What do investigations for hepatitis E show?
IgM antibody in active disease and IgG antibody in recovery disease
HEV RNA detected by PCR in stools/serum
What are the two biggest issues in hepatitis E?
no vaccination available
very dangerous in pregnant women due to leading to fulminant hepatitis
What is the treatment and prognosis of hepatitis E?
good sanitation and hygiene
10-20% mortality if pregnant
How is hepatitis C transmitted?
through childbirth, sex or blood
What is the virus in hepatitis C?
single stranded RNA of the flavivirus family, and there is a rpid change in envelope proteins
How long is the incubation period for hepatitis C?
What do investigations show in hepatitis C?
HCV IgG antiobody after 8 weeks
HCV RNA detected seen with PCR - can show recovery or chronic progression
negative HAV and BBV markers
recombinant immunoblot assay
How does recombinant immunoblot assay compare with enzyme immunoassay in specificity and sensitivity in HCV?
increased specificity and decreased sensitivity in HCV
What is the treatment of acute hepatitis C?
educate and prevent
antiviral meds e.g. interferon
What precautions can be done to prevent hepatitis C?
screen blood products
universal precautions of bodily fluids
Side effects of ribavirin antiviral meds?
haemolysis, pruritis, nasal congestion
Side effects of teloprevir antiviral meds?
rash and anaemia
What causes acute hepatitis C to lead to chronic?
Cytokines are profibrotic and lead to fibrosis
can be asymptomatic increased ALT and positibe HCV antibodies
How is hepatitis B transmitted?
childbirth, sex and blood
What is the virus causing hepatitis B and what is it made of?
a partially stranded, enveloped DNA virus with an e-antigen
outer surface protein of HBsAg with mutations that can lead to chronic
surface coat produced by infected hepatocyes
what percentage of acute hepatitis B develop to chronic and what does it largely depend on?
depends on what age you get the virus - the younger, the more likely
what is a major complication of hepatitis B?
What do investigation show in acute hepatitis B virus and what do these mean in its progression?
HBsAg = hepatitis B surface antigen
HBcAg = core antigen
e-antigen = marker of infected cells
IgM antibodies and IgG antibodies in window stage
HBV DNA in serum
serum sicklenesslike immunological syndrome - rashes, polyartitis, fever, arteritis
What is the incubation period for hepatitis B?
What is the treatment of acute hepatitis B?
treat symptoms, monitor markers
antiviral meds - entecavir and tenofovir
vaccine at 0, 1 and 6 years, 5 year booster
How do investigations of hepatitis B differ in acute and chronic?
chronic won't have IgM or IgG present
How do investigations in an active and inactive hepatitis B differ?
active - increased ATL, HBV DNA in serum
inactive - normal ATL, decreased HBV DNA in serum
What is the treatment of chronic hepatitis B?
- seroconversion of HBeAG to antiHBe and reduce HBV DNA to
- anitviral agents e.g. interferon, adefovir, entercavir, lamivuidine
- daily tablet to stop replications of undetectable DNA
- post exposure prophylaxis
- increases survival and reduces progression
What scoring system is used in chronic hepatitis B?
Knodell scoring system
What virus is in hepatitis D?
single stranded defective RNA that needs HBV, in the deltaviridae family
What is the difference between coinfection and superinfection in hepatitis D?
coinfection = B and D infect at the same time
superinfection = D infects after B which is more severe
What do investigations show in hepatitis D?
HDV IgM and IgG (but not a protective antibody is this casein active
How is hepatitis D transmitted?
sex, bloods, IV drug users
What is the treatment of hepatitis D?
pergulated alpha 2a IFN
What is the Rome III criteria for diagnositic IBS?
Recurrant abdominal pain at least 3 days a month with 2 or more of:
improvement of pain with defecation, change in stool frequency, change in form of stool