Hepatitis Self Learning Flashcards
(93 cards)
1
Q
What are the most important viral causes of hepatitis in the UK?
A
A, B, C, E
2
Q
What else must be done when Viral Hepatitis is diagnosed, separate to the patient?
A
Notify public health
3
Q
What is anicteric illness?
A
Symptoms with no jaundice
4
Q
What is icteric illness?
A
Symptoms with jaundice
5
Q
What is fulminant hepatitis?
A
Severe jaundice with hepatic failure and high mortality
6
Q
What Liver enzymes are raised in hepatitis? Why?
A
ALT
AST
Released into serum by damaged hepatocytes
7
Q
What are the initial clinical features of Hepatitis A?
A
Mild/subclinical
Anicteric in children <5
8
Q
How does the severity of HAV vary with age?
A
Increased severity with age
9
Q
What is the incubation period of HAV?
A
28 days (10-50)
10
Q
What is the post-incubation presentation of HAV?
A
Fever Malaise Anorexia N+V Upper abdominal pain Followed by jaundice later
11
Q
How is HAV spread?
A
Fecal-oral
Rarely fecal contaminated food/water
12
Q
Where is HAV endemic?
A
Worldwide
13
Q
When are HAV patients infectious?
A
1 week before onset of jaundice, few days after
14
Q
Which groups of the population are at risk of HAV?
A
MSM
IVDA
15
Q
What type of virus is HAV?
A
Picornavirus
16
Q
How does HAV present in the serum?
A
Anti-HAV IgM
17
Q
How is HAV treated?
A
Supportive
18
Q
When is Anti-HAV IgG raised?
A
Commonly in the general population >60
19
Q
How is HAV prevented?
A
Personal Hygiene
Sanitation
Human Normal Immunoglobulin for close contacts to patient
Killed virus Vaccine
20
Q
When is active immunisation against HAV indicated?
A
Risk of exposure:
- Sewage workers
- Seronegative haemophiliacs
- MSM
- Patients with CLD
21
Q
When does Acute Hepatitis occur after HBV infection?
A
Weeks - 6 months
22
Q
What are the symptoms of HBV infection?
A
Anorexia Lethargy Nausea Fever Abdominal discomfort Arthralgia Urticarial skin lesions Dark urine Jaundice
23
Q
How severe is Acute HBV?
A
Typically mild in 99%
24
Q
What are the infection outcomes for HBV?
A
Recovery 90-95%
Chronic Infection 5-10%
25
What type of virus is HBV?
Hepadnavirus
26
What are the viral forms seen in the blood in HBV?
Infectious virus particles
| Non-infectious spheres and tubules
27
What antigens are associated with HBV?
HBsAg (surface)
HBcAg (core)
HBeAg ("e")
28
What is the most important marker in HBV infection?
HBsAg
29
What does HBeAg +ve tell us about chronically infective individuals?
Highly infectious
| At risk of chronic liver disease and hepatoma
30
What does HBsAg +ve but HBeAg negative tell us?
Highly infectious with high serum HBV DNA with a mutant HBV genome
31
What are the main routes of transmission of HBV?
Perinatal
Sexual
Parenteral
32
Where is HBV most common?
```
SEA
China
Equatorial Africa
Oceania
South America
```
33
Where is HBV of "intermediate rate"?
East Europe
Mediterranean
South America
Middle east
34
Where is HBV least common?
Western Europe
North America
Australia
35
What are the major predisposing risk factors for HBV in the UK?
```
MSM
IVDA
immigration
Learning disability in residential care
Haemodialysis/Haemophilia
Babies born to mothers with HBV
Tattooing/body piercing
Medical equipment
```
36
What is the risk of perinatal infection in babies born to HBeAg mothers? How is it managed?
90% if no preventative immunisation given
37
How is acute HBV virus diagnosed?
HBsAg
Later: anti-HBc IgM antibodies
Seroconversion in serological profile
38
What are the clinical features of chronic HBV infection?
```
Serum HBsAg for >6mo
Non-specific Sx:
- Fatigue
- Anorexia
- Depression
```
39
How does risk of chronic infection vary with age?
Infants 90%
Children 40%
Adults 5-10%
40
How does risk of chronic infection vary in the population?
Age
Men
Immunodeficient
41
What long-term sequelae are associated with chronic HBV?
```
Chronic Liver Disease
Membranous Glomerulonephritis
Polyarteritis nodosa
Hepatoma
Cirrhosis
```
42
Which patients of acute HBV are more likely to progress to chronic disease?
Those with mild symptoms
43
What is the prognosis of Chronic HBV?
Cirrhosis/Hepatoma -25%
44
How is chronic HBV with raised ALT and HBeAg +ve treated?
Antiviral therapy
45
What are the Indications for antiviral therapy in those without cirrhosis?
HBV DNA > 2000 IU/ml
Raised ALT
Significant liver inflammation/fibrosis
46
How is chronic HBV treated?
```
Pegylated a-interferon
Nucleoside analogues
Entecavir
Tenofovir
Transplantation
```
47
When is transplantation indicated in chronic HBV?
Advanced cirrhosis
| Hepatoma
48
How is the risk of graft infection reduced in HBV?
Combined HBIG and antiviral therapy
49
What are the means of preventing HBV infection?
Immunisation
Infection control procedures
Screen blood/transplant donors
50
What vaccine is given for HBV?
HBsAg
51
Poor response to HBV vaccination are associated with what?
