Hepatitis Flashcards
(40 cards)
1
Q
What is hepatitis?
A
inflammation in the liver
- this can be a chronic low level inflammation
- or an acute, severe inflammation that results in large areas of necrosis + liver failure
2
Q
What are the possible causes of hepatitis?
A
- alcoholic hepatitis
- non-alcoholic fatty liver disease
- viral hepatitis
- autoimmune hepatitis
- drug-induced hepatitis (e.g. paracetamol overdose)
3
Q
What is the presentation of hepatitis typically like?
A
- it can be asymptomatic
- or present with non-specific symptoms:
- fever (viral)
- jaundice
- abdominal pain
- pruritis
- fatigue
- muscle / joint aches
- N&V
4
Q
What are the typical LFT findings in hepatitis?
A
- there are high transaminases (AST / ALT)
- there is a proportionally smaller raise in ALP
- this is called a “hepatitic picture”
- bilirubin may also be raised as a result of inflammation
- high bilirubin causes jaundice
transaminases are liver cell enzymes that are released into the blood as a result of inflammation of the liver cells
5
Q
How is hepatitis A transmitted?
A
- it is a RNA virus
- it is transmitted via the faecal-oral route through contaminated food / water
it is the most common viral hepatitis worldwide but relatively rare in the UK
6
Q
What are the symptoms associated with hepatitis A?
A
- N&V
- anorexia
- jaundice
- it can cause cholestasis with dark urine and pale stools
- moderate hepatomegaly
cholestasis = slowing of bile through the biliary system
7
Q
What is involved in the management of Hepatitis A?
A
- it will resolve without treatment in 1-3 months
- basic analgesia is given
- vaccination is available to reduce the chance of developing an infection
- it is a notifiable disease so Public Health must be notified in all cases
8
Q
In what ways can Hepatitis B be transmitted?
A
- it is a DNA virus
- transmitted through direct contact with blood or bodily fluids (sexual intercourse, sharing needles - IVDU / tattoos)
- can be passed through sharing contaminated household products - e.g. toothbrushes
- or between minor cuts / abrasions
- can be passed from mother to child during pregnancy / delivery (vertical transmission)
9
Q
What is the prognosis like following hepatitis B infection?
A
- most people fully recover within 2 months
- 10% will become chronic hepatitis B carriers
- the viral DNA has integrated into their own DNA so they continue to produce viral proteins
10
Q
What is meant by chronic hepatitis B?
A
- hepatitis B that lasts for 6 months or more
- it can potentially lead to cirrhosis or hepatocellular carcinoma
- it may be asymptomatic
11
Q
What are the 5 different viral markers that can be tested for in hep B?
A
surface antigen (HBsAg):
- a marker of active infection
E antigen (HBeAg):
- a marker of viral replication that implies high infectivity
core antibodies (HBcAb):
- implies past or current infection
surface antibodies (HBsAb):
- implies vaccination, past or current infection
Hep B virus DNA (HBV DNA):
- direct count of the viral load
12
Q
What does the presence of HBsAg indicate?
A
there is an active infection with Hep B
13
Q
What does the presence of HBeAg indicate?
A
- this indicates the patient is in the acute phase of the infection
- the virus is actively replicating
- a high level of HBeAg correlates with high infectivity
14
Q
What does the presence of HBcAb indicate?
A
either a past or current Hep B infection
15
Q
How can HBcAb be used to distinguish between an acute, chronic and past infection?
A
through measuring IgM and IgG versions of the HBcAb
- IgM implies active infection
- a high titre of IgM indicates acute infection
- a low titre of IgM indicates chronic infection
- IgG indicates a past infection when HBsAg is negative
16
Q
What does the presence of HBsAb imply?
A
- there has been an immune response to HBsAg
- this could be due to vaccination, current or past infection
17
Q
How can you tell if HBsAb is due to vaccination or infection?
A
- HBsAg is given in the vaccine
- a positive HBsAb could indicate an immune response to the vaccine
- other viral markers are needed to distinguish between vaccination or infection
18
Q
What is the order of tests when screening for Hep B?
A
- test for HBcAb for evidence of previous infection
AND
- test for HBsAg for evidence of active infection
- if these are positive, then test for HBeAg and viral load
19
Q
What does it mean if HBeAg is negative but HBeAb is positive?
A
- the patient has been through a phase where the virus was replicating
- now the virus has stopped replicating and they are less infectious
20
Q
What is involved in the vaccination for hep B?
