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Flashcards in Hepatitis Deck (21):
1

Features of HAV (4)

RNA virus

foecal-oral route

endemic in S. America/Africa

incubation of 2-6wks

2

Sx of HAV infection (5)

fever, malaise

arthralgia

anorexia, nausea

jaundice, hepatosplenomegaly, enlarged LNs

loss of taste for cigarettes

3

Tests for hep A (3)

AST and ALT rise 22-40d after exposure

IgM is raised acutely. Occurs after 4wks with jaundice.

IgG raised for life. Occurs after 6wks.

4

Rx and prognosis of hep A

supportive

no chronic carrier status

5

Vaccination for hep A

provides immunity for 1yr.

give to:
-those w. hep B/C who are not immune as superimposed hep A infection>very severe acute hepatitis
-MSM
-sewage workers
-IVDU
-travelers

6

Features of HBV (5)

DNA virus

most people don't become chronic carriers:
-infection in life>5% chance of chronicity
-infection in utero/1st 2-3yrs>90% chance of chronicity

incubation of 1-6mo

spread by blood, sex, vertically, direct contact

liver damage is immune-mediated

7

Prevention of vertical transmission of Hep B (3)

vaccinate baby at birth

maternal IVIg if HBeAg+ve

maternal antivirals e.g. tenofivir during 3rd timester if viral load high.

8

Sx of Hep B infection (3)

prodrome of malaise, anorexia and arthritis

Other Sx similar to hep A w. more pronounced arthralgia:
-arthralgia
-nausea, anorexia
-jaundice, hepatosplenomegaly, swollen LNs
-loss of taste for cigarettes

9

Hep B serology (3)

HBsAg:
-present 1-6mo after exposure
-if persists=carrier status
-if only anti-HBsAg antibodies are present, this implies vaccination.

HBeAg:
-implies high infectivity
-present in acute, active illness
-secreted by virus itself
-anti-HBeAg implies lower infectivity

HBcAg:
-IgM=acute infection
-IgG raised lifelong, implies past infection

10

Hep B carriers (4)

chronic carriers have HBsAg for >6mo

virus can be cleared but most become lifelong carriers

carriers can develop liver disease, cirrhosis and HCC

can also develop extra-hepatic disease e.g. membranous GN and polyarteritis nodosa.

11

Rx of hep B (3)

Rx as outpatient, monitor LFTs and coagulation closely

all with chronic liver inflammataion>antivirals:
-PEG-IFN
-nucleoside anaologues e.g. tenofovir
-aim to seroconvert to anti-e
-aim to prevent cirrhosis and HCC

12

Hep B prophylaxis (2)

primary prophylaxis; preventing infection: vaccination after exposure

secondary prophylaxis; preventing recurrence: Ig

13

Hep B vaccination and screening (3)

3 doses of vaccination+ booster at 5yrs. must test 12wks after last dose

vaccine offered to those at high risk e.g. IVDUs, sex workers, healthcare workers

screening for pregnant women, those w. potential exposure, and those with RFs e.g. HIV, immunosuppression etc.

14

Disease course in Hep C (3)

acute phase is mild:
-anorexia, lethargy

85%>silent chronic carriers

20%>develop cirrhosis in 20yrs of which 4% develop HCC

can trigger:
-autoimmune hepatitis
-porphyria cutanea tarda
-mixed essential cryoglobulinaemia

15

Tests for Hep C (4)

LFTs

serology
-can take up to 1mo to seroconvert therefore only useful for diagnosis chronic not acute infection
-HCV RNA PCR can be used to detect acute infection.

liver biopsy to assess damage

assess genotype

16

Rx of Hep C (5)

PEG-IFN+ribavirin+protease inhibitors (boceprevir, telaprivir)

ribavirin increases the liver's sensitivity to PEG-IFN

use viral load to assess response to Rx.

immunize vs hep A and B

duration of 24-48wks. 40-70% respond. cure=absent RNA for >3mo after end of Rx

17

Features of Hep D (3)

RNA

requires hep B for infection

parenteral/sexual transmission

18

clinical features of Hep D (2)

can have co-infection w. hep D. relatively benign

can have superinfection on background of chronic hep B>cirrhosis

19

Ix for Hep D (2)

detection of current illness: PCR

past infection: anti-HDV IgG

20

Features of hep E (3)

RNA

foecal-oral

assoc. w. pigs

21

Clinical features of hep E (3)

presents similar to hep A: malaise, nausea, anorexia

doesn't progress to chronic liver disease

severe infection in pregnancy>20% mortality rate.