Flashcards in Hepatitis Deck (57):
Name 4 causes of hepatitis?
Drug induced (paracetamol. rifampicin)
What are the types of acute hepatitis?
A and E
Normally resolve w/o long term problems
What are the types of chronic hepatitis?
Infection >6mnths with sequelae (occurrence and complication)
- Type B and C
What are you legally obliged to do by law when you discover a case of hepatitis?
(It's a notifiable disease)
What is the most common type of hepatitis in the UK?
(Followed by A, then B, then E, then D, then other)
What are the risk factors for Hepatitis?
Sharing drug equipment
Vaginal/ anal/ oral sex
Increased alcohol intake
Travel (epecially w/o vaccine)
What are the signs and symptoms of hepatitis?
RUQ pain, fatigue, malaise, anorexia, N+V
Jaundice (icterus), itching, dark urine
Rash and joint pain
What would appear on a blood test in a patient with hepatitis?
AST/ALT/ALP (+bilirubin later on)
What type of virus is hep A?
What type of virus is hep B?
What type of virus is hep C?
What type of virus is hep D?
What type of virus is hep E?
What type of hepatitis can be spread by pigs?
What types of hepatitis are spread by blood and body fluids?
B C D
What types of hepatitis are spread by faecal/ oral transmission?
A and E
What types of hepatitis have a carrier state?
B C D
What types of hepatitis carry an increased risk of developing liver cancer?
B C D
What types of hepatitis can you be passively immune to?
A and B
What types of hepatitis can you vaccinate against?
A B E
What type of hepatitis only occurs when another type is present?
Hep D only occurs when B also present
Which antibody is seen in the first three months of infection, what is it then replaced by?
IgM for first 3 months
Replaced by IgG for long term immunity
Presence of IgM in the blood indicates what?
What are the long term outcomes for patients with Hep B?
90% fully recover
10% go on to develop chronic disease
What are the long term outcomes for patients with Hep C?
15% fully recover
85% go on to develop chronic disease
What are the long term outcomes for patients with Hep A?
90% fully recover (it's always acute)
10% will have a re-occurrence
What is the most prevalent type of hepatitis worldwide?
350mil cases worldwide
What are the incubation times for the different types of hepatitis?
A, C, E = 2-9 weeks
B = 2-6months
What is cholestasis?
Where bile can't flow (so fatty change occurs)
Mainly occurs in zone 3
Mainly in alcohol/ drug related hepatitis
What is the pathophysiology of acute hepatitis?
Inflammation causes hepatocyte damage and necrosis (maximal in zone 3)
Veins can join up/ lobules become inflitrated with lymphocytes
What is the pathophysiology of chronic hepatitis?
Lymphocytes/ plasma cells and lymphoid follicles all present in portal tracts
Damage due to apoptosis not necrosis
Accompanied by fibrosis (mild) cirrhosis (severe)
What is the treatment for hep A?
Rest, painkillers and anti-emetics
What is the treatment for hep B or C?
Antiretrovirals (Interferon, tenofovir, entecavir)
Fluids, rest, avoid alcohol
What are some recommended lifestyle changes for Px with excessive itching?
No hot baths/ showers
How does treatment change if patient is Hep Be Ag+
Peg-interferon-alfa-2a (1st line)
Tenofovir disproxil (2nd line)
What must you do with patients who are Hep Bs Ag+
Refer to gastroenterologist
Where would you find Hep Be Ag+/ Hep Bs Ag+ antigens?
Hep Be Ag+ = On cell surface
Hep Bs Ag+= Extracelluar
What is transient elastography?
Quantitative (1D) image of tissue stiffness
Vibrates skin to create tissue distortion (shear wave)
Stiffness is given as a youngs modulus
What is seroconversion?
Where antibody becomes detectable in the blood and the corresponding antigen becomes undetectable
What does the presence of an antigen/ IgM antibody/ IgG antibody each suggest?
Antigen= Current infection
IgM= Recent infection conquered by antibodies
IgG= Long term immunity
What is the difference between attenuated and recombinant vaccines?
Attenuated= Live microorganism with virulence removed
Recombinant= Only antigen present, usually produced by bacteria or yeast and purified
Which of the following viruses is transmitted by the faecal-oral route and associated with an approximately 20% mortality rate in pregnant women?
What is the role of oval cells (aka ovalocytes)?
Bi-potential stem cells (into either hepatocytes or cholangiocytes). Activated when liver proliferation is impaired
What is the role of cholangiocyte cells?
They are the epithelial cells of the bile ducts
(secrete bicarbonate and water into bile)
What is the role of Hepatic stellate cells (aka Ito cells or perisinusoidal cells)?
Pericytes (wrap all the way round) found in space of Disse - they normally store vitamin A
When liver is damaged they become activated and secrete collagen scar tissue
What name two other names for perisinusoidal cells?
Hepatic stellate cells
What is the name for the fetal precursor of hepatocytes?
Which is the major cell type involved in liver fibrosis and cirrhosis?
(aka perisinusoidal cells)
(aka Hepatic stellate cells)
Which virus that can affect the liver is especially fond of immunocompromised people?
What is Arthralgia?
When doing serological tests, how do you distinguish between Px's who have had an active HepB infection and those who have been vaccinated?
(Only postive for HBc when had actual infection)
- Those who are vaccinated will be HBs +ve BUT HBc -ve
What serum test helps show the difference between Px who are acutely or chronically infected with HepB?
(+ve in those who are acute)
(-ve in those who are chronic)
What serum test allows one to differentiate between Px with active or no longer active (immune) Hep B disease?
(+ve in those with active infection)
(-ve in those who are immune/ unexposed)
What does the Hep Be antigen indicate?
+ve shows rapid virus replication
What does the Hep Bs antigen indicate?
Presence of current infection
What is cytochrome p450 and what is it's function?
It's a haemoprotein enzyme
- usually final bit of oxidation in ETC's
- Involved in hormone synthesis/ toxin breakdown and 75% of all drug metabolism