Hepatitis

Question 1

What type of virus is hep A and how does it spread?

Answer 1

• RNA picornavirus

- faeco-oral - water (shellfish)

Question 2

Prognosis and outcomes with hep A:

Answer 2

• typically benign, self-limiting
• serious outcome rare
• no chronic disease (so no increased risk HCC)

Question 3

Who is at risk of hep A?

Answer 3

• Asia and Africa

- mwhswm

Question 4

Incubation period of hep A:

Answer 4

2-4 weeks

Question 5

Hep A immunisation:

Answer 5

• effective vaccine
• after initial dose, booster 6-12 months later
• given to: >1yo if travelling or residing in areas of prevalence, chronic liver disease, haemophilia, mwhswm, IV drug users, occupational risk

Question 6

What kind of virus is hep B?

Answer 6

double stranded DNA hepadna virus

Question 7

What is the incubation period of hep B?

Answer 7

6-20 weeks

Question 8

How is hep B transmitted?

Answer 8

infected blood or bodily fluids, vertical transmission

Question 9

Complications of hep B:

Answer 9

• chronic: ground glass hepatocytes
• fulminant liver failure
• HCC
• GN
• polyarteritis nodosa
• cryoglobulinaemia

Question 10

Management of hep B:

Answer 10

• pegylated interferon-alpha: reduces replication increased 30% in chronic carriers
• tenofovir, entecavir, telbivudine

Question 11

Hep B and pregnancy:

Answer 11

• screening of all pregnant women
• chronically infected/acute during pregnancy - full course of vaccines and hep B immunoglobulin
• cannot be transmitted via breastfeeding

Question 12

Hep B immunisation:

Answer 12

• children vaccinated at 2, 3 and 4 months
• at risk groups vaccinated
• contains HBsAg absorbed onto aluminium hydroxide adjuvant prepared from yeast cells using recombinant DNA technology
• 10-15% respond poorly to 3 doses (>40yo, obesity, smoking, alcohol excess and immunosuppression)

Question 13

Anti-HBs levels in response to vaccine:

Answer 13

> 100: indicates adequate response, booster at 5 years
10-100: suboptimal response - additional vaccine given (not if immunocompetent)
<10: non-responder - test for current or past infection, further course (3 doses)

Question 14

Serology of acute hep B:

Answer 14

• HbsAg
• <6 mo
• also in chronic

Question 15

Serology of immunity to hep B:

Answer 15

• anti-HBs
• post exposure or immunisation
• negative in chronic

Question 16

Serology of previous or current infection to hep B:

Answer 16

• anti-HBc
• IgM - acute or recent (lasts 6 months)
• IgG - persists

Question 17

What is the marker for infectivity in hep B:

Answer 17

-HBeAg

Question 18

What type of virus if hep C:

Answer 18

RNA flavivirus

Question 19

Incubation period hep C:

Answer 19

6-9 weeks

Question 20

How is hep C transmitted:

Answer 20

• needle stick injury
• vertical transmission
• sexual intercourse
• IV drug users and blood transfusion pre 1991

Question 21

Chronic hep C and complications:

Answer 21

• majority develop chronic hep C
• HCV RNA >6 months
• rheumatological: arthralgia, arthritis
• eye problems: Sjogren’s
• cirrhosis
• HCC
• cryoglobulinaemia: type II
• porphyria butane tarda (PCT)
• membranoproliferative GN

Question 22

Management of hep C:

Answer 22

• depends on genotype
• clearance 95%
• combo of protease inhibitors e.g. daclatasvir and sofosbuvir or sofosbuvir and simeprevir (with or without ribavirin)
• no vaccine

Question 23

Complications with hep C treatments:

Answer 23

• ribavirin ADR: haemolytic anaemia, cough, women should not become pregnant within 6 months of stopping
• interferon alpha ADR: flu like, depression, fatigue leukopenia, thrombocytopenia

Question 24

What type of virus if hep D:

Answer 24

single stranded RNA

Question 25

How does hep D spread?

Answer 25

- parenteral spread - incomplete RNA that requires hep B surface antigen to complete replication and transmission cycle - superinfection: high risk of fulminant hepatitis, chronic hepatitis and cirrhosis - bodily fluids

Question 26

How can you treat hep D?

Answer 26

interferon

Question 27

What type of virus if hep E:

Answer 27

- RNA hepevirus | - no chronic or increased risk HCC (unless immunocompromised)

Question 28

How does hep E spread?

Answer 28

feaco-oral

Question 29

Incubation period of hep E:

Answer 29

3-8 weeks

Question 30

Where is hep E common?

Answer 30

- central and south east Asia - North and West Africa - Mexico

Question 31

Who does hep E particularly affect?

Answer 31

significant mortality during pregnancy

Question 32

Ischaemic hepatitis:

Answer 32

- diffuse hepatic injury from acute hypoperfusion - not inflammatory - inciting event e.g. cardiac arrest - marked increased aminotransferase levels - often in conjunction with AKI or end-organ dysfunction

Question 33

Who does autoimmune hepatitis most commonly affect and what is it associated with?

Answer 33

- most commonly young females | - other autoimmune conditions, hypergammaglobulinaemia, HLA B8 and DR3

Question 34

Type I autoimmune hepatitis:

Answer 34

- ANA - SMA - adults and children

Question 35

Type II autoimmune hepatitis:

Answer 35

- LKM1 | - children only

Question 36

Type III autoimmune hepatitis:

Answer 36

- soluble liver-kidney antigen | - middle aged adults

Question 37

Features of autoimmune hepatitis:

Answer 37

- signs of chronic liver disease - acute hepatitis: fever, jaundice - amenorrhoea - ANA/SMA/LKM1 antibodies - increased IgG

Question 38

Management of autoimmune hepatitis:

Answer 38

- steroids, other immunosuppressants e.g. azathioprine | - liver transplant