Infection 4 Hepatitis

Question 1

what is hepatitis?

Answer 1

inflammation of the liver due to cell injury or viruses
can cause collateral liver damage

Question 2

describe hepatitis ABCDE

Answer 2

A - acute
B - bit of both
C - chronic
D - double trouble (only happens with B)
E - like A

Question 3

transmission of hepatitis ABCDE

Answer 3

A - faeco-oral
B - blood, sex, vertical
C - blood, sex
D - blood, sex , vertical
E - faeco-oral

Question 4

which hepatitis is chronic?

Answer 4

B and C (+D)

Question 5

outline the viral structure of hepatitis A

Answer 5

ssRNA
positive
nonenveloped
icosahedral
same as E

Question 6

outline the viral structure of hepatitis B

Answer 6

dsDNA
enveloped

Question 7

outline the viral structure of hepatitis C

Answer 7

ssRNA
positive
enveloped
icosahedral

Question 8

outline the viral structure of hepatitis E

Answer 8

ssRNA
positive strand
nonenveloped
icosahedral
same as A

Question 9

blood test results of hepatitis patient

Answer 9

high bilirubin, ALT + ALP
damage to liver

Question 10

what are the different types of jaundice and their causes?

Answer 10

Prehepatic - haemolysis
Intrahepatic - hepatitis, drugs, alcohol, cirrhosis
Extraheptic - gall stones, carcinoma

Question 11

list some liver function tests

Answer 11

bilirubin
albumin
alanine transaminase ALT
aspartate aminotransferase AST
alkaline phophatase ALP
coagulation tests INR + PT

Question 12

three causes of increased ALT >1000

Answer 12

viral hepatitis
drugs
blood clots

Question 13

symptoms of acute hep B

Answer 13

jaundice
fatigue
abdominal pain
anorexia
vomiting
arthralgia
ALT/AST >1000

Question 14

outline hep B serology

Answer 14

• HBsAg surface antigen within 6 weeks
• HBeAg highly infectious e-antigen appears
• IgM - core antibody appears
• HBeAb e-antibody appears > less infectious
• HBsAb surface antibody last to appear > clears virus
• HBcAg / IgG - persists for life

Question 15

what is chronic hep B infection?

Answer 15

persistence of HBsAg after 6 months

Question 16

Management of chronic hep B

Answer 16

• no cure - integrates into host genome
• lifelong antivirals - suppresses viral replication
• screen for other viral infections e.g. HIV, hep ACD
• avoid alcohol
• contact tracing
• test for complications

Question 17

describe the hep B vaccination

Answer 17

consists of genetically engineered surface antigens
3 doses needed
produces a surface antibody response

Question 18

outline whether or not there are HBsAg, HBsAb, HBcAb in acute hep b infection

Answer 18

HBsAg +
HBcAb + IgM
HBsAb +/-

Question 19

outline whether or not there are HBsAg, HBsAb, HBcAb in cleared hep b infection

Answer 19

HBsAg -
HBcAb + IgG
HBsAb +

Question 20

outline whether or not there are HBsAg, HBsAb, HBcAb in chronic hep b infection

Answer 20

HBsAg +
HBcAb + IgG
HBsAb -

Question 21

outline whether or not there are HBsAg, HBsAb, HBcAb in patient who has been vaccinated for Hep B

Answer 21

HBsAg -
HBcAb -
HBsAb +

Question 22

who is at risk of hep C transmission

Answer 22

IV drug users
sexual contact
infants born to hep C positive mothers
needlestick injury

Question 23

complications of chronic liver disease due to chronic Hep C infection

Answer 23

decompensated liver disease
liver cancer
transplant
death

Question 24

symptoms of hep C

Answer 24

80% asymptomatic
- fatigue
- anorexia
- nausea
- abdominal pain

Question 25

describe serology test for Hep C

Answer 25

anti Hep-C antibody remains even after clearance

Question 26

what does a positive viral PCR for Hep C confirm?

Answer 26

chronic infection

Question 27

treatment for Hep C

Answer 27

no vaccine but there is a cure > can get reinfected antiviral drug combo

Question 28

Who are at risk of hep B transmission/modes of tranmssion?

Answer 28

- vertical - sexual transmission - IV drug users - close household contacts - blood exposure - healthcare working via needle stick injuries

Question 29

Patients who had a blood transfusion before what year are at risk of hepatitis C?

Answer 29

1991

Question 30

What are the risks of transmission from needle stick injury in: - HIV - Hep C - Hep B

Answer 30

- **HIV**: 1/300 - **Hep C**: 1/30 - **Hep B**: 1/3

Question 31

Types of autoimmune hepatitis

Answer 31

- **type 1**: affects women in 40/50s, presenting around menopause with fatigue - **type 2**: children or young people, presents with acute hepatitis with high ALP/ALT + jaundice

Question 32

Investigations of autoimmune hepatitis

Answer 32

- bloods: LFTs show raised ALT+ AST, raised IgG - autoantibodies - liver biopsy

Question 33

Autoantibodies in type 1 autoimmune hepatitis

Answer 33

ANA Anti actin Anti SLA

Question 34

Autoantibodies in type 2 autoimmune hepatitis

Answer 34

Anti LKM1 Anti LC1

Question 35

Histology findings of autoimmune hepatitis in biopsy

Answer 35

Interface hepatitis Plasma cell infiltration

Question 36

Management of autoimmune hepatitis

Answer 36

- high dose steroid *e..g prednisolone* - *azathioprine* - liver transplant in ESLD (but can reoccur in new liver)

Question 37

Causes of hepatitis

Answer 37

- viral ABCDE - alcoholic - non-alcoholic steatohepatitis NASH - autoimmune - drug induced *e.g. paracetamol overdose*

Question 38

How to reduce vertical transmission of hepatitis B

Answer 38

- neonates should be given both hep B vaccine + hep B immunoglobulin infusion within 24 hours of birth - additional hep B vaccine at 1 + 12 months of age - plus routine hep B vaccine at 8,12 + 16 weeks - tested for HBsAG at 1 year to see if they have contracted hep B

Question 39

Breastfeeding in hep B positive mothers

Answer 39

- baby would have already been exposed to virus during pregnancy + birth - should have recieved hep B vaccine + Ig infusion - safe for hep B positive mothers to breastfeed providing baby is properly vaccinated

Question 40

Breastfeeding in hep C positive mothers

Answer 40

Hep C is not spread through breastfeeding so safe to breastfeed But if nipples become cracked or bleed, stop temporarily until they heal