```
>40
Obesity
Smoking
Wrong injection site
Immunocompromisation
```
52
Post-vaccine anti-HBs
| level of >100 tells you what?
Good responder
No further check
Booster in 5 years
53
Post-vaccine anti-HBs
| level of 10-100 tells you what?
Poor responder
Booster now and in 5 years
No further check
54
Post-vaccine anti-HBs
| level of <10 tells you what?
Repeat course and recheck antibody level, 3mo after last dose
55
Active immunisation against HBV is indicated in which groups?
```
Healthcare personnel
Prolonged travel to endemic areas
Renal dialysis patients
MSM
Sex workers
IVDA
Emergency service personnel
Those in close contact
```
56
HBIG and vaccine is given to which patients?
Babies born to HBsAg positive mothers
Healthcare workers
Needlestick injury
Previously unprotected sexual contacts and family contacts of HBV patients
57
How should immunocompromised patients at risk of HBV infection be managed?
Ongoing prophylactic antiviral therapy
58
Previous HBV patients with no detectable HBsAg can reactivate viral disease how?
Chemotherapy
Prolonged immunosuppression
i.e Rituximab
59
What are the clinical features of acute HCV infection?
```
Mild or subclinical
Vague malaise
Anorexia
Fatigue
Jaundice is severe
```
60
What are the outcomes of acute HCV infection?
```
20-40% full recovery
60-80% chronic infection:
- 50-80% progress without cirrhosis
- 20-50% cirrhosis in 30y
- 10% hepatoma
```
61
Clearance of HCV is most common in which groups?
Icteric illness
| Females
62
What do AST or ALT values tell you in HCV infection
Can vary wildly in chronic HCV
| Increasing AST:ALT indicative of fibrosis/cirrhosis
63
How is HCV spread?
```
<5% sexual contact
<6% mother-child (unless HIV+)
20-50% IVDA
Haemophiliacs
Blood products prior to '89/'91
Tattooing
Household contacts
Dental/medical treatment
```
64
Where is the incidence of HCV high?
```
Japan
New Guinea
Gambia
Zaire
Brazil
Egypt
```
65
What type of virus is Hepatitis?
Flavivirus (RNA Virus)
66
How is HCV diagnosed?
IgG detectable late/remains negative
HCV antigen
HCV-RNA
Sequencing
67
How is HCV managed?
Abstinence
Test for HAV/HBV + immunisation
Pegylated a-interferon
Ribarvirin
68
Viral clearance is lower in which type of HCV?
HCV Genotype 1
69
What are the 4 recognised response patterns to HCV antiviral therapy?
Non-responder
Viral breakthrough
Relapser
Sustained viral response
70
What is a Viral breakthrough response?
Initial response to antiviral therapy followed by increase in the measured circulating level of virus by a factor of 10
71
What is a non-responder response?
Despite antiviral therapy, virus remains detectable
72
What is a relapser response?
Virus undetectable during antiviral therapy but becomes detectable on stopping treatment
73
What is a sustained viral response?
Virus undetectable for 6 months after antiviral therapy
74
Response to anti-HCV therapy depends on what?
```
Viral genotype
Age
Gender
Stage of liver disease
Viral load
```
75
How is the risk of progression to chronic HCV infection prevented?
Early diagnosis and treatment with pegylated a-interferon and Ribavirin
76
What are the factors in reducing risk of HCV transmission?
Blood, organ and tissue donor screening
Not sharing equipment
Covering cuts/lesions
77
What is essential for HDV infection?
HBV infection
78
How can HDV infection occur?
Co-infection (simultaneous)
| Superinfection (HBV then HDV)
79
What is the most common route of HDV infection?
IVDU
| Vertical/sexual transmission rare
80
Where is HDV infection most common?
Southern Europe
Middle East
Africa
South America
81
How is HDV diagnosed?
Anti-HDV IgG/IgM
HDV-RNA
HDAg
82
How is HDV co-infection distinguished from superinfection?
Co-infection: High levels of anti-HBc IgM
83
How is HDV treated?
Prolonged pegylated a-interferon
84
How does HEV infection present?
```
~40 days post-exposure
Similar to HAV
Increased mortality in pregnant women (<20%)
Arthritis
Anaemia
Neurological symptoms
```
85
When can persistent HEV infection develop?
Immunocompromised patients
86
Where is HEV endemic?
Globally
| Seasonal variation in developing countries
87
How may HEV spread?
```
Undercooked pork (85% of British pigs infected with HEV)
Contaminated water
Game
Occupation
Donated blood (not screened)
```
88
How is HEV diagnosed?
IgG
IgM
HEV-RNA
89
What type of virus is HEV?
Henevirus (small RNA virus)
90
How is HEV treated?
Supportive (self-limiting)
Reduced immunosuppression
Ribavirin if severe
Good hygiene/cooking
91
What are the HEV genotypes?
1 and 2 - epidemics in developing countries
3 - sporadic
3 and 4 - worldwide
92
When are healthcare workers with hepatitis excluded from exposure prone procedures?
1. Hep B e antigen positive
2. Hep B s antigen positive (HBV DNA >1000/ml)
3. Hep C PCR positive
93
After percutanous exposure to blood/body fluids, how should you respond?
1. Encourage bleeding
2. Wash thoroughly
3. Cover with waterproof plaster
4. Report to supervisor/GP
Approach source and request blood test with consent
Repeat blood testing on victim 3 and 6mo post
