Hepatitis Flashcards
(55 cards)
What are the different types of hepatitis?
Autoimmune A B C D E Alcoholic Ischaemic
What is autoimmune hepatitis?
Condition of unknown aetiology
Commonly seen in young women
3 types
Concurrent autoimmnue disease are often present
What are the 3 types of autoimmune hepatitis?
Type I: ANA and/or anti-SMA
Adults and children
Most common 80%
Type II: Anti-liver/kidney microsomal type 1 antibodies
Only children
Type III - Soluble liver kidney antigen
Middle aged adults
What are the presenting features of autoimmune hepatitis?
Acute - jaundice, fever Amenorrhoea Antibodies, raised IgG Liver biopsy showing inflammation Hepatomegaly and Splenomegaly Stigmata of chronic liver disease But patients can be asymptomatic
What is the management for autoimmune hepatitis?
steroids, other immunosuppressants e.g. azathioprine
liver transplantation
What is Hepatitis A?
Hepatitis A is typically a benign, self-limiting disease, with a serious outcome being very rare.
What causes Hepatitis A?
RNA picornavirus
transmission is by faecal-oral spread, often in institutions
2-4 week incubation
What are the presenting features of Hep A?
flu-like prodrome abdominal pain: typically right upper quadrant tender hepatomegaly jaundice cholestatic liver function tests
Who should have a Hep A vaccine?
people travelling to areas of high prevalence
people with chronic liver disease
patients with haemophilia
men who have sex with men
injecting drug users
individuals at occupational risk: laboratory worker; staff of large residential institutions; sewage workers; people who work with primates
What causes Hep B?
double-stranded DNA hepadnavirus
spread through exposure to infected blood or body fluids + vertical transmission from mother to child
6-20 week incubation
What are the presenting features of Hep B?
Fever
Jaundice
Elevated liver transaminases
What are some complications of hepatitis B?
chronic hepatitis (5-10%). ‘Ground-glass’ hepatocytes may be seen on light microscopy
hepatocellular carcinoma
Usually stays acute
Who is vaccinated against Hep B?
Children born in the UK at 2,3,4 months
Healthcare workers
IV drug users
Sex workers
What is the management for Hep B?
Acute - supportive
Chronic - pegylated interferon-alpha used to be the only treatment available
Reduces viral replication in up to 30% of chronic carriers
What causes Hep C?
hepatitis C is a RNA flavivirus
incubation period: 6-9 weeks
80% cases chronic
How is Hep C transmitted?
Risk from needlestick = 2%
Risk from vertical mother to child = 6% (higher in HIV mothers)
Risk from sexual intercourse = <5%
What features are present in 30% of those exposed to the Hep C virus?
a transient rise in serum aminotransferases / jaundice
fatigue
arthralgia
What is the investigation for Hep C?
HCV RNA
What is the outcome post Hep C infection?
around 15-45% of patients will clear the virus after an acute infection
the majority (55-85%) will develop chronic hepatitis C
What are some potential complications of Hep C infection?
Arthralgia, arthrtis
Eye problems (Sjorgen’s)
Cirrhosis
Hepatocellular cancer
What is the management for chronic hep C infection?
combination of protease inhibitors (e.g. sofosbuvir + simeprevir) with or without ribavirin are used
What is the aim of Hep C treatment and how is it measured?
Sustained virological response (SVR), defined as undetectable serum HCV RNA six months after the end of therapy
What are the side effects of Ribavirin?
Haemolytic anaemia
Cough
Teratogenic
What is Hep D?
single stranded RNA virus that is transmitted parenterally
Needs Hep B surface antigen to replicate
