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Hepatitis Flashcards

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1
Q

What is hepatitis?

A

Inflammation of the liver

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2
Q

What is the difference between acute and chronic hepatitis?

A

Acute: less than 6 months, usually self limiting and liver returns to normal

Chronic: over 6 months, repeated attacks on liver takes a toll on it.

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3
Q

How does acute hepatitis present?

A

Can be asymptomatic

Malaise
GI upset
Myalgia
Abdominal pain
Jaundice
Dark urine + pale stools
Tender hepatomegaly
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4
Q

Causes of acute hepatitis?

A

Infection:

  • viral
  • bacterial
  • parasitic
Alcohol
Drugs
Toxins
Pregnancy
Autoimmune
Genetic conditions
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5
Q

Which viruses can cause acute hepatitis?

A

Hepatitis A-E

Herpes viruses

  • Epstein Barr virus
  • Cytomegalovirus
  • Varicella Zoster virus
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6
Q

Which bacteria can cause acute hepatitis?

A

Leptospirosis

Coxiella

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7
Q

Which parasite(s) can cause acute hepatitis?

A

Toxoplasmosis

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8
Q

How does chronic hepatitis present?

A

Asymptomatic

Jaundice
Ascites
Low albumin
Coagulopathy

Signs of chronic liver disease:

  • Clubbing
  • Palmar erythema
  • Spider naevi
  • Dupuytren’s contracture
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9
Q

What is coagulopathy?

A

Impaired ability to clot blood, because the liver isn’t producing enough of the proteins in the coagulation cascade

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10
Q

What is palmar erythema?

A

Red palms

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11
Q

What are spider naevi?

A

On the skin

A central red spot and reddish extensions which radiate outwards like a spider’s web.

They are caused by swollen blood vessels

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12
Q

What is Dupuytren’s contracture?

A

Fixed forward curvature of finger(s) caused by the development of fibrous tissue between finger tendons and on the skin of the palm

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13
Q

What happens in chronic hepatitis that means liver function is maintained?

A

Compensation

The body compensates for the problems, meaning chronic hepatitis can sometimes be asymptomatic

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14
Q

What are some complications of chronic hepatitis?

A

Chronic liver disease - fibrosis, cirrhosis

Hepatocellular carcinoma

Portal hypertension

Gastro-oesophageal varices

GI bleed

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15
Q

What causes chronic hepatitis?

A

Hepatitis B-D

Autoimmune hepatitis
Drugs
Alcohol
Genetic conditions

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16
Q

Describe the effect on acute hepatitis on the liver?

A

Damage to cells

Influx of neutrophils causes necrosis

Death of cells due to necrosis or apoptosis

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17
Q

Describe the effect of chronic hepatitis on the liver?

A

Damage and destruction of hepatocytes and other cells

The liver regenerates not in an orderly fashion

Damaged cells are replaced with scar tissue

Over time, there are only a few islands of hepatocytes left amongst the scar tissue

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18
Q

How would you distinguish autoimmune hepatitis from other types?

A

Blood tests:
Increased IgG levels
Antibodies against liver proteins

Biopsy: mononuclear infiltrate, you would see white blood cells in the liver

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19
Q

What causes autoimmune hepatitis?

A

Genetics

Sometimes viral infections (viral hepatitis or EBV)

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20
Q

How do patients with autoimmune hepatitis present?

A

Acute initially, but they will eventually become chronic

Fatigue
Anorexia
Weight loss
Amenorrhoea
Abdominal pain
Coagulopathy
Jaundice
Hepatomegaly
Ascites
Signs: Palmar erythema, spider naevi
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21
Q

How would you manage autoimmune hepatitis?

A

Immunosuppressants

  • prednisolone
  • non-steroids

Liver transplant

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22
Q

Name the hepatitis viruses.

A 
A
B
C
D
E
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23
Q

How is hepatitis A spread?

A

Faecal-oral route

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24
Q

What type of virus is hepatitis A?

