Gastro - Viral Hepatitis

Question 1

Fill out the table

Answer 1

Question 2

What does it mean that hepatitis is notifiable?

Answer 2

UK HSA must be notified of all cases

Question 3

What are the other causes of hepatitis?

Answer 3

Alcoholic hepatitis
Non-alcoholic steatohepatitis
Autoimmune hepatitis
Drug induced hepatitis

Question 4

What can cause drug induced hepatitis?

Answer 4

Paracetamol overdose

Question 5

How does viral hepatitis present?

Answer 5

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

Question 6

What does a hepatic picture look like on LFTs?

Answer 6

High ALT
High AST
Slightly elevated ALP

Question 7

Why does AST and ALT rise in hepatitis?

Answer 7

Transaminases released into the blood due to inflammation

Question 8

What is the most common form of viral hepatitis?

Answer 8

Hepatitis A

Question 9

What type of virus is Hepatitis A?

Answer 9

RNA virus

Question 10

How is Hepatitis A spread?

Answer 10

Faecal-oral route

Contaminated water or food

Question 11

Is there vaccination for Hepatitis A?

Answer 11

Yes

Question 12

What does Hepatitis A cause?

Answer 12

Cholestasis
Pruritis
Significant jaundice
Dark urine
Pale stools

Question 13

What is diagnosis of Hepatitis A based on?

Answer 13

IgM antibodies

Question 14

What can Hepatitis A potentially cause?

Answer 14

Acute liver failure (fulminant hepatitis)

Question 15

How is Hepatitis A managed?

Answer 15

Usually resolved without treatment

Supportive management

Question 16

What type of virus is Hepatitis B?

Answer 16

Double-stranded DNA virus

Question 17

How is Hepatitis B spread?

Answer 17

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

Vertical transmission

Question 18

How long are patients affected by Hepatitis B?

Answer 18

1-3 months

5-15% become chronic hepatitis B carriers

Question 19

What happens in chronic Hepatitis B carriers?

Answer 19

Virus DNA integrated into cell nucleus

Continue to produce viral proteins

Question 20

What are the different antigens and antibodies in Hepatitis B?

Answer 20

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

Question 21

What does screening for Hepatitis B involve?

Answer 21

HBcAb - previous infection
HBsAg

If positive further testing for

HBeAg and HBV DNA

Question 22

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

Answer 22

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

Question 23

What does HBeAg correlate to?

Answer 23

Infectivity

Question 24

What does the presence of HBeAg mean?

Answer 24

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

Question 25

What does vaccination involve?

Answer 25

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

Question 26

How is Hepatitis B managed?

Answer 26

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)

Question 27

What type of virus is Hepatitis C?

Answer 27

RNA virus

Question 28

How is Hepatitis C spread?

Answer 28

Coming into contact with infected blood and bodily fluids

Question 29

Is there a vaccine for Hepatitis C?

Answer 29

No but there is a cure

Question 30

How is Hepatitis C cured?

Answer 30

Direct-acting antivirals **Sofosbuvir** Must be tailored to specific viral genotype Cures 90%, taking 8-12 weeks

Question 31

What is the prognosis in untreated patients?

Answer 31

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

Question 32

What are the complications of Hepatitis C?

Answer 32

Liver cirrhosis Hepatocellular carcinoma

Question 33

What testing is used for Hepatitis c?

Answer 33

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

Question 34

How is Hepatitis C managed?

Answer 34

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)

Question 35

What type of virus is Hepatitis D?

Answer 35

RNA virus

Question 36

Who is affected by Hepatitis D?

Answer 36

Can only survive in patients who also have Hepatitis B infection

Question 37

Why can you not get Hepatitis D without Hepatitis B?

Answer 37

Hepatitis D attaches itself to HBsAg and cannot survive without it

Question 38

How many people are affected by Hepatitis D?

Answer 38

Very few

Question 39

What does Hepatitis D cause in Hepatitis B patients?

Answer 39

Increased complications Increased disease severity

Question 40

How is Hepatitis D treated?

Answer 40

Pegylated interferon alpha Over 48 hours Not very effective and significant side effects

Question 41

What type of virus is Hepatitis E?

Answer 41

RNA virus

Question 42

How is Hepatitis E transmitted?

Answer 42

Faecal-oral route Contaminated food or water Very rare in the UK

Question 43

How does Hepatitis E present?

Answer 43

Mild illness Virus is cleared within a month No treatment required

Question 44

Is there a vaccination for Hepatitis E?

Answer 44

No

Question 45

What are some rare complications of Hepatitis E?

Answer 45

Progression to chronic hepatitis Liver failure Usually in immunocompromised patients