Hepatitis Flashcards

(62 cards)

1
Q
A
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2
Q

How is hepatitis A spread?

A
  • Faecal oral - faecally contiminated water
  • Shellfish
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3
Q

What is the incubation period for hepatitis A?

A

2-6 weeks

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4
Q

What are non-viral infections which can cause hepatitis?

A
  • Toxoplasma gondii
  • Leptospira
  • Coxiella burnetii (Q fever)
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5
Q

What are viral causes of hepatitis?

A
  • Hep A - E
  • EBV
  • CMV
  • Yellow fever
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6
Q

What drugs can cause hepatitis?

A
  • Paracetamol
  • Alcohol
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7
Q

What are symptoms of hepatitis A?

A
  • Fever
  • Malaise
  • Anorexia
  • Nausea
  • Athralgia
  • Jaundice
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8
Q

What are signs of hepatitis A?

A
  • Hepatomegaly
  • Adenopathy
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9
Q

How is HBV spread?

A
  • Blood products
  • IVDU
  • Sexual
  • Direct contact
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10
Q

What groups are most at risk of HBV infection?

A
  • IVDU and sexual partners
  • Health workers
  • Haemophiliacs
  • MSM
  • Haemodialysis/CKD
  • Sexually promiscuous
  • Foster carers
  • Close family memebers of carrier
  • Staff/residernts of institutions/prisons
  • Babies of HBsAg +ve mothers
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11
Q

What is the incubation period HBV?

A

1-6 months

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12
Q

What are features of acute HBV infection?

A
  • Anorexia
  • Lethargy
  • Nausea
  • Fever
  • Abdominal Discomfort
  • Arthralgia
  • Urticarial skin lesions
  • Jaundice + Dark coloured urine
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13
Q

What is HBsAg, and what does its presence indicate?

A

Hepatitis B surface antigen - acute or chronic infection

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14
Q

What is HBeAg, and what does it indicate?

A

Pre-core antigen for HBV - Acute hepatitis B

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16
Q

What is Anti-HBs, and what does its presence indicate?

A

Antibodies against HB surface protein - immunity to HBV, previous epxosure or vaccination

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17
Q

What is Anti-HBe, and what does it’s presence indicate?

A

Antibodies against E-protein - Seroconversion

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18
Q

What is HBc-IgM, and what does its presence indicate?

A

IgM produced against HB core protein - indicates acute hepatitis B in high titres, and chornic hepatitis B with low titres

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19
Q

What hepatitis virology and LFT results would indicate that someone has an acute HBV infection?

A
  • Markedly increased LFT
  • Positive HBsAg
  • Positive HBeAg
  • Postive Anti-HBc IgM
  • Positive Anti-HBc IgG
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20
Q

What hepatitis virology and LFT results would indicate that someone is a carrier of HBV?

A
  • Raised LFTs
  • Positive HBsAg
  • Positive/Negative HBeAg
  • Anti-HBe positive/negative
  • Anti-HBc IgM positive/negative
  • Anti-HBc IgG positive
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21
Q

What is Anti-HBc IgG, and what does its presence indicate?

A

Past exposure to hepatitis B

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24
Q

What proportion of those with hepatitis B fully recover following acute infection?

A

90-95%

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25
Q

What proportion of those with hepatitis B develop chornic hepatitis?

A

5-10%

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26
Q

What proportion of those with acute HBV infection develop fulminant hepatic necrosis?

A

1%

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27
Q

What are the different the different outcomes of chronic HBV infection?

