Viral Hepatitis C

Question 1

def

Answer 1

hepatitis by infection with HCV

often follows a chronic course (80%)

Question 2

what sort of virus is HCV

Answer 2

small, enveloped, ssRNA virus of flavivirus family

Question 3

aetiology

Answer 3

1 transmission
-parenteral route
2 pathogenesis
-HCV not directly hepatotoxic
-humoral + cell-mediated response leads to hepatic inflammation + necrosis

Question 4

what groups are at risk of HCV

Answer 4

1 IV drug users
2 tattooing
3 those on haemodialysis

Question 5

what is a characteristic feature of HCV

Answer 5

lymphoid follicles in portal tracts

Question 6

epi

Answer 6

common
prevalence is <2% in developed countries
prevalence is higher in developing countries (middle east)

Question 7

history

Answer 7

1 asymptomatic (90%)
2 mild flu-like illness (<10%)
3 may be diagnosed incidentally with abnormal LFTs or in elderly with cirrhosis

Question 8

examination

Answer 8

1 no signs/signs of CLD
2 extra-hepatic manifestations
-skin rash
-renal dysfunction

Question 9

what is a skin rash caused by in HCV and what does it cause

Answer 9

mixed cryoglobulinaemia causing small-vessel vasculitis

Question 10

what are cryglobulins

Answer 10

proteins which become insoluble at low temperature

Question 11

what causes renal dysfunction

Answer 11

glomerulonephritis

Question 12

investigations

Answer 12

1 bloods
-HCV serology
-reverse transcriptase PCR
-LFTs
2 liver biopsy
-assesses inflammation + liver damage

Question 13

what would you look for in HCV serology for

Answer 13

acute: anti-HCV antibodies (igM)

past exposure/chronic: anti-HCV antibodies (igG)

Question 14

why is reverse transcriptase PCR used

Answer 14

to confirm infection following serology

Question 15

what would be found on LFTs with acute HCV

Answer 15

raised AST + ALT

Question 16

what would be found on LFTs with chronic HCV

Answer 16

2-8fold elevation in AST +ALT

Question 17

what is the AST to ALT ratio

Answer 17

most causes of liver injury mean ALT>AST

however an AST to ALT ratio of greater than 2:1 suggests alcoholic liver disease

Question 18

management

Answer 18

1 acute
-no specific management
-antipyretics, antiemetics, cholestyramine
2 chronic
-combined interferon-alpha and ribavirin

3 regular USS with cirrhosis

Question 19

what is inteferon-alpha

Answer 19

a cytokine which enhances bodies antiviral response

Question 20

how long are HCV genotypes treated for

Answer 20

1+4: 24-48wks

2+3: 12-24wks

Question 21

complications

Answer 21

1 fulminant hepatic failure
2 chronic HCV carriage
3 cirrhosis
4 hepatocellular carcinoma

Question 22

prognosis

Answer 22

80% progress to chronic HCV infection

20-30% develop cirrhosis

Question 23

what is the chief reason for liver transplant in the west

Answer 23

HCV

Question 24

risk factors for progression

Answer 24

male
older
alcohol use