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GI > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

what do hepatitis viruses cause

A

liver disease as their chief or sole manifestation

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2
Q

how is hep A spread

A

faecal oral, poor hygiene/ overcrowding

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3
Q

what are the clusters of hep A

A

in gay men/ PWIDs

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4
Q

can you get chronic hep A infection

A

no

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5
Q

how can all hep infections be confirmed

A

yellow top bottle of blood

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6
Q

how is acute hep A infection confirmed in the lab

A

clotted blood for serology (gold top vacutainer),

hep A IgM- usually detectable by onset

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7
Q

where is Hep E more common

A

in tropics

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8
Q

how is hep e spread

A

faecal oral

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9
Q

cases of hep e in the uk are thought to be acquired from

A

zoonoses- animals/ animal meat (pigs, dear, rabbits)

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10
Q

is there a vaccine for hep a

A

yes

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11
Q

is there a vaccine for hep e

A

no

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12
Q

who gets chronic hep e infection

A

immunocompromised

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13
Q

where in hep d found

A

only in people already infected with hep b

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14
Q

how is hep b spread

A

sex, mother to child, blood to blood

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15
Q

who is at higher risk of hep b in the uk

A

multiple sex partners, PWIDs, children of infected mothers,

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16
Q

what is vertical transmission

A

from blood at delivery

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17
Q

when is an infection chronic

A

when more than 6 months (presence of HBsAg)

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18
Q

what does a positive HBsAg mean

A

hep b surface antigen- present in blood of all infectious individuals

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19
Q

what is usually present in highly infectious hep b patients

A

hep b e antigen HBeAg

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20
Q

what s found in highly infectious hep b patients

A

HBeAg, hep B virus DNA in high titre

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21
Q

where is hep B IgM most likely found

A

in recently infected patients

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22
Q

when are anti-HBs present

A

in immunity to hep B

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23
Q

what can provide hep B immunity

A

vaccine or past infection

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24
Q

what can Hep B DNA test predict

A

risk of chronic liver disease

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25
Q

when does hep B affect liver function

A

when high HBV DNA level and inflammation of liver high as immune clearance or escape occurs

26
Q

how is HEP B controlled

A

minimise exposure, vaccination (pre and post exposure), post exposure prophylaxis (vaccine + HBIG)

27
Q

how is hep c transmitted

A

same as hep B- sex, blood to blood, mother to child

28
Q

is there a vaccine for hep B

A

yes

29
Q

is there a vaccine for hep C

A

no

30
Q

can you get chronic hep C

A

yes- 75% of cases are chronic

31
Q

what are the three immediate outcomes of hep a infection

A

asymptomatic- resolution

acute hepatitis- resolution

acute liver failure (rare)- resolution or death

32
Q

what happens if acute hepatitis develops into chronic infection

A

can cause chronic hepatitis- resolution or cirrhosis

cirrhosis- leads to cancer/chronic liver failure then death

33
Q

in hep c and hep b is there spontaneous cures to chronic infections

A

in hep B only

34
Q

how long usually does it take for cirrhosis to occur from chronic infection

A

more than 20 years

35
Q

how long does it take for cancer (hepatocellular carcinoma) to typically develop from chronic infection

A

more than 30 years

36
Q

what is another possible cure for hep infections

A

antiviral

37
Q

what are the outcomes of hep c infections

A

acute infection or asymptomatic

asymptomatic- (25% resolution) chronic infection- chronic hepatitis, cirrhosis 9or cancer), chronic liver failure, death

38
Q

what is usually the presenting complaint asymptomatic hep c infection

A

signs of chronic liver disease after decades of no symptoms

39
Q

how many people develop chronic infection in hep B

A

less than 5%, most resolve naturally

40
Q

what is infection of children with hep B like

A

more like pattern of hep C infection: high levels of chronic infection and complications

41
Q

what is the most common hep infection locally

A

hep E

42
Q

what can a positive antibody test for hep c not distinguish between

A

past or active infection

43
Q

how do you distinguish between a past or active hep c infection

A

hep c virus RNS by PCR- pos= active infection

44
Q

what is the antibody for hep c

A

IgG

45
Q

what is hep c virus control

A

no vaccine- minimise exposure

46
Q

what is the management for acute viral hepatitis

A

no antivirals

monitor for encephalopathy (brain disease, damage or malfunction)

monitor for resolution

notify public health

immunisation of contacts

test for other infections

vaccinate against other infections if at risk

47
Q

how is chronic viral hepatitis managed

A

anti virals (adefovir, entercavir, tenofovir, interferon alpha, peginterferon etc)

vaccination (against other hep viruses and if cirrhotic influenza and pneumococcal)

infection control

reduced alcohol

hepatocellular carcinoma awareness/ screening

48
Q

who should get antivirals

A

patients with;
chronic infection

risk of complications (evidence of inflammation/ fibrosis)

who are fit for treatment (cirrhotic treated as priority although established cirrhosis harder to treat, liver cancer contraindication, HIV coinfection contraindication)

49
Q

when should anti virals be given

A

before complications,
when evidence of inflammation,
when patient ready/ clinical priority

50
Q

what is interferon alpha

A

human protein that is part of the immune response to viral infection

51
Q

what are the side effects of interferon

alpha when given as antiviral via injection

A

minor; flu like symptoms

major: autoimmune disease, psychosis

52
Q

what is peginterferon used to treat

A

hep c

53
Q

what are the adverse effects of peginterferon

A

common: flu like symptoms- chills, sore muscles- malaise

rare, more severe: thyroid disease, autoimmune disease (SLE), psychiatric disease

54
Q

what are the adverse effects of ribavirin

A

anaemia

55
Q

what are the two treatment options for chronic hep b

A

suppressive antiviral drug (entecavir, tenofovir)- safer but suppression not cure

peginterferon- cure but side effects

56
Q

how does viral suppression work

A

reduction in HBV DNA and loss of HBeAg

57
Q

how do anti viral cures work

A

loss of HBsAg

58
Q

what are the aims/ benefits of chronic hep C therapy

A

virological, improved liver biochem and histopathology, reduced infectivity progression to cirrhosis and cancer and mortality

59
Q

what is sustained virological response (SVR)

A

loss of HCV RNA in blood sustained to 6 months after end of therapy

60
Q

what antiviral works against all virus genotypes

A

sofosbuvir, voxilaprevir, velpatasvir

61
Q

what is the standard treatment for HCV

A

interferon free courses of 2 or 3 antivirals- choice based on genotype of virus and load, stage of disease

GI (64 decks)

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