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NME > Infective Hepatitis > Flashcards

Infective Hepatitis Flashcards

1
Q

What are some common causes of hepatitis?

A

Common causes of hepatitis include drugs such as paracetamol, alcohol, viruses, and autoimmune disease.

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2
Q

What are the symptoms that can be associated with hepatitis?

A

Symptoms of hepatitis can include nausea, vomiting, fevers, joint pain and muscle aches, jaundice, abdominal pain, itchy skin, pale stools, and dark urine.

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3
Q

What are the possible outcomes of hepatitis?

A

Hepatitis can be acute, chronic, or both. Chronic hepatitis is characterized by persistent inflammation leading to scarring and eventually cirrhosis. Examples of acute hepatitis include paracetamol overdose or hepatitis A, while examples of chronic hepatitis include hepatitis C and autoimmune hepatitis.

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4
Q

Can hepatitis B and hepatitis E be both acute and chronic?

A

Yes, hepatitis B and hepatitis E can be both acute and chronic in nature.

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5
Q

Name some specific examples of acute and chronic hepatitis.

A

Examples of acute hepatitis include paracetamol overdose or hepatitis A. Examples of chronic hepatitis include hepatitis C and autoimmune hepatitis.

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6
Q

What are some risk factors for hepatitis?

A

Risk factors for hepatitis include exposure to infected blood or bodily fluids, unprotected sex, sharing needles, certain medical procedures, and having a weakened immune system.

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7
Q

What are the key enzymes investigated in hepatitis?

A

The key enzymes investigated in hepatitis are alanine transaminase (ALT) and aspartate aminotransferase (AST).

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8
Q

What is the location of ALT and what is its function?

A

ALT is located in the cytoplasm, with high expression in hepatocytes. Its function is to catalyze the conversion of alanine and α-ketoglutarate to pyruvate and glutamate

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9
Q

Where is AST located and what is its function?

A

AST is located in both the cytoplasm and mitochondria, with expression in multiple organs but higher concentrations in the liver. Its function is to catalyze the conversion of aspartate and α-ketoglutarate to oxaloacetate and glutamate.

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10
Q

What is the significance of the AST/ALT ratio in investigating hepatitis?

A

The AST/ALT ratio can provide insight into the possible causes of hepatitis. A ratio greater than 1 may indicate cirrhosis or chronic viral hepatitis, while a ratio less than 1 is often seen in viral hepatitis. However, it is important to note that the ratio is not definitive in diagnosis.

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11
Q

In infective hepatitis, what are the key liver enzymes that are predominantly raised?

A

In infective hepatitis, both ALT and AST will be predominantly raised.

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12
Q

What does an ALT level greater than 1000 suggest in hepatitis?

A

An ALT level greater than 1000 is more consistent with acute viral causes, ischaemia (lack of blood supply), or paracetamol overdose.

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13
Q

Apart from ALT and AST, what other markers should be checked in hepatitis to assess liver function?

A

In addition to ALT and AST, bilirubin, creatinine, albumin, and blood glucose should be checked as they are markers of liver failure.

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14
Q

What are the different types of viral hepatitis?

A

The different types of viral hepatitis are Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, and Hepatitis E. Other viruses such as Cytomegalovirus (CMV), Epstein-Barr Virus (EBV), and Human Immunodeficiency Virus (HIV) can also cause hepatitis.

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15
Q

What are the differences between acute and chronic viral hepatitis?

A

Acute viral hepatitis refers to a short-term infection that typically resolves within six months, while chronic viral hepatitis refers to a long-term infection that lasts for more than six months.

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16
Q

How is Hepatitis A transmitted and what are its sources?

A

Hepatitis A (HAV) is transmitted through the fecal-oral route, often due to contaminated water and food sources.

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17
Q

Where is Hepatitis A more prevalent and who is at higher risk?

A

Hepatitis A is more prevalent in low socioeconomic groups or individuals who travel to high-risk areas.

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18
Q

What is the incubation period for Hepatitis A?

A

The incubation period for Hepatitis A is typically 2-6 weeks.

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19
Q

How is Hepatitis A diagnosed and what is the characteristic diagnostic marker?

A

Hepatitis A is diagnosed by the presence of IgM anti-HAV in the serum, which indicates an acute infection.

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20
Q

What are the common symptoms of Hepatitis A?

A

The common symptoms of Hepatitis A include jaundice (yellowing of the skin and eyes), fever, and lethargy.

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21
Q

Does Hepatitis A lead to chronic liver disease or acute liver failure?

A

Hepatitis A does not lead to chronic liver disease, and acute liver failure is rare.

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22
Q

What is the treatment for Hepatitis A, and are there any available vaccines?

