infective, autoimmune, iscahemic hepatitis

Question 1

what is acute hepatitis

Answer 1

liver dysfunction in previously well liver lasting less than 6 months

Question 2

what are the common causes of acute hepatitis (5)

Answer 2

alcohol // autoimmine // infection (hep a–>E) // ischaemia // drugs eg paracetamol

Question 3

presentation acute hepatitis

Answer 3

prodromal flu like illness + fever // jaundice // itch // RUQ pain // hepatosplenomegaly // deranged LFTs

Question 4

how is hep A spread + what is the virus

Answer 4

faecal oral // RNA picornavirus

Question 5

who should be vaccinated for hep A (6)

Answer 5

travel to high prevalance areas // chronic liver disease // haemophillia // MSM // IV drugs // occupational risk eg sewage

Question 6

mx hep A

Answer 6

vaccine // conservative

Question 7

what type of vaccine is hep A

Answer 7

inactive

Question 8

how is hep B spread and what is incubation

Answer 8

blood/ bodily fluid spread // 6-20 weeks

Question 9

what are some complications of Hep B (6)

Answer 9

chronic hepatitis // liver failure // hepatocellular carcinoma // GN // polyarteritis nodosa // cyroglobulinaemia

Question 10

what pathology could you expect in a slowly deteriorating hep B patient

Answer 10

hepatocellular carcinoma

Question 11

1st line mx hep B

Answer 11

pegylated interferon alpha

Question 12

2nd line mx hep B

Answer 12

antivirals eg tenofovir, entecavir

Question 13

at what age are children in the UK vaccinated against hep B

Answer 13

1 vaccine each at: 2, 3, and 4 months

Question 14

what antibody does the hep C vaccine contain + what vaccine is it

Answer 14

HBsAg - subunit vaccine

Question 15

who is at risk for failing to respond to hep B vaccine

Answer 15

obese, 40+, smoking, alcohol excess, immunosuppressed

Question 16

who needs tested for anti-HBs to see if vaccine has worked + when

Answer 16

occupational exposure + CKD patietns // 1-4 months after first vaccine

Question 17

what anti-HBs level indicates good vaccine response + when would booster be required

Answer 17

100+ // 5 years

Question 18

what anti-HBs level indicates suboptimal vaccine response + what should be done

Answer 18

10-100 // give 1 more vaccine

Question 19

what anti-HBs level indicates non-responder vaccine + what should be done (4)

Answer 19

<10 // test for current infection // give 3 more vaccines + retest // if fails HBIG

Question 20

what should babies born to women with chronic hepatitis or acute B hepatitis in pregnancy be given

Answer 20

full course of vaccine + HBIG

Question 21

can hep B patients breast feed

Answer 21

yes

Question 22

what is the antigen and antibody in hep B

Answer 22

antigen = HBsAg // antibody = anti HBs

Question 23

what antigen/ antibody is raised in acute hep B infection (1-6 months)

Answer 23

HBsAg

Question 24

what antigen/ antibody would show chronic hep B disease ie is a disease carrier, how long would it be raised for

Answer 24

HBsAg >6months

Question 25

what antibody indicates immunity from hep B

Answer 25

anti HBs (negative in chronic disease)

Question 26

how can immunity from hep B be acquired

Answer 26

exposure or vaccine

Question 27

what antibody indicates previous (or current) infection in hepatitis

Answer 27

anti-HBc // (remember c for caught by the virus)

Question 28

what antigen is a marker of hep B infectivity

Answer 28

HbeAg

Question 29

what hep B serology would be seen in an immunised hep B person

Answer 29

anti-HBs +ive // all negative

Question 30

what hep B serology would be seen in a patient with previous hep B infection who is not a carrier

Answer 30

anti-HBc +ive // HBsAg negative

Question 31

what hep B serology would be seen in a patient with previous hep B infection who is a carrier

Answer 31

anti-HBc +ive // HBsAG positive

Question 32

how is Hep C spread

Answer 32

parenteral (blood) // sexual // vertical

Question 33

what vaccine for hep C

Answer 33

none!!

Question 34

symptoms of hep C

Answer 34

transient rise in ALT // jaundice // fatigue // arthralgia

Question 35

invx hep C

Answer 35

HCV RNA

Question 36

what is a very common complication of acute hep C illness

Answer 36

chronic hep C (50%+)

Question 37

how is chronic hep C diagnosed

Answer 37

HCV RNA +ive for 6 months

Question 38

liver problems with chronic hep C

Answer 38

cirrhosis // hepatocellular cancer

Question 39

extraliver problems with chronic hep C

Answer 39

rheum // eyes // cryoglobulinaemia // PCT // GN

Question 40

mx of chronic hep C

Answer 40

protease inhibitors -vir +/- ribavirin

Question 41

s/e ribavirin

Answer 41

haemolytic anaemia // teratogenic

Question 42

how is hep D transmitted

Answer 42

via bodily fluids

Question 43

what is hep D always seen with AKA coinfection

Answer 43

hep B (co infection) at the same time

Question 44

what is hep D super infection

Answer 44

chronic infected hep B patients (HBsAg) develops hep D

Question 45

invx hep D

Answer 45

PCR

Question 46

mx hep D

Answer 46

interferon alpha

Question 47

how is hep E spread

Answer 47

faecal oral

Question 48

where is hep E common

Answer 48

SE asia, africa, mexico

Question 49

who does hep E raise mortality in

Answer 49

pregnancy

Question 50

who commonly gets autoimmune hepatitis

Answer 50

young females

Question 51

what conditions are assoc with autoimmune hepatitis

Answer 51

HLA // hypergammaglobulinaemia

Question 52

what antibodies are in type 1 autoimmune hepatitis and who is affected

Answer 52

ANA or anti smooth muscle (SMA) // adults and kids

Question 53

what antibodies are in type 2 autoimmune hepatitis and who is affected

Answer 53

anti liver/ kidney (LKM1) // children onlu

Question 54

what antibodies are in type 3 autoimmune hepatitis and who is affected

Answer 54

soluble liver kidney // adults only

Question 55

how does autoimmune hepatitis present

Answer 55

chronic liver disease // acute hepatitis (fever, jaundcice) // AMENORRHEA

Question 56

invx for autoimmune hepatitis

Answer 56

antibodies // IgG // liver biopsy --> bridging necrosis

Question 57

mx autoimmune hepatitis

Answer 57

steroids // immunosuppressants eg azathioptine // liver transplant

Question 58

what causes ischaemic hepatitis

Answer 58

hypoperfusion (not inflammation)

Question 59

what is a common cause of ischaemic hepatitis.

Answer 59

cardiac arrest

Question 60

what LFTs are seen in ischaemic hepatitis

Answer 60

ALT massively increased (>1000)

Question 61

what other organ dysfunction is common in ischaemic hepatitis

Answer 61

AKI (tubular necrosis)

Question 62

which hepatitis causes ground glass hepatocytes

Answer 62

hep B