep B and C?
Liver transplant for end stage disease
What is the transmission, symptoms, investigations, management, prognosis, complications and availability of vaccine for Hep C?
- Transmission: direct contact with blood or bodily fluids
- Symptoms: Hep C asymptomatic until it causes chronic liver disease
- Investigations: Hep C antibody (screening), Hep C RNA (diagnostic)
- Management: refer to gastro/ hepatology/ infectious diseases + notify PHE; management may be conservative, medical or surgical
- Prognosis: 25% make full recovery, 75% become chronic
- Complications: liver cirrhosis and hepatocellular carcinoma
- No hep C vaccine available
Hepatitis D?
- Very rare in UK
- Needs Hep B to be present to survive as it attaches to HBsAg
- Increases Hep B severity and complications
- No specific treatment
Hepatitis E?
- Very rare in UK
- Faeco-oral transmission (particularly pork)
- Causes mild, self limiting disease (no specific treatment)
- Can process to chronic hepatitis/liver failure in immunocompromised
- Suspect in severe hepatitis in pregnancy
What are the 2 types of autoimmune hepatitis?
Types 1 and 2