A

Treatment for Hepatitis A is mainly supportive, focusing on rest and adequate hydration. Vaccines are available for Hepatitis A.

23
Q

: Describe the life cycle of a positive strand RNA virus, such as Hepatitis A.

A

The life cycle of a positive strand RNA virus involves viral entry and genome release, translation of the RNA genome, assembly of the viral replication complex, RNA replication (generation of negative strands followed by synthesis of positive strands), virus assembly, and virion exit.

24
Q

What type of virus is Hepatitis E (HEV) and what is its genome type?

A

Hepatitis E (HEV) is an RNA virus with a positive strand genome.

25
Q

How is Hepatitis E transmitted?

A

Hepatitis E can be transmitted through the fecal-oral route or through blood products.

26
Q

How many genotypes of Hepatitis E exist and what are their geographical distributions?

A

There are four genotypes of Hepatitis E: Genotype 1 is found in Asia, Africa, and South America; Genotype 2 is found in Central America and Africa; Genotype 3 is found worldwide and is zoonotic, transmitted from pigs to humans; Genotype 4 is found in Japan and China and is also zoonotic.

27
Q

Who is particularly vulnerable to Hepatitis E, and what are the risks during pregnancy?

A

Pregnant women are especially vulnerable to Hepatitis E, as it can cause liver failure in pregnancy. However, middle-aged men are often seen to be infected as well.

28
Q

What are the common manifestations and symptoms of Hepatitis E?

A

Most cases of Hepatitis E remain asymptomatic. However, other manifestations can include jaundice (yellowing of the skin and eyes), fever, myalgia (muscle pain), vomiting, and abdominal pain.

29
Q

What is the typical incubation period for Hepatitis E?

A

The incubation period for Hepatitis E is typically 2-9 weeks.

30
Q

How is Hepatitis E diagnosed, and what is the characteristic diagnostic marker?

A

Hepatitis E is diagnosed by the detection of anti-HEV IgM antibodies, indicating an acute infection.

31
Q

Can Hepatitis E cause chronic hepatitis, and in which population is it more likely?

A

Hepatitis E can cause chronic hepatitis, especially in immunosuppressed individuals. However, cirrhosis does not occur.

32
Q

What is the recommended treatment for Hepatitis E?

A

Treatment for Hepatitis E is mainly supportive, focusing on symptom management and rest.

33
Q

How many people are affected by Hepatitis B (HBV) and where is it endemic?

A

Hepatitis B (HBV) affects over 350 million people worldwide. It is endemic in Sub-Saharan Africa and Southeast Asia.

34
Q

How is Hepatitis B primarily transmitted, and what are common transmission routes in developed countries?

A

Hepatitis B is primarily transmitted vertically, from mother to baby during delivery, or acquired in early childhood. In developed countries, sexual transmission and intravenous drug use (IVDU) are common causes of transmission.

35
Q

What are the long-term complications associated with Hepatitis B?

A

Hepatitis B can cause cirrhosis (scarring of the liver) and hepatocellular cancer (a type of liver cancer).

36
Q

How many genotypes of Hepatitis B exist?

A

There are eight genotypes of Hepatitis B.

37
Q

Describe the life cycle of Hepatitis B.

A

The life cycle of Hepatitis B involves attachment and entry into hepatocytes via the NTCP surface receptor, uncoating and nucleus entry with viral DNA released and converted into covalently closed circular DNA (cccDNA) in the cell nucleus, transcription of cccDNA into viral mRNA, translation of viral mRNA into viral proteins, replication of viral polymerase using positive RNA to synthesize cDNA, formation of double-strand genome, virion assembly with core proteins and viral DNA, release of mature Dane particles, and release of non-infectious capsids.

38
Q

What is the general structure of the Hepatitis B virion or “Dane particle”?

A

The Hepatitis B virion, also known as the “Dane particle,” consists of an encapsulated nucleocapsid in a membrane with three surface antigens: HBs (surface antigen), M-HBs (middle surface antigen), and S-HBs (small surface antigen). It also contains core protein (HBc) and viral polymerase (HBV Pol). The genomic structure is DNA, specifically a relaxed circular form (rcDNA) of approximately 3.2 kilobases.

39
Q

What is chronic Hepatitis B defined as?

A

Chronic Hepatitis B is defined as testing positive for Hepatitis B surface antigen (HBsAg) for more than six months.

40
Q

What are the four states of HBV infection in chronic Hepatitis B?

