ABCDE of hepatitis

Question 1

What is acute hepatitis?

Answer 1

Inflammation of the liver within 6 months

Question 2

What is chronic hepatitis?

Answer 2

Inflammation of the liver that persists longer that 6 months (by molecular test rather than symptoms)

Question 3

What is hepatitis?

Answer 3

Inflammation of the liver

Question 4

Symptoms of acute hepatitis

Answer 4

May be asymptomatic
GI upset
Tiredness
Muscle aches
Abdominal pain
Liver capsule swelling
Jaundice
pale stool and dark urine

Question 5

Signs of acute hepatitis

Answer 5

Tender hepatomegaly and jaundice

Signs of fulminant hepatitis (acute liver failure) eg. bleeding, ascites, encephalopathy

Question 6

What would bloods show for acute hepatitis

Answer 6

Raised transaminases and raised bilirubin

Question 7

What are viral causes of acute hepatitis?

Answer 7

Hepatitis A, B, D, C &E
Human herpes viruses (eg HSV, VZV, CMV, EBV)
Influenza, SARS-CoV-2

Question 8

What are non-viral, infectious causes of acute hepatitis?

Answer 8

Spirochaetes (syphilis)
Mycobacteria (M. tuberculosis)
Bacteria (bartonella)
Parasites (toxoplasma)

Question 9

What are non-infectious causes of hepatitis

Answer 9

Drugs
Alcohol
Other toxins/ poisoning
Non-alcoholic fatty liver disease
Pregnancy
Autoimmune hepatitis
Hereditary metabolic causes

Question 10

What are signs of chronic hepatitis

Answer 10

May be asymptomatic
Signs of chronic liver disease:
clubbing
Palmar erythema
Dupuytren’s contracture, spider naevi

Question 11

What does compensated chronic hepatitis mean?

Answer 11

Liver function is maintained

Question 12

What would decompensated chronic hepatitis show as?

Answer 12

Coagulopathy, jaundice, low albumin, ascites, encephalopathy

Question 13

What are other complications of chronic hepatitis?

Answer 13

HCC (hepatocellular carcinoma)
Portal hypertension (varices, bleeding)

Question 14

What are infectious causes of chronic hepatitis?

Answer 14

Hepatitis B, D, C (and E)

Question 15

What are non-infectious causes of hepatitis?

Answer 15

Drugs
Alcohol
Other toxins/ poisoning
Non-alcoholic fatty liver disease
Autoimmune hepatitis
Hereditary metabolic causes

Question 16

How is hepatitis A transmitted?

Answer 16

Faeco-orally
contaminated food and water
In high income countries can be due to travel, sex or injecting drugs.

Question 17

What is the incubation period for hepatitis A?

Answer 17

15-50 days (normally 14-28 days)

Question 18

True or false: hepatitis A is normally asymptomatic in adults?

Answer 18

False - normally symptomatic including abdominal pain in pre-iteric phase

Question 19

True or false: hepatitis A is self-limiting and is not a chronic disease?

Answer 19

True
Have 100% immunity after infection

Question 20

Which immunoglobulin is raised after initial exposure to hepatitis A?

Answer 20

anti-HAV IgM

Question 21

How to manage hepatitis A

Answer 21

Monitor liver function
Management of close contacts via vaccines

Question 22

How many genotypes of hepatitis E are there?

Answer 22

4 (G1, G2, G3, G4)

Question 23

How is hepatitis E transmitted?

Answer 23

Faeco-orally

G1 and G2:
contaminated food and water

G3 and G4:
undercooked meat (mammalian zoonotic reservoir, including pigs)

Question 24

True or false: more than 95% of cases are asymptomatic?

Answer 24

True

Question 25

Acute hepatitis is usually s____-l_____

Answer 25

self-limiting

Question 26

In G3 and G4 of hepatitis E, there is a risk of chronic infection in i_________ patients

Answer 26

immunosuppressed Rapid progression to cirrhosis

Question 27

Hepatitis E can occasionally cause a____-o_-c_____ liver failure

Answer 27

acute-on-chronic

Question 28

How to manage acute infection of hepatitis E?

Answer 28

Monitor for fulminant hepatitis / acute-on-chronic liver failure

Question 29

How is chronic hepatitis E managed?

Answer 29

Reverse immunosuppression if possible If persist despite this, give ribavirin for at least 3 months

Question 30

How is hepatitis B transmitted?

Answer 30

Blood-borne virus via blood and bodily fluids Including mother-to child. Baby vaccinated at birth also: household contact, blood products, iatrogenic, occupational, sexual, injecting drug use

Question 31

Over 95% of immunocompetent adults who get acute HBV infection, there is spontaneous r____

Answer 31

resolution

Question 32

What can chronic HBV infection cause?

Answer 32

Cirrhosis, decompensated cirrhosis, hepatocellular carcinoma

Question 33

What percentage of neonates/infants have development of Hep B to become chronic HBV?

Answer 33

90%

Question 34

What does a positive result for Hepatitis B surface antigen test

Answer 34

You are currently infected

Question 35

What is the incubation period of acute hepatitis B?

Answer 35

30-180 days (mean = 75 days)

Question 36

How is acute hepatitis B managed?

Answer 36

Monitor liver function Management of close contacts

Question 37

Over 95% of acute HVC infection will have...

Answer 37

spontaneous resolution

Question 38

What are treatment options for chronic hepatitis B?

Answer 38

Pegylated interferon-alpha 2a or Oral nucleoside analogues

Question 39

What are side effects of Pegylated interferon-alphas 2a?

Answer 39

Flu-like symptoms Myalgia autoimmune conditions Neuropsychiatric problems Blood dysplasia

Question 40

How does oral nucleoside analogues work?

Answer 40

Inhibit viral replication (HBV DNA polymerase)

Question 41

What hepatitis B prevention is there?

Answer 41

Antenatal screening of pregnant mothers Universal childhood immunisation immunisation of healthcare workers Screening and immunisation of sexual and household contacts Sterile equipment in healthcare

Question 42

What does hepatitis D require to replicate?

Answer 42

HBsAg (need surface antigen from hepatitis B to "cloak" itself and transmitt)

Question 43

How is Hepatitis D spread?

Answer 43

Blood-borne virus Via blood and bodily fluids

Question 44

True or false: Hepatitis D can be acquired simultaneously or after HBV

Answer 44

True

Question 45

How to treat Hepatitis D

Answer 45

Pegylated interferon-alpha for 48 weeks, buleviritide

Question 46

How is hepatitis C transmitted?

Answer 46

Blood-borne Via blood and bodily fluids

Question 47

What percentage of acute HCV infections would spontaneously resolve?

Answer 47

30%

Question 48

Testing for Hepatitis C

Answer 48

HCV antibody test (doesn't show whether infection is current or not) HCV RNA (shows whether infection is current) HCV genotype

Question 49

What treatment is there for hepatitis C?

Answer 49

Direct-acting antiviral therapy (DAA) Have high efficacy, minimal side effects 8-16 weeks, one tablet daily

Question 50

True or false: there is a vaccine for hepatitis C

Answer 50

False no vaccine

Question 51

True or false: previous infection of hepatitis C means no chance of re-infection

Answer 51

False