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Year 3 TCD > 3. Hepatitis > Flashcards

3. Hepatitis Flashcards

1
Q

What does hepatitis mean?

A

Inflammation of the liver

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2
Q

What are the different causes of hepatitis?

A
  • Alcoholic hepatitis
  • Non alcoholic fatty liver disease
  • Viral hepatitis
  • Autoimmune hepatitis
  • Drug induced hepatitis (e.g. paracetamol overdose)
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3
Q

How does hepatitis present in a patient?

A

THEY CAN BE ASYMPTOMATIC

Typical symptoms include;

  • RUQ Abdominal pain
  • Fatigue
  • Pruritus (itching)
  • Muscle and joint aches
  • Nausea and vomiting
  • Jaundice
  • Fever (in viral hepatitis)
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4
Q

What is classed as acute hepatitis and what is classed as chronic hepatitis?

A

Anything under 6 months is acute, and anything over 6 months is chronic

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5
Q

How does a patient with acute hepatitis present?

A

Regardless of the cause, all patients with acute hepatitis present the same.

  • generally unwell
  • jaundiced
  • RUQ pain
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6
Q

What would you expect from a blood test of someone with acute hepatitis?

A
  • Raised AST and ALT above 1000

- High bilirubin

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7
Q

How does a patient with chronic hepatitis present?

A

As chronic involves low-grade inflammation, these individuals don’t normally present with symptoms, and instead are picked up through screening.

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8
Q

What would you expect from a blood test of someone with chronic hepatitis?

A

Blood tests show mild elevation of ALT

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9
Q

What is fulminant hepatitis?

A

Fulminant hepatitis is when the acute hepatitis gets worse, and is associated with liver failure. It is defined as the development of encephalopathy within 28 days of jaundice, but it has to be acute liver disease. ie. If someone came in with the first presentation of alcohol related liver disease, it would not be called fulminant hepatitis as the alcohol related problem has been there for a lot longer than 28 days.

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10
Q

How does a patient with fulminant hepatitis present?

A

Same as acute (generally unwell, jaundiced, RUQ pain) PLUS

  • bruising (due to coagulopathy)
  • Confusion (due to hepatic encephalopathy)
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11
Q

What would you expect from a blood test of someone with fulminant hepatitis?

A

Same as acute hepatitis (Raised AST and ALT above 1000 + High bilirubin) PLUS

  • Coagulopathy
  • Signs of renal failure
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12
Q

What is the management of someone with fulminant hepatitis?

A

They have a very poor prognosis, with the patient requiring an urgent liver transplant, or it results in death.

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13
Q

How are the levels of hepatitis A worldwide and in the UK?

A

Worldwide - Most common viral hepatitis

UK - relatively rare with under 1000 cases a year

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14
Q

What type of virus is hepatitis A?

A

RNA virus

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15
Q

How is hepatitis A transmitted?

A

Faecal-oral route usually by contaminated water or food

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16
Q

What does it indicate if someone has a distaste of cigarretes?

A

Hepatitis

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17
Q

How do you treat hepatitis A?

A

It normally resolves itself without treatment in 99% of individuals

For the 1%, these people normally have underlying liver conditions, and they go on to get fulminant hepatitis, so require a liver transplant.

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18
Q

Is a vaccination available for hepatitis A?

A

Yes, and it is typically offered to those travelling, or with another liver disease present

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19
Q

How long does it take before viral markers are detected in the blood in hepatitis A?

A

After 2 weeks, IgM antibodies build up in the blood, and they peak at 4 weeks

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20
Q

What happens to IgG antibodies in hepatitis A?

A

They very slowly increase from around 2 weeks onwards, and they surpass the levels of IgM by around the 8th week

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21
Q

If someone is IgM positive for hepatitis, what does this indicate?

A

IgM is the first viral marker made, so therefore it is indicative of an acute infection

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22
Q

If someone is IgG positive, and IgM negative for hepatitis, then what is this a sign of?

A

A previous hepatitis infection

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23
Q

Who do you need to inform if someone has viral hepatitis? For which viral hepatitis?

A

Public Health need to be informed of any viral hepatitis cases in the UK

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24
Q

What type of virus is hepatitis B?

A

DNA virus

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25
Q

How is hepatitis B transmitted?

A

Direct contact with blood or bodily fluids (tattoos, unprotected sex, minor abrasions)

AND

Vertical transmission (mother to child during pregnancy)

26
Q

What percentage of people with hepatitis B fully recover? What space of time does this take? What happens to the rest?

A

90% recover within 2 months.

10% go on to become chronic hepatitis B carriers.

27
Q

What increases your chance of having a hepatitis B infection become chronic?

A

The younger you are, the more likely you are to have it become chronic.

28
Q

What is a major risk of having hepatitis B?

A

It can cause primary liver cancer, which is the most commonest childhood tumour in the areas of the world without a hepatitis B infection

29
Q

What is the chance of developing a primary liver cancer for those with hepatitis B and a cirrhotic liver?