A

Immune tolerant: Host activity to HBV is minimal, viral load is high.
Immune reactive: Immunity is engaged, leading to destruction of infected hepatocytes and rise in ALT levels. Viral load fluctuates.
Inactive: Viral load decreases, ALT levels fall. Some individuals may still have moderate to severe fibrosis.
Immune active: Risk of reactivation, with rising viral load accompanied by increased ALT levels.

41
Q

How does acute Hepatitis B typically present?

A

Acute Hepatitis B is mostly asymptomatic, but some patients may present with jaundice and fever. Acute liver failure is rare.

42
Q

What percentage of adults seroconvert after acute Hepatitis B infection, and how many develop chronic Hepatitis B?

A

Approximately 95% of adults seroconvert, meaning they develop antibodies and clear the infection. However, around 5% of adults will progress to develop chronic Hepatitis B.

43
Q

What are the common investigations for Hepatitis B?

A

ALT (alanine transaminase) levels, which are typically >1000 in acute Hepatitis B and normal or slightly elevated in chronic Hepatitis B.
Raised bilirubin levels in acute Hepatitis B.
Serology tests, including Hepatitis B surface antigen (HBsAg), Hepatitis B core antibody (HBcAb), Hepatitis B e antigen (HBeAg), and Hepatitis B surface antibody (HBsAb).

44
Q

What do the different serological markers indicate in Hepatitis B?

A

HBsAg: Corresponds to the presence of Hepatitis B surface antigen, indicating active infection.
Anti-HBsAg: Antibodies to Hepatitis B surface antigen, indicating immunity (either through vaccination or natural infection).
Anti-HBcAg: Antibodies to Hepatitis B core antigen, which can be present during acute or chronic infection.

45
Q

What are the treatment options for Hepatitis B?

A

Treatment for Hepatitis B typically involves lifelong antiviral medications. Treatment is initiated when patients show signs of fibrosis, have HBV DNA levels >2000 IU/ml, or have elevated ALT levels on multiple occasions. Pregnant women in the third trimester may also receive treatment to prevent transmission. Additionally, immunosuppressed patients may require treatment. Vaccination against Hepatitis B is available for prevention.

46
Q

What is Hepatitis D (HDV) and how does it affect individuals with Hepatitis B?

A

Hepatitis D is an RNA virus that requires Hepatitis B in order to replicate. It affects approximately 5% of individuals who are carriers of Hepatitis B. Hepatitis D can occur as either a coinfection, where HDV and HBV are acquired simultaneously, or a superinfection, where HDV is acquired on top of existing chronic Hepatitis B. HDV infection leads to a more aggressive form of hepatitis and increases the risk of liver failure.

47
Q

What is the genomic structure of Hepatitis C (HCV) and how many genotypes are there?

A

Hepatitis C is an RNA virus with a positive strand genome. There are six genotypes of Hepatitis C.

48
Q

How many people are infected with Hepatitis C each year, and what is the global prevalence?

A

Approximately 3-4 million people are infected with Hepatitis C every year, and there are around 170 million people worldwide who have chronic Hepatitis C. High prevalence areas include Egypt, Pakistan, and China.

49
Q

How is Hepatitis C primarily transmitted, and what are the common modes of transmission?

A

Hepatitis C is primarily transmitted through exposure to contaminated blood, such as through contaminated blood transfusions, sharing needles during intravenous drug use (IVDU), or less commonly, through sexual intercourse. Vertical transmission from mother to baby is relatively low.

50
Q

What is the typical clinical presentation of Hepatitis C, and what are the chances of developing chronic infection?

A

Most patients with Hepatitis C are asymptomatic, although fatigue is a common symptom. Jaundice is rare and associated with a reduced risk of chronic infection. Approximately 85% of those acutely infected with Hepatitis C develop chronic infection.

51
Q

What are the common diagnostic tests used to detect Hepatitis C?

A

Hepatitis C is detected by testing for Hepatitis C antibodies (HCV Ab) and Hepatitis C RNA (HCV RNA). Genotyping may also be performed to determine the specific genotype of the virus.

52
Q

What are the key considerations in the treatment of Hepatitis C?

A

Treatment for Hepatitis C is evolving rapidly. It can be expensive, genotype-specific, and depends on other factors such as the presence of cirrhosis or renal failure. Newer direct-acting antiviral medications have significantly improved treatment outcomes.

53
Q

What are the long-term consequences of untreated Hepatitis C?

A

Without treatment, approximately 30% of individuals with Hepatitis C progress to cirrhosis over 10-20 years, another 30% over 20-30 years, and a further 30% over 30 years. Additionally, 1-3% of patients may develop hepatocellular carcinoma (liver cancer).

54
Q

Is there a vaccine available for Hepatitis C?

A

Currently, there is no vaccine available for Hepatitis C.

NME (49 decks)

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