Viral Hepatitis

Question 1

What is viral vs non viral hepatitis?

Answer 1

Non-viral is inflammation of the liver by another cause e.g. autoimmune/drugs/alcohol

Can lead to liver damage and cirrhosis

Viral is liver inflammation due to viral infection

Question 2

Which is more common in World/uk HepB or C

Answer 2

Hep B world 400,000,000

Hep C uk (1:1000 compared to 1:200)

Question 3

Which leads to worse consequences if not treated?

Answer 3

Hep C - 80% liver cirrhosis compared to Hep B 10%

Question 4

Can both lead to hepatocellular carcinoma?

Answer 4

Yes

Question 5

What is specific about hepatitis viruses compared to viruses that can have an effect on the liver (EBV, CMV, VZV) (2)?

Answer 5

They replicate in hepatocytes

They destroy hepatocytes

Question 6

What happens over time if hepatocytes are destroyed?

Answer 6

Cirrhosis

Question 7

What is the incubation period for Hep B vs Hep C

Answer 7

Hep B - 6wks-6months

Hep C- 6-12 weeks

Question 8

What is the viral structure of HepB vs C

Answer 8

Hep B - DNA double stranded enveloped

Hep C - RNA - ss + sense enveloped

Question 9

What blood test abnormalities might you see with Hepatitis and why?

Answer 9

Raised bilirubin - due to problem with conjugation to albumin during Haem (from RBC) metabolism

Raised ALT/AST - indication of cellular integrity

Raised ALP (not as much as raised ALT/AST though - more raised if blocked bile duct due to something else EXTRAHEPATIC

Raised INR/PT - due to coag factors made in liver

Low albumin - gives idea of liver FUNCTION - as it’s a protein made in the liver

Question 10

What are some extra hepatic causes of jaundice and what blood test in particular might be raised?

Answer 10

ALP

Carcinoma of bile duct etc
Common duct stones
Cholangitis

Question 11

What are the two causes of intrahepatic jaundice that show similar blood results?

Answer 11

Paracetamol overdose and hepatitis

Question 12

Which of Hep B and Hep C can be vertically transmitted?

Answer 12

Hep B

Question 13

What are symptoms of Hep B? Are there always symptoms?

Answer 13

Jaundice
Fatigue 
Abdo pain
Anorexia/Nausea/Vomitting
Arthralgia

Up to half no/vague symptoms

Question 14

What % of Hep B goes on to be chronic in adult and children? Is Hep B normally cleared? Can it lead to liver failure?

Answer 14

10% go on to chronic Hep B as adults
90% as children

Yes normally cleared within 6months

1% can lead to liver failure

Question 15

What serology can you do to test for Hep B?

Answer 15

Surface Antigen
E antigen
Core antibody IgM
E Antibody
Surface antibody 
Core antibody IgG

Question 16

What is chronic Hep B defined by in the serology? What is the outcome of these patients?

Answer 16

Persistence of surface antigen after 6 months

25% lead to cirrhosis
5% develop hepatocellular carcinoma

Question 17

If someone has surface antibody or core antibody IgG what does it mean?

Answer 17

Means infection clearing or cleared

Question 18

What test would you do for management of Hep B?

Answer 18

Hep B virus PCR

Question 19

Is there a cure for Hep B and why? What is the treatment?

Answer 19

No cure because it integrates into host genome

Lifelong anti-virals to suppress viral replication

Question 20

What is an inactive carrier of Hep B?

Answer 20

Presence of surface antigen but no symptoms, normal LFTs, low viral load, no liver damage - do need to be monitored though as this can change

Question 21

What is the vaccination for Hep B?

Answer 21

Genetically engineered surface antigen
3 doses + boosters if required
Produces surface antibody response
>100 = long term protection

Question 22

Why would you have + core antibody (IgG) but no surface antibody in chronic Hep B infection?

Answer 22

Because surface antibody indicates infection is clearing and chronic infection infection is not yet cleared

Question 23

Who is most at risk for Hep C?

Answer 23

IVDU

Question 24

Can you get vertical transmission?

Answer 24

Yes

Question 25

What is the disease progression of Hep C?

Answer 25

80% get chronically infected

Leads to end stage liver disease
Hepatocellular carcinoma
Transplant
Death

Question 26

What are the symptoms for Hep C?

Answer 26

80% don’t have symptoms - can have vague fatigue, anorexia, nausea, abdo pain

Question 27

What are the two serology tests for Hep C?

Answer 27

Hep C antibody

Viral load

Question 28

What does the results of Hep C antibody mean? and Viral load?

Answer 28

If + means either have it or have had it (as it persists forever)
If - means definitely don’t have it

If viral load positive after positive Hep C antibody test means have Hep C

Question 29

Is it curable? Vaccine?

Answer 29

Yes curable but no vaccine
Antivirals
8-12weeks 90% chance of clearing

Question 30

What is the problem with treating an IVDU with Hep C?

Answer 30

Likely to get reinfected - need rehab

Question 31

What would a HCSW do if get needlstick from known HIV patient who is an IVDU?

Answer 31

Patient: take blood to test for Hep B and C too

HCSW: take blood to test for HIV, Hep B and C baseline
Give PEP HIV for 28 days 
Bleed wound 
Check Hep B immunisation status
Inform occupational health
Condoms while at risk of HIV
Counselling and follow up

Question 32

Is there PEP available for Hep C? Hep B?

Answer 32

No

Hep B - can give booster vaccine

Question 33

What is the best prevention for Hep C?

Answer 33

Risk avoidance only as no vaccination and no PEP

Question 34

Which is the best prevention for HIV?

Answer 34

Condoms and PEP

Question 35

What is the best prevention for Hep B?

Answer 35

Vaccination