A

5% each year

30
Q

What are the different viral markers you can test for in hepatitis B

A
  • Hep. B Surface Antigen (HBsAg)
  • Hep. B Surface Antibody (HBsAb)
  • Hep. B E Antigen (HBeAg)
  • Hep. B E Antibody (HBeAb)
  • Hep. B Core Antigen (HBcAg)
  • Hep. B Core Antibody (HBcAb)
  • Hep. B DNA Viral Load (HBV DNA)
31
Q

Which viral markers do you use to screen someone for hepatitis B?

A
  • Hep. B Core Antibody (HBcAb) - check for previous infection
  • Hep. B Surface Antigen (HBsAg) - check for active infection
32
Q

If the hepatitis B screen comes back positive, what should you then check for?

A
  • Hep. B E Antigen (HBeAg) - to see how infective the individual is
  • Hep. B DNA Viral Load (HBV DNA)
33
Q

When and why would HBeAg rise?

A

HBeAg is found in the space in between the the outer membrane and the core of the virus. Therefore, it only gets into the blood when there is active replication going on, indicating that the individual is infective.

34
Q

When can you have a positive HBsAb result?

A

You can have it either during

  • the infection (once you start to mount an immune response)
  • after a vaccination
35
Q

How can you tell if the individual is having an acute hepatitis B infection?

A

High concentration of IgM HBcAb

36
Q

How can you tell if the individual has got a chronic hepatitis B infection?

A

Low concentration of IgM HBcAb

37
Q

How can you tell if the individual has had a previous hepatitis B infection?

A

High concentration of IgG HBcAb

PLUS

Negative test of HBsAg

38
Q

What does it indicate when the HBeAg is negative but the hepatitis B e antibody is positive?

A

This implies they have been through a phase where the virus was replicating and but the virus has now stopped replicating and they are less infectious.

39
Q

How can you tell if someone has had a hepatitis B vaccination from the viral markers?

A

They will have a positive HBsAb, but a negative for everything else

40
Q

Who gets the hepatitis B vaccination in the UK?

A

As of 2017, everyone does, as part of the 6 in 1 vaccine at childbirth.

41
Q

How many doses are required for the hepatitis B vaccine?

A

3

42
Q

What is the most important factor in determining whether an acute hepatitis B infection becomes chronic?

What are the percentages?

A

Age

  • If you get it before your 1st birthday, there is a 90% chance that it leads to chronic hepatitis
  • If you are between 1-5 years old, it then drops down to a 30% chance
  • If you are older than 5, then there is only a 1-5% chance that it becomes chronic
43
Q

How do you manage a chronic hepatitis B infection?

A
  • Stop smoking and alcohol
  • Education about reducing transmission and informing potential at risk contacts
  • Testing for complications: FibroScan for cirrhosis and ultrasound for hepatocellular carcinoma
  • Antiviral medication can be used to slow the progression of the disease and reduce infectivity
  • Liver transplantation for end-stage liver disease
44
Q

What type of virus is hepatitis C?

A

RNA virus

45
Q

How is hepatitis C spread?

A

Blood and bodily fluids

46
Q

Is there a vaccine for hepatitis C?

A

No

47
Q

How is hepatitis C managed?

A

Hepatitis C is curable with direct acting antiviral medications.

48
Q

What percentage of people make a full recovery from hepatitis C? What happens to the rest?

A

25% of individuals fight off the virus and make a full recovery, whilst for the remaining 75% of individuals, the infection becomes chronic leading to cirrhosis.

49
Q

What is used to confirm the diagnosis of hepatitis C?

A

Hepatitis C RNA testing is used to confirm the diagnosis of hepatitis C

50
Q

What type of virus is hepatitis D?

A

RNA virus

51
Q

Who can get a hepatitis D infection?

A

The virus attaches itself to HBsAg to survive, and cannot survive without this protein. Therefore, it can only affect those with a hepatitis B infection

52
Q

What does hepatitis D cause?

A

It increases the complications and disease severity of hepatitis B

53
Q

How is hepatitis D treated?

A

There is no specific treatment for hepatitis D

54
Q

What virus is hepatitis E?

A

RNA virus

55
Q

How is hepatitis E transmitted?

A

faecal oral route

56
Q

How serious is hepatitis E?

A

Normally it produces only a mild illness, the virus is cleared within a month and no treatment is required. Rarely it can progress to chronic hepatitis and liver failure, more so in patients that are immunocompromised.

57
Q

Is there a vaccination for hepatitis E?

A

No

58
Q

What is autoimmune hepatitis?

A

This is a rare cause of chronic hepatitis where the body produces T-cells against its own hepatocytes.

59
Q

What are the types of autoimmune hepatitis?

A

Type 1 autoantibodies : typically affects women in late 40s/50s. More chronic than type 2.

Type 2 autoantibodies : patients in their teenage or early twenties present with acute hepatitis with high transaminases and jaundice.

60
Q

How is autoimmune hepatitis diagnosed?

A

Liver biopsy

61
Q

How is autoimmune hepatitis treated?

A
  • High dose steroids (prednisolone) initially
  • Other immunosuppressants such as azathioprine. This is successful in inducing remission but is required life long.
  • Liver transplant can be required in end stage liver disease, but the autoimmune hepatitis can recur in transplanted livers.

Year 3 TCD (36 decks)

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