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Medicine > Gastro - Viral Hepatitis > Flashcards

Gastro - Viral Hepatitis Flashcards

1
Q

Fill out the table

A
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2
Q

What does it mean that hepatitis is notifiable?

A

UK HSA must be notified of all cases

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3
Q

What are the other causes of hepatitis?

A

Alcoholic hepatitis
Non-alcoholic steatohepatitis
Autoimmune hepatitis
Drug induced hepatitis

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4
Q

What can cause drug induced hepatitis?

A

Paracetamol overdose

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5
Q

How does viral hepatitis present?

A

Nausea and vomiting
Jaundice
Pruritis
Muscle and joint aches
Abdominal pain
Fatigue
Flu-like illness

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6
Q

What does a hepatic picture look like on LFTs?

A

High ALT
High AST
Slightly elevated ALP

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7
Q

Why does AST and ALT rise in hepatitis?

A

Transaminases released into the blood due to inflammation

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8
Q

What is the most common form of viral hepatitis?

A

Hepatitis A

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9
Q

What type of virus is Hepatitis A?

A

RNA virus

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10
Q

How is Hepatitis A spread?

A

Faecal-oral route

Contaminated water or food

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11
Q

Is there vaccination for Hepatitis A?

A

Yes

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12
Q

What does Hepatitis A cause?

A

Cholestasis
Pruritis
Significant jaundice
Dark urine
Pale stools

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13
Q

What is diagnosis of Hepatitis A based on?

A

IgM antibodies

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14
Q

What can Hepatitis A potentially cause?

A

Acute liver failure (fulminant hepatitis)

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15
Q

How is Hepatitis A managed?

A

Usually resolved without treatment

Supportive management

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16
Q

What type of virus is Hepatitis B?

A

Double-stranded DNA virus

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17
Q

How is Hepatitis B spread?

A

Direct contact with blood or bodily fluids during sexual intercourse or sharing needles

Vertical transmission

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18
Q

How long are patients affected by Hepatitis B?

A

1-3 months

5-15% become chronic hepatitis B carriers

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19
Q

What happens in chronic Hepatitis B carriers?

A

Virus DNA integrated into cell nucleus

Continue to produce viral proteins

20
Q

What are the different antigens and antibodies in Hepatitis B?

A

Surface antigen HBsAg
Active infection

E antigen HBeAg
Highly infectious

Core antibodies HBcAb
Previous or current infection

Surface antibodies HBsAb
Vaccination, previous or current infection

Hepatitis B virus DNA HBV DNA
Direct count of viral load

21
Q

What does screening for Hepatitis B involve?

A

HBcAb - previous infection
HBsAg

If positive further testing for

HBeAg and HBV DNA

22
Q

How can you distinguish acute, chronic and past infection using HBcAb?

A

Measure IgM and IgG versions of HB

IgM
Active infection
High titre with acute infection
Low titre with chronic infection

IgG
Previous infection where HBsAg is negative

23
Q

What does HBeAg correlate to?

A

Infectivity

24
Q

What does the presence of HBeAg mean?

A

Patient is in the acute phase where virus is actively replicating

High HBeAg- highly infectious

Negative HBeAg and positive HBeAb implies virus was replicating but has stopped and now less infectious

25
Q

What does vaccination involve?

A

Injecting HBsAG

Patients then tested for HBsAb to confirm vaccine response

Vaccine requires 3 doses at different intervals

Part of UK 6-in-1 vaccine

26
Q

How is Hepatitis B managed?

A

Low threshold for screening patients at risk
Screen other viral infections
Referral to gastro, hepatology or ID for specialist management
Avoid alcohol
Education about reducing transmission
Contact tracing
Test for complications
Antiviral medication to slow disease
Liver transplantation (fulminant hepatitis)

27
Q

What type of virus is Hepatitis C?

A

RNA virus

28
Q

How is Hepatitis C spread?

A

Coming into contact with infected blood and bodily fluids

29
Q

Is there a vaccine for Hepatitis C?

A

No but there is a cure

30
Q

How is Hepatitis C cured?

A

Direct-acting antivirals

Sofosbuvir

Daclatasvir

Must be tailored to specific viral genotype

Cures 90%, taking 8-12 weeks

31
Q

What is the prognosis in untreated patients?

A

1/4 make full recovery
3/4 develop chronic hepatitis C

32
Q

What are the complications of Hepatitis C?

A

Liver cirrhosis
Hepatocellular carcinoma

33
Q

What testing is used for Hepatitis c?

A

Hepatitis C antibody
Hepatitis C RNA testing to confirm diagnosis, calculate viral load and identify genotype

34
Q

How is Hepatitis C managed?

A

Low threshold for screening patients at risk
Screen other viral infections
Referral to gastro, hepatology or ID for specialist management
Avoid alcohol
Education about reducing transmission
Contact tracing
Test for complications
Antiviral medication to slow disease
Liver transplantation (fulminant hepatitis)

35
Q

What type of virus is Hepatitis D?

A

RNA virus

36
Q

Who is affected by Hepatitis D?

A

Can only survive in patients who also have Hepatitis B infection

37
Q

Why can you not get Hepatitis D without Hepatitis B?

A

Hepatitis D attaches itself to HBsAg and cannot survive without it

38
Q

How many people are affected by Hepatitis D?

A

Very few

39
Q

What does Hepatitis D cause in Hepatitis B patients?

A

Increased complications
Increased disease severity

40
Q

How is Hepatitis D treated?

A

Pegylated interferon alpha

Over 48 hours

Not very effective and significant side effects

41
Q

What type of virus is Hepatitis E?

A

RNA virus

42
Q

How is Hepatitis E transmitted?

A

Faecal-oral route

Contaminated food or water

Very rare in the UK

43
Q

How does Hepatitis E present?

A

Mild illness
Virus is cleared within a month

No treatment required

44
Q

Is there a vaccination for Hepatitis E?

A

No

45
Q

What are some rare complications of Hepatitis E?

A

Progression to chronic hepatitis
Liver failure

Usually in immunocompromised patients

Medicine (91 decks)

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