Hepatitis

Question 1

Hepatitis A incubation period

Answer 1

2-4 weeks

Question 2

Type of virus found in Hepatitis A

Answer 2

RNA picornavirus

Question 3

Spread of Hepatitis A

Answer 3

faecal-oral spread

Question 4

Can Hep A cause chronic disease?

Answer 4

No

Question 5

Clinical features of Hep A

Answer 5

• flu-like prodrome
• RUQ pain
• tender hepatomegaly
• jaundice
• deranged LFTs

Question 6

A vaccine against Hep A exists. TRUE/FALSE?

Answer 6

TRUE

Question 7

How long after the initial Hep A vaccine should you have a booster?

Answer 7

6-12 months later

Question 8

Who should receive Hep A vaccination?

Answer 8

• Travelling to prevalent area
• chronic liver disease
• haemophilia
• MSM
• IVDU
• Occupational risk (Lab, sewage worker, large residential area, work with primates)

Question 9

Hepatitis B incubation period

Answer 9

6-20 weeks.

Question 10

Type of virus found in Hep B

Answer 10

double-stranded DNA hepadnavirus

Question 11

Hep B spread

Answer 11

• infected blood or body fluids
• vertical transmission from mother to child

Question 12

Clinical features of Hep B

Answer 12

fever
jaundice
elevated liver transaminases.

Question 13

Complications of Hep B infection

Answer 13

• chronic hepatitis
• liver failure
• hepatocellular carcinoma
• glomerulonephritis
• polyarteritis nodosa
• cryoglobulinaemia

Question 14

When are children in the UK vaccinated against Hep B?

Answer 14

2, 3 and 4 months of age

Question 15

What at risk groups should be vaccinated against Hep B

Answer 15

• healthcare workers
• IVDU
• sex workers
• prisoners
• family contacts of an individual with Hep B
• regular blood transfusions
• CKD who may need RRT
• chronic liver disease patients

Question 16

Management of Hep B

Answer 16

1st line: pegylated interferon-alpha

Other antiretrovirals:
- tenofovir
- entecavir
- telbivudine

Question 17

Groups at risk of Hep C infection

Answer 17

IVDU
blood transfusion prior to 1991 (e.g. haemophiliacs).

Question 18

What type of virus is Hep C

Answer 18

RNA flavivirus

Question 19

Transmission of Hep C

Answer 19

Blood/body fluid
Vertical transmission

Question 20

Incubation period of Hep C

Answer 20

6-9 weeks

Question 21

Is there a vaccine for Hep C?

Answer 21

No

Question 22

Clinical features of Hep C

Answer 22

Asymptomatic in some
Transient rise in LFTs
jaundice
fatigue
arthralgia

Question 23

Diagnostic investigation for Hep C

Answer 23

HCV RNA
- anti-HCV antibodies

Question 24

Chronic hepatitis C may be defined as the persistence of HCV RNA in the blood for how long?

Answer 24

6 months

Question 25

Complications of chronic Hep C

Answer 25

- arthralgia/arthritis - Sjogren's - cirrhosis - hepatocellular cancer - cryoglobulinaemia - porphyria cutanea tarda - glomerulonephritis

Question 26

Management of Chronic Hep C

Answer 26

- depends on viral genotype - combination of protease inhibitors (e.g. daclatasvir + sofosbuvir or sofosbuvir + simeprevir) with or without ribavirin are used

Question 27

Complications/ side-effects of treatment for chronic Hep C

Answer 27

ribavirin - haemolytic anaemia - cough - teratogenic interferon alpha - flu-like symptoms - depression - fatigue - leukopenia/thrombocytopenia

Question 28

What type of virus is Hep D?

Answer 28

single stranded RNA virus => incomplete RNA virus that requires hepatitis B surface antigen to complete its replication and transmission cycle

Question 29

Transmission of Hep D

Answer 29

- similar to Hep B => exchange of bodily fluids patients may be infected with hepatitis B and hepatitis D at the same time.

Question 30

Difference between coinfection and superinfection

Answer 30

Co-infection: Hep B + D infection at same time Superinfection: Patient with Hep subsequently develops a Hep D infection.

Question 31

Superinfection of Hep D on top of Hep B brings a higher risk of what complications?

Answer 31

- fulminant hepatitis - chronic hepatitis - cirrhosis

Question 32

Diagnostic test for Hep D

Answer 32

- reverse polymerase chain reaction of hepatitis D RNA

Question 33

Treatment currently used for Hep D

Answer 33

Interferon (poor evidence base)

Question 34

What type of virus is Hepatitis E?

Answer 34

RNA hepevirus

Question 35

Transmission of Hepatitis E

Answer 35

faecal-oral route

Question 35

Incubation period of Hep E

Answer 35

3-8 weeks

Question 36

In what areas is Hep E prevalent?

Answer 36

Central and South-East Asia, North and West Africa,

Question 37

Can Hep E cause chronic disease or lead to an increased risk of cancer?

Answer 37

No

Question 38

Is there a vaccine for Hep E?

Answer 38

vaccine is currently in development, but is not yet in widespread use