A
- it involves injection of HBsAg
- individuals are then tested for HBsAb to confirm response to the vaccine
- there are 3 doses at different intervals
it is part of the UK routine vaccination schedule
21
Q
Who should be screened for Hep B?
A
- there should be a low threshold for screening patients at risk of Hep B
- other bloodborne viruses (hep A / HIV) and other STDs should also be screened for
22
Q
What advice is given to a patient with hepatitis B?
A
- stop smoking and drinking alcohol
- education about reducing transmission and informing potential at risk contacts
23
Q
What is involved in the management of hepatitis B?
A
- PHE must be informed as it is a notifiable disease
- FibroScan to check for cirrhosis
- USS to check for hepatocellular carcinoma
- antiviral medication can be given to slow progression of disease + reduce infectivity
- liver transplantation for end-stage liver disease
the patient is referred to gastroenterology, hepatology or infectious diseases for specialist management
24
Q
What is hepatitis C and how is it spread?
A
- it is an RNA virus
- it is spread via blood and bodily fluids
25
What is the prognosis of Hepatitis C like?
* 1 in 4 will make a full recovery
* **3 in 4** will develop **chronic Hep C infection**
* chronic infection is associated with **liver cirrhosis** + **hepatocellular carcinoma**
26
How can Hepatitis C be tested for?
* the screening test looks for **Hepatitis C antibody**
* if this is positive, **Hepatitis C RNA testing** is used to **confirm** the diagnosis, calculate **viral load** and assess **individual genotype**
27
What is involved in the management of Hep C?
* it is the SAME as hepatitis B except for:
* **no vaccine** is available
* **direct acting antivirals** (DAAs) tailored to the specific **viral genotype** can cure the infection in 90% patients when taken for **8-12 weeks**
28
What is Hepatitis D and which individuals can contract this infection?
* it is an RNA virus
* it can only survive in patients with a **concurrent Hep B infection**
* it **attaches to the HBsAg** to survive and cannot survive without this protein
## Footnote
there are very low rates in the UK
29
What are the consequences of hepatitis D?
How is it managed?
* it **increases the complications and severity** of **hep B infection**
* there is no specific treatment for hep D
* PHE must be notified as it is a **notifiable disease**
30
What is hepatitis E and how is it transmitted?
* it is an RNA virus
* it is transmitted via the **faecal-oral route**
## Footnote
it is very rare in the UK
31
What type of illness is typically produced by Hep E?
* it usually produces a **mild illness**
* this clears within 1 month and **no treatment is required**
* rarely it can progress to **chronic hepatitis** and liver failure in **immunocompromised patients**
## Footnote
it is a notifiable disease + no vaccine is available
32
What is thought to be the cause of autoimmune hepatitis?
* there is a **genetic predisposition** and it is triggered by **environmental factors**
* a viral infection causes a **T-cell mediated response** against liver cells
* the T cells recognise the liver cells as being **harmful**
* they alert the rest of the immune system to **attack these cells**
## Footnote
the exact cause is unknown
33
What are the 2 different types of autoimmune hepatitis?
* Type 1 tends to occur in adults
* Type 2 tends to occur in children
34
Who tends to be affected by Type 1 autoimmune hepatitis?
* **women** in their **late 40s or 50s**
* it presents **around or after the menopause**
* it presents with **fatigue** and features of liver disease on examination
* the course is **less acute** than T2
35
Who is typically affected by Type 2 autoimmune hepatitis?
* it typically affects **teenagers** / individuals in their **early 20s**
* they have an acute picture with **high transaminases** and **jaundice**
36
What will investigations for autoimmune hepatitis show?
* raised transaminases (ALT / AST)
* raised IgG
* it is associated with many autoantibodies
37
What autoantibodies are associated with Type 1 autoimmune hepatitis?
* anti-nuclear antibodies (ANA)
* anti-smooth muscle antibodies (anti-actin)
* anti-soluble liver antigen (anti-SLA/LP)
38
What autoantibodies are associated with Type 2 autoimmune hepatitis?
* anti-liver kidney microsomes-1 (anti-LKM1)
* anti-liver cytosol antigen type 1 (anti-LC1)
39
How is autoimmune hepatitis diagnosed?
liver biopsy
40
What is involved in the treatment for autoimmune hepatitis?
* **high dose steroids** - typically **prednisolone**
* prednisolone is tapered over time as other immunosuppressants (typically **azathioprine**) are introduced
* immunosuppressant treatment **induces remission** but is usually required **life-long**
* liver transplant may be required in end-stage disease but **autoimmune hepatitis can recur in transplanted livers**
