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hepatitis Flashcards

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1
Q

what is most obvious sign hepatitis

A

jaundice with hepatic tenderness

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2
Q

viral hepatitis should be notified to

A

public health

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3
Q

subacute illness

A

no symptoms

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4
Q

anicteric illness

A

symptoms with no jaundice

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5
Q

icteric illness

A

symptoms w jaundice

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6
Q

fulminant hepatitis

A

severe jaundice with hepatic failure and high mortality

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7
Q

acute infections biochemistry

A

raised ALT and AST which are released into serum in excess quantities by damaged hepatocytes

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8
Q

HAV severity

A

usually mild and often subclinical/anicteric in <5yrs

severity inc w age but fulminant hepatitis is rare

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9
Q

HAV incubation

A

mean incubation 28ay s

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10
Q

HAV clinical features

A 
fever, malaise
N&V
anorexia
upper abdo pain 
jaundice developing 3-10days later
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11
Q

spread of HAV

A

fecal-oral route

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12
Q

when is HAV most infectious

A

~1wk before jaundice and a few days after

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13
Q

HAV virological diagnosis

A

antiHAV-IgM present in serum from onset symtoms until 3-6mo

antiHAV-IgG represents immunity

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14
Q

HAV Mx

A

no specific treatment

supportive management

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15
Q

who is at risk of HAV in UK

A 
travellers to endemic areas
sewage workers 
contacts of cases
MSM
PWID
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16
Q

prevention of HAV

A

good personal hygiene + sanitation
HNIg (prophylaxis for contacts)
innactivated vaccing

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17
Q

HAV who is offered vaccine

A 
PWID
MSM multiple partners
travellers to endemic areas
sewage workers
seronegative haemophiliacs
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18
Q

when may acute hepatitis occur after HBV infection

A

few weeks - 6mo

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19
Q

symptoms acute hepatitis

A 
anorexia
lethargy 
nausea
fever
abdominal pain 
urticarial skin lesions 
jaundice
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20
Q

HBV viral forms seen in blood

A

infectious viral particles

non-infectious spheres and tubules containing HBsAg

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21
Q

HBV: core/nucleocaspid contains

A

HBcAg

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22
Q

hepaitits B core e antigen

A

splits of from HBcAg in liver cells during new virus formation + released in free soluble form in the serum

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23
Q

HBV: markers for viral replication

A

HBeAg

HBV-DNA

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24
Q

where is HBV-DNA present

A

infectious viral particles in the serum

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25
HBsAg
on outershell of HBV | marker for acute + chronic HBV infection
26
HBV routes of transmission
perinatal parenteral sexual
27
HBV: main populations at risk UK
``` immigrants from high prevelence areas PWID multiple sexual partners healthcare workers babies of HBsAg + mums ```
28
HBeAg chronically infected patients
highly infectious | at risk of chronic liver disease and hepatoma
29
diagnosing acute HBV
HBsAg in serum | anti-HBV IgM
30
chronic HBV infection
persistence of HBsAg in serum >6mo 90% infants 40% kids 5-10% adults
31
HBV: who is chronic infection more common in
men, immunodeficient patients with mild/asymptomatic acute infection rather than severe symptoms
32
chronic HBV long-term sequelae
chronic hepatitis cirrhosis hepatoma
33
clinical features of chronic HBV
fatigue, anorexia, depression jaundice unusual unless advanced disease
34
who gets HBV anti-viral Rx
those w asymptomatic HBV w raised ALT, HBeAg positive + progressive lier disease those w cirrhosis + evidence of viral replication (HBV-DNA)
35
HBV: ART indications in those without cirrhosis
2/3 of - raised ALT - HBV-DNA >2000 - signigicant liver inflammation, fibrosis
36
HBV Rx options
pegylated alpha-interferon injection nucleoside analogues liver transplant
37
HBV nucleoside analogues
inhibit viral enzyme transcriptase entecavir, tenofovir
38
HBV vaccine poor responders
>40yrs obese wrong injection site immunocompromised
39
HBV vaccine >100
good response
40
HBV vaccine 10-99
poor response - booster now and in 5yrs
41
HBV vaccine <10
no response | repeat course
42
who gets HBV vaccine
``` healthcare workers PWID multiple sexual partners renal dialysis travellers to endemic areas ```
43
HBV passive immunisation
HBIg - infants born to HbsAg positive mothers - healthcare worked without anti-bodies who are exposed - close contacts cases
44
HCV acute infection
usually subclinical/mild malasie, anorexia, fatigue severe hepatitis w jaundice may occur
45
HCV chronic infection
develops in most most no symptoms wide variations AST/ALT levels
46
HCV transmission
blood-borne sexual perinatal
47
HCV main populations at risk UK
PWID | recipients of unscreened blood products
48
HCV diagnosis
antiHCV-IgG | HCV-RNA
49
HCV chronic sequelae
chronic hepatitis cirrhosis hepatoma
50
HCV Mx
hep A + B vaccine | combo of pegylated alpha-interferon and ribavirin
51
HCV Rx: non-responsed
virus remains detectable
52
HCV Rx: viral breakthrough
initial response to ART followed by increase circulating level virus
53
HCV Rx: relapser
virus undetectable during ART but beomes detectable when stop Rx
54
HCV Rx: sustained viral response
virus undetectable for 6mo after
55
HVC: response to Rx varies according to
``` viral genotype age gender stage liver disease viral load ```
56
how is HDV a defective virus
always found with HBV | HBV essential for its transmission
57
HDV co-infection
simultaneous infection w HDV and HBV
58
HDV superinfection
person w chronic HBV catches HDV
59
HDV transmission
parenteral
60
HDV main pops at risk UK
PWID
61
HDV chronic sequelae
chronic heaptitis | cirrhosi s
62
HDV diagnosis
anti-HDV IgM, IgG
63
HDV how can co-infection and superinfection be distinguished
high levels anti-HBV IgM in co-infection
64
HDV Rx
pegylated alpha-interferon
65
HEV
subclinial/mild ilmness | most severe disease in elderly men
66
HEV incubation
40ays
67
HEV route
fecal-oral
68
HEV developing countries
extra-hepatic features e.g. arthritis, anaemia
69
HEV chronic infection
immunocompromosed persistent hepatitis and cirrhosis
70
HEV main pop at risk UK
travellers to endemic areas | exposure to under-cooked pig products
71
HEV genotypes 1 + 2
developing countries
72
HEV genotypes 3 + 4
developed countries
73
HEV diagnosis
IgM, IgG | HEV-RNA
74
HEV Mx
no licensed Rx, mostly self limiting
75
HEV prevention
good personal hygiene and sanitation adequate cooking food vaccine in china only
76
HBV incubation
90 days
77
HCV incubation
60 days
78
when are healthcare workers with hepatitis excluded from performign EPP
HBeAg positive HBsAg positive + HBV-DNA 1000+ HCV PCR +ive
79
exposure prone procedure
risk that injury to worker may result in exposure of patient's open tissues to blood of worker

infection (36 decks)

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