General

Question 1

HBV serology:

sAg - Neg

sAb - Neg

cAb - Neg

Answer 1

Never had HBV and not vaccinated

Question 2

HBV serology

sAg - Neg

cAb - Neg

sAb - Pos

Answer 2

Vacinated but never had HBV

Question 3

HBV Serology

sAg - neg

sAb - Pos

cAb - Pos

Answer 3

Previous HBV infection, now resolved

Question 4

HBV serology

sAg - Positive

sAb - Positive

cAb - Positive

Answer 4

Currently infected with HBV

Question 5

How is Hep A&E transmitted?

Answer 5

Oral-faecal

Question 6

Symptoms of hepatitis

Answer 6

Abdo pain

Dark urine

Pale steatorea

Jaundice

Puritis (itch)

Question 7

What is the incubation period of viral hep?

Answer 7

about 2 weeks before detectable in faeces, and 4 weeks before Ig is detectable.

If there is an exposure eg needlestick, multiple follow up tests are required to check for new development of Ag/Ab.

Question 8

?Hepatitis investigations

Answer 8

LFT

U&E

FBC

Serology

Clotting

if serology positive - PCR for virus genotype

Question 9

Acute HBV treatment

Answer 9

Nothing!

Unless otherwise indicated - immunocomp, pregnant, cirrhosis etc.

If it becomes chronic (6 months) - treat

Question 10

Chronic HBV treatment - 1st and 2nd line

Answer 10

1st Peginterferon

2nd Entecavir / Tenefovir

Question 11

Treatment for acute HCV

Answer 11

Nothing - usually self limiting

Question 12

Treatment for chronic HCV

Answer 12

A changeable feast!

• Need PCR for genotype
• differs depending on previous treatment for Hepatitis.
• Generally mixture/all of:

Pegylated IFN

Ribavirin

Directly Acting Antivirals (DAAs)

Question 13

Treatment of HDV

Answer 13

Only occurs in the presence of HBV,

treat at same time ie :

1. IFN
2. entecavir / tenafovir

Question 14

What enzyme is associated with the clearence of high levels of alcohol (indicative of long term alcohol use)

Answer 14

Gamma GT

Question 15

Disease and relevance to liver

Answer 15

Wilson’s disease

Inability to excrete copper, which then builds up in certain organs: eyes and liver among others. Can lead to acute liver disease.

Question 16

What different classifications of jaundice and anaemia can there be?

Answer 16

prehepatic, associatd with unconjugated bilirubin anaemia

posthepatic, associated with conjugated bilirubin

Question 17

Other than Hep A-G, what other viruses can commonly cause hepatitis?

Answer 17

EBV, CMV.

Both also AIDS defining ilnesses if causing hepatitis in HIV pos.

Question 18

Non viral causes of hepatitis

Answer 18

Fatty liver disease

Non-alcohol fatty liver disease (NAFLD)

Wilsons

Autoimmune

Budd-Chiari

Primary Sclerosing Cholangitis (PSC)

Question 19

LFT raise AST causes

Answer 19

AST is a mitochondrial enzyme. It can be raised due to:

• CHF
• Muscle injury
• Hepatitis……high levels in necrosis
• MI

Question 20

LFT raised ALT causes

Answer 20

specific to liver injury (unlike AST)

It’s ratio wrt AST can indicate specific pathologies

Question 21

Acute viral hepatitis. What do you expect AST and ALT to be?

Answer 21

Both raised, ALT higher than AST

If AST is raised - chirrosis

Question 22

Viral hepatitis confirmed,

AST and ALT are raised,

AST is higher than ALT

What can be deduced?

Answer 22

Chirrosis

AST higher than ALT in viral hepatits = ChirroSiS

Question 23

Serology negative

high ALT

Very high AST

Most likely cause?

Answer 23

Alcoholic and or fatty liver disease

usually presents with high AST:ALT ratio

Question 24

Rasied ALP alone

Answer 24

• choleostasis
• Bone mets
• intestineal problems
• from placenta

Look at ASP in conjunction with the other LFTs - if Gama GT is also raise, assume the ASP is rasied due to liver.

Question 25

Raised Gama GT Rasied ASP

Answer 25

Safe to assume that rasied ASP is due to liver Intra and extrahepatic **Choleostasis** causes raised ASP