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Infection > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

Define hepatitis

A

Infection of the liver
Destruction of the hepatcytes - chronic inflammation, scarring, cirrhosis
Can caused by alcohol, autoimmune conditions,

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2
Q

What can cause “collateral” liver damage

A

Many systemic viruses cause “collateral”
liver damage
– Eg EBV, CMV, VZV

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3
Q

What are hepatitis viruses

A

Hepatitis viruses
– Replication specifically in hepatocytes
(hepatotropic)
– Destruction of hepatocytes

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4
Q

Describe the transmission and incubation. Hey b and c

A

B - blood/vertical/sex - 6wks-6mth
C - blood/sex - 6-12wks
Both may end up with chronic infection

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5
Q

Describe the viral structure of hepatitis

A

See slide

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6
Q

Describe the production/excretion of bilirubin

A

See slide

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7
Q

What are types of jaundice

A

Can be prehepatic, hepatic or post hepatic

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8
Q

What causes prehepatic jaundice

A

Haemolysis- unconjugated bilirubin to build up

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9
Q

What causes hepatic jaundice

A

Viral hepatitis, drugs ,alcoholic hepatitis, cirrhosis,

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10
Q

What causes pothepatic jaundice

A

Carcinoma of bile duct, pancreas head, ampulla, biliary stricture,

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11
Q

What are some liver function tests

A 
• Bilirubin 
• Liver transaminases
– Alanine transaminase
(ALT) - produced when hepatocytes are damaged
– Aspartate aminotransferase (AST) 
– Hepatocyte damage / cellular integrity
• Alkaline phosphatase (ALP)
– Biliary tract cell damage / cholestasis

• Albumin - a protein synthesises in liver

• Tests of coagulation
– clotting factors are synthesised in liver
– INR (International Normalised Ratio)
– Prothrombin time (PT)

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12
Q

How is hepatitis transmitted

A 
Transmission-who is at risk? 
• Vertical transmission (75% cases globally)
– Perinatal transmission in pts from highly endemic areas 
• Sexual contact 
• People who inject drugs 
• Close household contacts
– significant blood exposure 
• HCW via needlestick injuries
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13
Q

What are they symptoms of acute hep b

A
  • Jaundice
  • Fatigue
  • Abdominal pain
  • Anorexia/Nausea/Vomiting
  • Arthralgia
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14
Q

Hwo long is hepatitis b smth

A

• Incubation 6wks - 6 months.
• AST/ALT in 1000s
• Up to 50% - no/vague symptoms
• Clear infection within 6 months
• <1% - fulminant hepatic failure
• Becomes chronic in <10% if infected as adult
– 90% if infected in infancy (Asia/China)

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15
Q

What is the first antigen detectable in hepatitis b

A

Surface antigens - definitely have hepatitis - within 6/52; rise in ALT/DNA
Followed by e-antigen - highly infection

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16
Q

What is the first antibody to appear

A

Core antibody IGM

Followed by e-antibody - heralds disappearance of e-antigen + infectivety

17
Q

What is the last antibody to appear

A

Surface antibody - clearance of virus/recovery

Core antibody persists for life

18
Q

Define chronic hepatitis b infection

A
  • Persistence of HBsAg after 6 months - still infected

* 25% chronic infection leads to cirrhosis and ~5% will develop hepatocellular carcinoma.

19
Q

What is the treatment for chronic hepatits b

A

• NO CURE – integrates into host genome
• Life-long anti-virals to suppress viral replication
• Not required for everyone (e.g. “inactive” carrier)
– Low VL / normal LFTs / no liver damage
Important to keep monitoring lifelong

20
Q

Describe hep b vaccination

A 
• Genetically engineered surface antigen 
• 3 doses + boosters if required 
• Effective in most people 
• Produces surface antibody response
– >10 adequate
– >100 long-term protection
21
Q

Who is at risk of hepatitis c

A

• People who inject drugs (“Intravenous drug
users”) >90% of those with Hep C in UK
- IV Heroin / crack / metamphetamines - Crack or heroin smokers
• Sexual contact (<1% but higher if HIV co- infected)
• Infants born to HCV positive mothers (<5%)
• Blood transfusion prior to 1991.
• Needlestick injuries to HCW etc.

22
Q

Hoe does hepatitis c progress

A

~80% become chronically infected
• Of these some will develop chronic liver disease/cirrhosis. Resulting in:
– Decompensated liver disease
– Hepatocellular carcinoma (primary liver cancer)
– Transplant
– Death

23
Q

What are the symptoms of hep c

A

80% have no symptoms (acute or chronic)
• 20% have vague symptoms
–Fatigue –Anorexia –Nausea –Abdominal pain (RUQ)

24
Q

What are the blood tests for hep c

A

• Serology – anti-Hep C antibody only
• Remains positive life longer, even after clearance / cure
– Not protective, can get re-infected
• Viral PCR
– If positive, confirms on-going / chronic infection - this will confirm if currently infected or not

25
Q

What is the treatment for hep c

A 
• CAN BE CURED! 
• Directly acting antiviral drug combo
– 8-12 weeks
– >90% chance of cure
– £20,000 - £60,000 per course!
– Can get re-infected 
• No vaccine
26
Q

Give a summary of hiv/herb/c

A

Seeslide

Infection (14 decks)

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