Hepatitis

Question 1

How is Hepatitis A spread?

Answer 1

Faecal-oral spread

Question 2

How does Hep A harm the liver?

Answer 2

Directly cytopathic - kills hepatocytes by being in them

Question 3

Is it possible to have a carrier state for Hep A?

Answer 3

No

Question 4

What are the symptoms of Hep A?

Answer 4

jaundice
pale stools
dark urine

Question 5

How is Hep A confirmed in the lab?

Answer 5

Clotted blood for serology

Question 6

How is Hep A controlled?

Answer 6

Hygiene

Vaccine prophylaxis - travellers, MSM, IVDU

Question 7

Pt presents with abnormal LFTs with high ALT/AST, should viral hep be considered a DD?

Answer 7

Yes

Question 8

What are the general symptoms of viral hepatitis?

Answer 8

headache
myalgia 
arthralgia
nausea
anorexia 
jaundice follows a few days to 2 weeks later with N&V and abdo discomfort

Question 9

Where in the world is hep E most common?

Answer 9

Tropics

Question 10

Is Hep A more common than Hep E in the UK?

Answer 10

No Hep E is more common

Question 11

How is Hepatitis E spread?

Answer 11

Faecal-oral spread

Question 12

Cases in the UK of Hep E are thought to be what?

Answer 12

Zoonoses

Question 13

Is there a vaccine available for Hep E?

Answer 13

No

Question 14

Hep D is only found with which other Hepatitis?

Answer 14

Hep B - parasitizes off this and exacerbates the Hep B infection

Question 15

What are the modes of transmission of Hep B?

Answer 15

Sex - Intercourse
Mother to child - Infant
Blood to blood - Inoculation

Question 16

What groups of people in the UK are at higher than average risk of Hep B infection?

Answer 16

Ethnic minorities
Multiple sexual partners
IVDU, tattoos, needle-stick injuries
Children of infected mothers

Question 17

What blood tests are required for the diganosis of Hep B? At what time intervals are they required?

Answer 17

2 blood tests 6 months apart for HBsAg

Question 18

Hep B IgM is most likely to be present in…

Answer 18

recently infected cases

Question 19

HBsAg is present in…

Answer 19

blood of all infectious individuals

Question 20

How is the spread of Hep B controlled?

Answer 20

Safe blood
safe sex
needle exchange programme
screening of pregnant women

Question 21

How does Hepatitis B harm the liver?

Answer 21

antiviral immune response

Question 22

After initial infection with Hep B, how do patients present?

Answer 22

asymptomatically
nausea for a period of days or weeks
may become very ill very quickly (fulminant hepatitis)

Question 23

What is the mode(s) of transmission of Hep C?

Answer 23

sex
infant
blood- blood

Question 24

Does Hep C result in chronic infection?

Answer 24

Yes, in about 75% of cases

Question 25

What symptoms are caused by Hep C?

Answer 25

Most pts are asymptomatic - slip into the phase of chronic infection easily

Question 26

How are Hep B and Hep C differentiated?

Answer 26

Serology

Question 27

Is a spontaneous cure seen in Hep C?

Answer 27

No

Question 28

Is a spontaneous cure seen in Hep B?

Answer 28

Not uncommon, even after many years of infection

Question 29

How long does it take for chronic hepatitis to develop into cirrhosis?

Answer 29

typically >20 years

Question 30

How long does it take for chronic hepatitis to develop into hepatocellular carcinoma?

Answer 30

typically >30 years

Question 31

Histologically, how is Hep C described?

Answer 31

councilman bodies with small amounts of steatosis (fat infiltration of hepatocytes) present

Question 32

Is autoimmune Hep more common in males or females?

Answer 32

Females

Question 33

What autoantibodies are seen in autoimmune hepatitis?

Answer 33

autoantibodies to smooth muscle, nuclear or LKM | there is also raised IgG

Question 34

Histologically, how is autoimmune hep described?

Answer 34

chronic hepatitis with marked piecemeal necrosis and lobular involvement. Numerous plasma cells.

Question 35

What is the treatment for autoimmune hepatitis?

Answer 35

Prednisolone and azathioprine (long term)

Question 36

What is the treatment for chronic hep B?

Answer 36

peginterferon alone or supressive antiviral drug (e.g. entecavir, tenofovir)

Question 37

What is the pharmacological management for chronic hep C?

Answer 37

Peginterferon injections given in combination with ribavirin tablets (PR) 12-48 week course