Liver Symposium - Viruses

Question 1

What are the 5 main viruses affect the liver

Answer 1

Hepatitis:

A,B,C,D

Question 2

What Hepatitis viruses are enteric (Viruses that take the faecal-oral route)

Answer 2

Hepatitis A, E

Question 3

What Hepatitis viruses are Parenteral viruses - occur outside alimentary canal

Answer 3

Hepatits B,C,D

Question 4

What type od hepatits infection results in self limiting acute infections and chronic disease

Answer 4

Acute - Hep. A,E

Chronic- Hep B,C,D

Question 5

What is the clinical course of Hepatitis A

in regard to antibodies

Answer 5

Vireamia presents and IgM antibodies increase

People initially feel unwell experiencing flu like symptoms

IgG antibodies increase above IgM around 8 weeks and clinical illness begins to disappear

Question 6

When does Hepatitis A occur

Answer 6

Sporadically

or an epidemic

Question 7

How is Hepatitis A transmitted

Answer 7

Faecal -oral route

Sexual

Blood

Question 8

What is a very common case for hepatitis A infection

Answer 8

Patient can present asymptomatic

Question 9

What is the demographic of Hepatitis A

Answer 9

Age - common 5-14 Years

Countries -

Question 10

Who are vaccinated against hepatitis A

Answer 10

Travellers

Patients with chronic liver disease

Haemophiliacs

Occupational exposure

Men who have sex with men (MSM)

Question 11

What is the structure of Hepatitis B

Answer 11

There is a inner protein core containing genetic material and is surrounded by outer lipid envelop that has a surface antigen

Question 12

What is the antigen present in the protein core of hepatitis B that is not detected in the blood

Answer 12

Hepatits B c antigen

Question 13

What antigen is released from the core of the hepatitis B virus and can be detected in the blood

Answer 13

Hepatitis B e antigen

Question 14

What is the surface antigen present on the Hepatitis B virus

what does this indicate

Answer 14

Hepatitis B s Antigen

Indicating that the virus is present

Question 15

What antigens present from Hepatitis B indicated active replication is occurring

Answer 15

Hepatits B c/e antigen

Question 16

What antibody is present when hep B first appears,

How long does it take to clear

Answer 16

IgM

6 months

Question 17

What antibody In hepatitis B when the infection becomes chronic

Answer 17

IgG

Chronic > 6months

Question 18

What antibody presence shows that the hepatitis B infection is now inactive

Answer 18

Antibody Hepatitis B e

Question 19

What dies the presence of antibody HB s indicate in a hepatic B infection

Answer 19

The presence of anti-HBs is generally interpreted as indicating recovery and immunity from hepatitis B virus infection

Question 20

So what are the overall steps in diagnosis Hepatitis B infection

Answer 20

Is Hepatits B antigen present?

Is there
Clinical evidence of infection

If no = chronic infection

If yes –> Test for IgM

If Igm is positive = acute infection

If IgM infection negative = Chronic infection

Question 21

What is the pathology of chronic hepatitis B if further progression occurs

Answer 21

Liver Cirrhosis

which Further leads to Liver cancer and end stage liver disease

Question 22

What is the treatment options for Hepatitis B

Answer 22

Pegylated Interferon

Oral antiviral drugs

Question 23

What are examples of Oral antiviral drugs used to treat Hep B

Answer 23

Entecavir
Adenofovir
Lamivudine, telbivudine, Tenofovir

Question 24

What is Pegylated interferon

Answer 24

3 drug therapy of
alpha 2a, alpha 2b, beta 1a

targeting intracellular signalling

Question 25

Hepatitis C is mostly asymptomatic till what progression occurs

Answer 25

Liver cirrhosis | - have normal liver function tests

Question 26

What is the natural history and pathology of hepatis C infection

Answer 26

``` Exposure Resolved - 15% Chronic - 85% Cirrhosis - 20% Liver cancer - 25% ```

Question 27

What further intervention occurs with an hepatitis C infection to result in Liver caner

Answer 27

HIV infection and alcohol

Question 28

What is the percentage of people that present with acute jaundice due to hepatitis C

Answer 28

10%

Question 29

What is the structure of Hepatitis C

Answer 29

Genetic material located at the core of virus, surrounded by a protective shell of protein encased in a lipid envelope with 2 glycoprotein embedded in envelope

Question 30

When do you know recovery is happening in hepatitis C

Answer 30

When Hepeptisi C RNA decreases ALT tests decrease When there is an increased presence of antibody hepatic C

Question 31

What does ALT test for

Answer 31

Liver damage

Question 32

What is the treatment plan for hepatitis C

Answer 32

IFN free combination of direct acting antiviral drugs e.g ledipasvir, simeprevir, sofosbuvir giver for 3 months

Question 33

What is the structure of Hepatitis D

Answer 33

Smalll RNA virus | doesn't have protein coat

Question 34

How does Hepatitis D envelope itself

Answer 34

Envelopes itself with hebatits B antigen in a co-infection/superinfection

Question 35

What affect does treatment have on hepatitis D

Answer 35

very resistant

Question 36

What is the biggest source of infection is Hepatitis D

Answer 36

Pigs eg infected pork meat

Question 37

What hepatitis virus is the commonest cause of acute hepatitis in NHS grampian

Answer 37

Hep E

Question 38

What is the treatment for Hep E

Answer 38

Non specific and there is a vaccine yet self limiting g- resolves itself without medicine

Question 39

What are other viruses causing potentially damage to the liver

Answer 39

``` Hepatitis F Hepatitis G Hepatitis GB EBV CMV Herpes simplex ```