A
  • Asymptomatic chronic infection (carrier)
  • Chronic active hepatits -> Cirrhosis/Primary liver cancer
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28
What hepatitis virology and LFT results would indicate that someone has been vaccinated?
* **Normal LFTs** * **HBsAg positive**
29
What viral component is looked at first before doing a full HBV screen?
HBsAg, or Anti-HBc IgM in acute infection
30
What does HBsAg presisting for \> 6 months imply?
The person is a carrier
35
What are features of chronic HBV infection?
* **Fatigue, anorexia, depression** * **Signs of advanced disease** * **Chronic liver disease** - jaundice, hepatoma, cirrhosis * **Membranous glomerulonephritis** * **Polyarteritis nodosa**
36
What would you do if you suspected HAV?
* **LFTs** - raised due to hepatocellular injury * **Anti-HAV IgM** - acute * **Anti-HAV IgG** - previously infected
37
How would you manage someone with confirmed acute hepatitis A?
* **Conservative management** * **Avoid alcohol** * **Interferon alpha** - if fulminant hepatitis
38
What are complications that can occur in heptatitis A?
* **Cholestatic jaundice** * **Relapsing hepatitis (may be more severe than first episode)** * **Aplastic anaemia**
39
Is there a form of immunisation available for HAV? If so, what is it?
Yes - inactivated viral protein
40
How would you determine whether someone had a good response to active HBV vaccination?
Post vaccine anti-HBs levels
41
Who would you consider giving HAV vaccination to?
* **MSM with multiple sexual partners** * **Sewage workers** * **Seronegative haemophiliacs** * **Travellers to endemic areas**
42
What does the presence of HBV DNA indicate?
Implies viral replication. Levels indicate response to treatment
43
What are complications of Hepatitis B?
* **Fulminant hepatic failure** * **cirrhosis** * **HCC** * **Cholangiocarcinoma** * **Cryoglobulinaemia** * **Membranous nephropthy** * **Polyarteritis nodosa**
44
How would you manage someone with hepatitis B?
**Conservative** * **Avoid alcohol** **Medical** * **Pegylated alpha-2a interferon** * **Nucleoside analgogues** - tenofovir, entecavir **Surgical** * **Liver transplantation**
45
What are indications for anti-viral therapy in hepatitis B?
* **Asymptomatic chronic HBV with raised ALT and HBeAg positive** * **Cirrhosis with evidence of ongoing viral replicaton** * **Those without cirrhosis, with 2/3 of following criteria** * HBV DNA \> 2000 IU/ml * Raised ALT * Significant liver inflammation/fibrosis
46
Is there a method of immunisation available for hepatitis B? If so, what is it?
**Yes** * Passive immunisation with specific anti-HBV * Active immunisation - HBsAg recombinant vaccine
47
What is the dose regimen used for the HBV vaccine?
One of: * **Three doses at 0, 1 and 6 months** * **Four doses at 0, 1, 2 and 12 months** * **Four doses at 0, 7, 21 days and 12 months** - rapid protection
49
What proportion of those with HCV infection progress to chronic infection?
60-80%
50
What proporrtion of those with chronic HCV progress without cirrhosis?
50-80%
51
What proportion of those with chronic HCV infection progress to cirrhosis within 30 years?
20-50%
52
What proportion of those with chronic HCV progress to hepatoma?
10%
53
What public health measure would you want to take if someone was confirmed to have HBV?
Contact tracing
54
How is hepatitis C spread?
* **Blood** - transfusion, IV abuse * **Sexual contact**
55
What are risk factors for progression of hepatitis C to chronic disease?
* **Male** * **Older** * **Higher viral load** * **Use of alcohol** * **HIV** * **HBV**
56
What are features of acute HCV infection?
Most asymptomatic, but 10%: * **Mild flu-like symptoms** - malaise, anorexia, fatigue * **Jaundice**
57
What are features of chronic hepatitis C infection?
Asymptomatic, or: * **Variations in AST/ALT - over short time period** * **Cirrhosis** * **Hepatoma**
58
How would you investigate for HCV?
* **Bloods** - LFTs, Anti-HCV antibodies * **HCV-PCR**
59
What investigations would you perform in someone who you suspected had hepatitis B?
Bloods * **LFTs** * **HBsAg** - If positive, then full HBV screen * **HBeAg** * **Anti-HBs** * **Anti-HBe** * **Anti-HBc IgM** * **Anti-HBc Ig**M Liver Biopsy
60
How would you manage someone with HCV?
Conservative * **Alcohol cessation** Medical * **Pegylated interferon + Ribrivarin** * **Consider protease inhibitors** - genotype 1
65
How is hepatitis D spread?
Parenteral infection - related to IVDU Little vertical/sexual transmission
66
What is needs to be present for HDV infection to spread?
**Hepatitis B** - needs to be there in order for HDV to spread - HBV used for HDV assembly
67
How does HDV present?
Clinically indistinguishable from HBV infection
68
How would you investigate for HDV infection?
* **LFTs** * **HDV** - IgM/IgG * **HDV RNA** - IgM/IgG * **HDAg** - IgM, IgG
69
How would you manage someoen with HDV?
* **Consider interferon alfa** * **Liver transplantation**
70
What complications can occur in those with HDV?
Severe chronic hepatitis
71
How is Hepatitis E spread?
Enterally transmitted * **From pork meat** - sausages * **Blood exposure** - abattoir workers
72
How does HEV present?
Subclinical or mild illness in woman and young people Most severe illness in elderly * **Liver failure** * **Arthritis** * **Anaemia** * **Neurological manifestations**
73
What blood test would you do to look for HEV?
HEV-RNA - IgG, IgM
74
How would you manage someone with HEV?
Most is self limiting + No licensed treatment * **Consider ribrivarin therapy**