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Infection > Hepatitis Self-Learning Guide > Flashcards

Hepatitis Self-Learning Guide Flashcards

1
Q

What is the most obvious sign of hepatitis?

A

Jaunice with liver tenderness

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2
Q

True or false:

Viral hepatitis is a disease which should be notified to public health

A

True

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3
Q

What are the four presentations of viral hepatitis?

A 
Subclinical illness
Anicteric illness (symptoms but no jaundice) 
Icteric illness (symptoms with jaundice) 
Fulminant hepatitis (severe jaundice w hepatic failure & high mortality)
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4
Q

What will biochemistry Ix show in acute hepatitis infection?

A

Raised ALT and AST (which are released into serum in xs by damaged hepatocytes)

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5
Q

How does hepatitis A often present?

A

Usually mild/subclinical or anicteric in children under 5

Severity increases with age

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6
Q

What is the incubation period of Hep A?

A

28d

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7
Q

What are the symptoms of Hep A?

A

Fever, malaise, anorexia, nausea, vomiting, upper ab pain

Jaundice and darkening of urine develop later due to presence of unconjugated bilirubin

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8
Q

What is the transmission of Hep A?

A

Faecal-oral

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9
Q

In which groups of people are outbreaks of HAV more common?

A

MSM

IVDA

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10
Q

What kind of virus is HAV?

A

Picornavirus (small RNA virus)

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11
Q

What is the serology of someone with HAV like?

A

HAV IgM antibodies usually present at onset of symptoms & decline to non-detectable levels after 3-6m

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12
Q

What is the serology of someone who has had HAV in the past like?

A

Anti-HAV IgG antibodies present (reflecting immunity)

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13
Q

What is the treatment of HAV infection?

A

Supportive

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14
Q

How can HAV be prevented?

A

Good hygiene and sanitation

HAV vaccine

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15
Q

What is usually used as prophylaxis for close contacts for those with HAV?

A

Human normal Ig (which gives immediate passive protection for about 4m)

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16
Q

What kind of vaccine is HAV?

A

Killed

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17
Q

Who should be vaccinated against HAV?

A

Sewage workers, seronegative haemophiliacs, MSM with multiple partners, travellers to endemic areas, PWID, chronic liver disease, HIV patients

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18
Q

What is the prognosis of Hep A infection?

A

Usually good

No chronic liver damage

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19
Q

What are uncommon complications of Hep A infection?

A

Prolonged cholestatic jaundice
Relapsing hepatitis
Haematological problems, e.g. aplastic anaemia

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20
Q

What is the incubation period of Hep B?

A

Few weeks-6m

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21
Q

What are the symptoms of acute Hep B infection?

A

Anorexia, lethargy, nausea, fever, ab discomfort, arthralgia,

Later - urticarial skin lesions, dark urine, jaundice

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22
Q

What is the mechanism of acute hepatitis (HBV)?

A

Believed to be immune mediated - the greater the antibody/antigen reaction the more severe the hepatitis

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23
Q

How do children tend to present with HBV?

A

Neonates - asymptomatic
Subclinical/anicteric infection most common in childhood
Clinical disease increases with age

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24
Q

1% of patients with HBV infection develop what?

A

Fulminating hepatitis with DIC and encephalopathy

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25
Q

What is the course of HBV infection in most patients?

A

Full recovery and clearance of infection

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26
Q

What kind of virus is Hep B?

A

Hepadnavirus

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27
Q

What are the three viral forms of HBV seen in blood?

A

Infectious viral particles
Non-infectious spheres
Tubules which consist of Hep B surface antigen

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28
Q

Where is the Hep B core antigen found?

A

In the core/nucleocapsid

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29
Q

What is Hep B e antigen derived from?

A

It splits off from the HBcAg in the liver cell during new virus formation and is release in a free soluble form in the serum

30
Q

Where is HBV-DNA found in the serum?

A

In infectious viral particles

31
Q

What are the markers of viral replication in the blood in those infected with Hep B?

A

HBeAg and HBV-DNA

32
Q

What is HBsAg a marker of?

A

Acute and chronic HBV infection

33
Q

What Ag is a marker of high infectivity?

A

HBeAg +ve chronically infected individuals

Those individuals are also at increased risk of hepatoma

34
Q

What are the routes of transmission of HBV?

A

Vertical, sexual, parenteral (e.g. needlestick injury)

35
Q

What are the risk factors (most –> least) for HBV in the UK?

A

PWID
Multiple sexual partners
Immigration from area of high endemnicity
People with learning disability/live in residential care
Those on haemodialysis/with haemophilia
Sexual partners of those with above risk factors
Babies born to mothers at risk
Tattooing or body piercing with non-sterile equipment
Medical equipment not properly decontaminated

36
Q

What is the issue with pregnant woman being infected with HBV?

A

Babies born to these mothers are at v high risk of perinatal infection
90% become chronically infected if no preventative immunisation given at birth

37
Q

What is the risk of transmission following needle stick injury of HBV?

