Hepatitis C Flashcards
What is hepatitis C?
An infectious disease caused by the hepatitis C virus that primarily affects the liver
Describe the initial infection of hepatitis C?
People often have mild or no symptoms
In what % of people does hepatitis C persist after initial infection?
75-85%
How can hepatitis C be transmitted?
- IV drug use
- Blood transfusions or organ transplantations
- Skin piercings or tattoos
- Mother to infant
- Sexual intercourse
What increases the risk of hepatitis C transmission with sexual intercourse?
Concurrent HIV infection
In what % of cases does hepatitis C cause acute symptoms?
15%
What are the symptoms of acute hepatitis C infection?
- Decreased appetite
- Fatigue
- Nausea
- Muscle or joint pains
- Weight loss
What happens in the first few decades of chronic hepatitis C infection?
Most experience minimal or no symptoms, however may be associated with fatigue and mild cognitive problems
What are the risk factors for progression of chronic hepatitis C infection?
- High circulating virus levels
- Long duration of disease
- Male gender
- Older age at acquisition
- Alcohol excess
- Co-infection with HIV/hepatitis B
What are the extra-hepatic manifestations of hepatitis C?
- Cryoglobulinaemia
- Membranous glomerulonephritis
- Sjorgen’s sndrome
- Lichen planus
- Autoimmune hepatitis
- Thyroiditis
- Polyarteritis nodosum
- Polymyositis
How is a diagnosis of HCV made?
- Anti-HCV antibody
- HCV RNA by PCR
What does a positive anti-HCV antibody show?
Confirms exposure to HCV (but not persistent infection)
What does positive HCV RNA by PCR show?
Confirms ongoing infection
What initial investigations should be done in HCV?
- HCV genotyping
- Bloods
- Look for signs of hep B infection
- HIV testing
- Screening for other STIs
What bloods should be done in HCV?
- FBC
- U&Es
- LFTs
- Clotting screen
- HbA1c
- TFTs
Why is FBC required in HCV?
- Anaemia
- Neutropenia
- Thrombocytopenia
Why are TFTs required in HCV?
Need to establish baseline as anti-virals can cause thyroid dysfunction
What specialist investigations may be done in HCV?
- Viral load
- Autoantibodies
- Liver ultrasound
- Liver biopsy
Why might viral load be done in HCV?
To assess response to treatment
When is liver ultrasound used in HCV?
In patients with advanced fibrosis or cirrhosis, to screen for hepatocellular cancer
What is the role of liver biopsy in HCV?
To assess extent of damage caused by inflammation, fibrosis, cirrhosis, and exclude other causes of liver damage
Why might autoantibodies be checked in HCV?
Because autoimmune hepatitis may be exacerbated by anti-viral therapy
How does chronic hep C present?
Chronic HCV is indicated by persistently elevated or fluctuating liver enzyme levels.
It can go undetected for ages until incidental liver testing or tries to donate blood
What is involved in the management of hepatitis C?
- Education
- Lifestyle advice
- Antiviral therapy
- Liver transplantation
- Vaccination against hepatitis A and B
