Hepatitis Flashcards

1
Q

Viral causes of Hepatitis

A

Hep A, B, D, C, E
Human herpes viruses (HSV, VZV, CMV, EBV)

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2
Q

Which viral hepatitis are the most common contributers to liver disease and why

A

B & C because they go chronic

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3
Q

Non viral causes of hepatitis

A

Spirochetes (leptospirosis, syphilis)
Mycobacteria (tb)
Bacteria e.g. bartonella
Parasites e.g. toxoplasma

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4
Q

Global burden/trends of hep

A

Going up
B especially going up as no cure
C now a cure - so starting to come down
Chronic Hep B: 296 million
Chronic Hep C: 60 million

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5
Q

Hep B Transmission

A

Blood borne
Mother to child
Household contact
Blood products
Iatrogenic
Occupational
Sexual
IVDU

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6
Q

Natural history of Hep B
In immunocompetent adults

A

Acute infection either leads to spontaneous resolution (95%) (risk of reactivation if immunosuppressed) or chronic HepB infection (5%).
25% Chronic hep B leads to cirrhosis. Then may lead to HCC or decompensated cirrhosis

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7
Q

Symptoms of decompensated cirrhosis

A

Jaundice
Ascites
Encephalopathy
Coagulopathy
Hypoalbuminaemia
Variceal bleeding

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8
Q

Hep B natural history in neonates and infants

A

10% spontaneous resolution
90% chronic HBV infection

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9
Q

Hep D

A

defective RNA virus
requires HBsAg presence to replicate
Transmission: blood borne - most common = blood products, iatrogenic or IVDU

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10
Q

Hep C transmission

A

Blood borne - blood & bodily fluids
mother to child
household contact
blood products
iatrogenic
occupational
MSM
injecting drug use
tattoos, piercings

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11
Q

Hep C Natural history in immunocompetent

A

30% spontaneous resolution
70% chronic –> cirrhosis & HCC

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12
Q

Hep E

A

Endemic in UK
Faeco-oral transmission
- contaminated food and water
- undercooked meat

chronic - rare

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13
Q

Hep A

A

Very low prev UK
Faeco-oral transmission
- contaminated food and water
- linked to poor access to WASH
- In high income countries: travel, MSM & IVDU
.35% fulminant hep
No chronic disease
Lifelong immunity post exposure

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14
Q

What is elimination of disease

A

reduction to 0 incidence in defined geographical location, continued intervention measures recquired

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15
Q

What is elimination of infection

A

Reduction to zero of incidence of infection caused by a specific agent in a defined geographical area as a result of deliberate efforts; continued measures to prevent re-establishment of transmission are required.
e.g. poliomyelitis

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16
Q

What is eradication

A

Permanent reduction to zero of worldwide incidence of infection caused by a specific agent as a result of deliberate efforts; intervention measures are no longer needed.
e.g. smallpox

17
Q

What is extinction

A

doesn’t even exist in labs etc

18
Q

Indicators of eradicability

A
  • effective intervention available to interrupt transmission of agent
  • practical diagnostic tools to determine levels of infection that can lead to transmission
  • humans are essential for lifecycle: independent reservoir/environmental amplification makes v difficult to control
19
Q

Measures to eradicate Hep B

A
  • Universal childhood hep V vaccination
  • PEP for neonates with positive mothers
  • Screening of blood products
  • Single use sterile medical equipment
  • safe disposal of sharps & body waste
  • needle syringe exchange
  • opiate substitution therapy
  • safe sex education & condoms
  • vaccination of high risk
  • screening & immunisation of susceptible contacts
  • patient education
  • treatment as prevention
20
Q

potential measures to eradicate Hep C

A

No vaccine
- screening blood products
- sterile medical equipment
- universal precautions
- safe disposal
- needle exchange
- opiate therapy
- safe sex & condoms
- screening of contacts
- patient education
- DAA (treatment)
- treatment as prevention

21
Q

5 core WHO strategy interventions for viral hep

A
  • Vaccines (ABE)
  • Prevention of mother to child transmission of HBV
  • Injection, blood & surgical safety
  • harm reduction for IVDU
  • Treatment (B&C)
22
Q

Barriers to hep B elimination

A
  • immigrant population
  • stigma
  • low education levels
  • low resources (expand)
  • lack of political priority
23
Q

Barriers to Hep C elimination

A
  • difficult to engage at risk population (mostly IVDU)
  • Conflicting priorities
  • lack of awareness
  • stigma
  • cost of treatment
  • lack of resources
  • lack of political priority
24
Q
A