A

30%

38
Q

In most patients who present with HBV infection, ______ can be detected in the serum

A

HBsAg

If present late/severe fulminant acute disease then anti-HBc IgM may be present

39
Q

In patients who recover completely from acute infection, what seroconversion takes place?

A

HbsAg –> anti-HBs

i.e. development of antibodies against surface antigen

40
Q

What is seroconversion?

A

Development of significant levels of specific antibody following vaccination or infection

41
Q

Define chronic HBV infection

A

Persistence of HBsAg in the serum for more than 6 months

42
Q

In which groups of people is chronic HBV infection more common?

A

Infants/children, males, immunodeficient

43
Q

What are chronically HBV infected individuals at risk of?

A

Chronic liver disease, less commonly, membranous glomerulonephritis, polyarteritis nodosa

44
Q

What are two of the long term sequlae of untreated liver disease?

A

Cirrhosis and hepatoma

45
Q

True or false:

Jaundice is a common finding in HBV infection

A

False

Unless advanced disease

46
Q

What are the indications for antiviral therapy in those with chronic HBV infection?

A

2 of the following:

  • HBV DNA >2 000 IU/ml
  • Raised ALT
  • Significant liver inflammation or fibrosis
47
Q

How do you treat chronic HBV infection?

A

Pegylated alpha-interferon (s/c injection once weekly for 12m)
Nucleotide analogues - entecavir/tenofovir
Liver transplant for advanced cirrhosis/hepatoma

48
Q

How do the nucleotide analogues work?

A

Inhibit the viral enzyme reverse transcriptase which is req for HBV replication

49
Q

What is the problem with transplanting a liver in someone with chronic HBV infection?

A

V. likely to get HBV infection in new liver

Must give combined antivirals and hep B specific immunoglobulin to reduce this risk

50
Q

What are the most important ways of preventing HBV infection?

A

Immunisation
ICP
Screening of blood/organ donors

51
Q

What does the HBV vaccine contain?

A

Contains HBsAg

52
Q

What is the basic regimen for giving HBV vaccine?

A

0, 1, 6 months

53
Q

What are poor responses to HBV vaccine associated with?

A

Age >40, smoker, obese, wrong injection site, immunocompromised

54
Q

In which groups of people is HBV vaccine recommended?

A

Healthcare workers, those travelling to endemic areas for >1y, renal dialysis patients, those who change sexual partners frequently, selected police and emergency services personnel, close contacts of those with chronic/acute HBV infection

55
Q

What is used for passive immunisation against HBV?

A

Hep B specific immunoglobulin

56
Q

Who is Hep B specific immunoglobulin given to?

A

Infants born to mothers with chronic HBV infection who are HBsAg +ve following acute infection
Healthcare workers not adequately immunised who have had contact with mucous membranes/needle stick injuries with an infected patient
Previously unprotected sexual contacts & family contacts of individuals who have acute/chronic HBV infection

57
Q

What are complications of hepatitis B infection?

A 
Chronic hepatitis (Ground glass hepatocytes may be seen on light microscopy)
Fulminant liver failure
Hepatocellular carcinoma
GN
Polyarteritis nodosa
Cryoglobulinaemia
58
Q

What level of anti-HBs indicates an adequate response to the vaccine?

A

> 100

10-100 suboptimal give additional dose

<10 - nonresponder, give further vaccine course

59
Q

What toxin does c. perfringens produce?

A

alpha-toxin which causes gas gangrene and haemolysis

60
Q

What are features of c. perfringens infection?

A

Tender, oedematous skin with haemorrhagic blebs and bullae

61
Q

What does c. botulinum infection lead to?

A

Prevents ACh release leading to flaccid paralysis

62
Q

What toxins does c. difficile produce?

A

Exotoxin and cytotoxin

63
Q

What does c. tetani infection lead to?

A

Releases exotoxin (tetanospasmin) that prevents release of glycine from Renshaw cells in spinal cord –> spastic paralysis

64
Q

What two types of tests can be done to check for syphillis infection?

A 
Cardiolipin test (not treponeme specific), e.g. VDRL or RPR become negative after treatment
Treponemal specific antibody tests, e.g. TPHA remains positive after treatment
65
Q

What are causes of false cardiolipin tests?

A 
Pregnancy
SLE
Anti-phospholipid syndrome
TB
Leprosy
Malaria
HIV
66
Q

What kind of virus is hepatitis E?

A

RNA hepevirus

67
Q

How is hep E spread?

A

Faecal-oral

68
Q

What are the symptoms/signs of hep E like?

A

Very similar to hep A

69
Q

Can hep E lead to chronic liver disease/increased risk of hepatocellular carcinoma?

A

No

70
Q

What organism causes diphtheria?

A

Gram positive bacteria corynebacterium diphtheriae

71
Q

What are clinical features of diphtheria?

A

Diphtheria toxin causes diphtheric membrane on tonsils (due to necrotic mucosal cells)
Systemic distribution can lead to myocardial, neural, and renal tissue necrosis

Suspect in recent travel to Eastern europe/russia/asia
Sore throat
Bulky cervical lymphadenopathy
Neuritis, e.g. cranial nerves
Heart block

Infection (22 decks)

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