A

RNA virus

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25
What food is hepatitis A commonly found in?
Shellfish
26
Does hepatitis A cause an acute or chronic illness?
Acute, it never progresses to chronic It is a self-limiting infection
27
Do you acquire immunity to hepatitis A after an infection with it?
Yes | 100% immunity
28
How long does a hep A infection usually last?
3-6 weeks
29
Management of hep A infection.
Supportive care Monitor liver Check close contacts and give them prophylaxis
30
What can you do to prevent hep A infection?
Vaccinate HNIG - human normal immunoglobulin - provide someone with donor hep A antibodies
31
Summarise hep A!
A is Acquired by mouth for Anus, is Always cleared Acutely and only ever Appears once
32
How is hep E spread?
Faecal-oral route Water or food-borne
33
What type of virus is hep E?
A small RNA virus
34
There are different genotypes of hep E, one of these is found in an animal, which animal?
Pigs | Virus can be found in some British sausages
35
Does hep E cause an acute or chronic infection?
Usually self-limiting acute infection It can become chronic in the immunocompromised
36
Which people do you need to be extra concerned about if they get hep E?
Pregnant women: mortality is as high as 10-20% Immunocompromised: can progress to chronic hepatitis
37
Summarise hep E!
E is Even in England and can be Eaten, if not always beaten
38
What is the link between hep B and D?
You can't be infected with D without having B too
39
What type of virus is hep B?
DNA virus
40
How is hep B spread?
Blood-borne - needle stick - tattoos - sexual - vertical
41
Is hep B an acute or chronic infection?
Acute | But can become chronic if the immune system can't right it off
42
Management of hep B?
Supportive care Monitor liver function Treat with drugs Contacts: post-exposure prophylaxis, vaccination
43
What is a serious complication that can occur from hep B?
Fulminant liver failure
44
What 2 drug treatment options are there to treat hep B? Describe them briefly
Pegasys - stimulates the immune system to fight off infection better - weekly subcut injection - nasty side effects Nucleoside analogues - inhibit viral replication - one tablet per day - fewer side effects - lifelong
45
What is fulminant liver failure?
Acute liver failure that results in encephalopathy within 8 weeks
46
What is encephalopathy?
Neurological symptoms: confusion, coma, can lead to death
47
What is the delta virus?
Hepatitis D
48
Why is it that hep D cannot infect without hep B?
The virus is a bit defective | It needs the hep B surface antigens to survive
49
Is it best to have hep B and D together or to have just hep B?
Best to have just hep B Hep B and D together cause a faster rate of fibrosis of the liver
50
In an infection of hep B and D, which virus is dominant?
Hep D
51
Does hep D cause a chronic or acute infection?
Acute leading to chronic
52
Where is hep B virus found?
All over the place
53
Summarise hep B?
B is Blood-Borne and if not Beaten can be Bad
54
Summarise hep B and D?
B and D are DastarDly
55
What type of virus is hep C?
A flavivirus - RNA
56
How is hep C spread?
Blood-borne Sexually transmitted Mother to baby
57
What are the complications of a hep C infection?
Chronic hep C can lead to cirrhosis Which can lead to Hepatocellular carcinoma
58
Is hep C a chronic or acute infection?
Acute that becomes chronic
59
Management of hep C?
Drug treatment: Pegasys + Ribvirin Contacts: screen
60
How do you prevent hep C?
No vaccine Take precautions: needle exchanges, condoms
61
Summarise hep C?
C is usually Chronic but Can be Cured at a Cost
62
How does hep A present?
``` Nausea Anorexia Jaundice Dark urine + pale stools Hepatomegaly Skin rash Lymphadenopathy ```
63
How does hep B present?
Skin rash Arthralgia ``` Nausea Anorexia Jaundice Dark urine + pale stools Hepatomegaly Lymphadenopathy ```
64
How does hep C present?
Mild symptoms, occasionally jaundice Not usually picked up until infection is chronic
65
How does hep E present?
``` Nausea Anorexia Jaundice Dark urine + pale stools Hepatomegaly Skin rash Lymphadenopathy ``` Signs of chronic liver disease

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