Mi - Viral Hepatitis Flashcards by Lottie Barot

what is hepatitis

inflammation of liver

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causes of hepatitis

ischaemia
AI
toxic
metabolic
infection
- viruses
- bacteria
- parasites

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bacterial causes of hepatitis

sepsis
leptospira
syphilis

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parasitic causes of hepatitis

amoeba
fasciola
toxoplasma
opisthorchis

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primary viral hepatitis causes

A, B, C, D, E

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name some secondary viral hepatitis causes

EBV **key one
CMV **key one
HIV
adenovirus
parvovirus b19
rubella
coxsackie B
Dengue
Yellow fever
VHF
enteroviruses

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where is hep A prevelant

Africa
Central / South America
South east asia

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what type of virus is hep A

pucornaviridae

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transmission of hep A

faecal oral route
person to person contact
food / drink that has been contaminated

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incubation period of hep a

2-6 weeks but usually 4 weeks

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sx of acute hepatitis

non specific
- fever, malaise, fatigue, loss of appetite, abdo pain
specific (due to BR)
- jaundice, dark urine, pale stools, pruritis

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acute Ix for hep a

anti-HAV IgM

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what is important to remember with anti-HAV IgM

may be negative in first week of Sx

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how do you test for immunity to hep A

anti - HAV IgG

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is anti HAV IgG raised post infection / vaccination / both

BOTH

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what marker must be elevated for you to request anti HAV IgG and why

ALT > 500
- impossible to have hepatitis if ALT isn’t raised, so no point requesting it (may be super early phase, so false negative)

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infectious period of hep A

2 weeks pre Sx to 1 week after jaundice onset

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when should pt self isolate with hep a

7 days post Sx onset

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tx for hep A

mainly supportive

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who is most likely to die from hep a

old people

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is hep A a notifiable disease?

YES - report to UKHSA

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when is hep a vaccine indicated

travel to endemic countries
chronic liver disease
chronic hep B/C
haemophillia
IVDU
MSM
occupational risk - labs / sewage workers

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what causes death in hep a

fulminant hepatic necrosis

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how many doses are needed for hep a vaccine

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prevalence of hep B carriers

250 million carriers worldwide

areas with high prevalence of hep B

africa south east asia increasing in europe - migration

what type of virus is hep b

DNA (ONLY HEP VIRUS THAT IS DNA)

transmission of hep b

blood products sex vertical mother to baby

incubation period of hep b

2-6 months

sx of acute hep b infection <5 y/o

none

complication of acute hep b infection in <5 y/0

90% go to chronic hep B infection

what % of adults are Sx-atic with hep B

20-40%

what % of adults progress to chronic hep b infection after acute infection

10%

define chronic hep B infection

HBsAg reactivity >6 months

Sx of chronic hep B

usually none

complications of chronic hep b infection

cirrhosis hepatocellular carcinoma extra hepatic manifestations - rashes / arthritis

what does HBsAg + mean

CURRENT HBV infec

what does HBeAg + mean

high viral replication / highly infectious

what does HBcIgM + mean

ABs produced to ACUTE infection (<3 months)

what does anti HBc + mean

ABs produced due to EXPOSURE to HBV - can be past or present

what is anti HBc

total / IgG core AB

what does anti HBe + mean

ABs produced. shows IMMUNE CONTROL ie imminent / already achieved eAg clearance

what does anti HBs + mean

ABs produced as IMMUNE to HBV. past infection or vaccination

what is this person's HBV status: HBsAg - anti HBc IgG - anti HBc IgM - anti HBs -

never been infected or vaccinated - therefore susceptible to HBV

what is this person's HBV status: HBsAg + anti HBc IgG + anti HBc IgM + anti HBs -

ACUTE infection

what is this person's HBV status: HBsAg - anti HBc IgG - anti HBc IgM - anti HBs +

VACCINATED - immune

what is this person's HBV status: HBsAg + anti HBc IgG + anti HBc IgM - anti HBs -

CHRONIC infection

what is this person's HBV status: HBsAg - anti HBc IgG + anti HBc IgM - anti HBs +

PAST INFECTION - cleared therefore immune

complications of hep B

cirrhosis hepatocellular carcinoma

how do you assess cirrhosis

child-pugh score

radiology of cirrhosis

coarse, echotexture, nodularity

what Ix is specific for HBV cirrhosis

transient elastography

gold standard for cirrhosis Ix

histopathology after biopsy (rarely done due to invasiveness)

Ix for ?HCC

AFP Imaging - USS every 6 months if risk

what is the main indicator for Tx for HBV

high viral load

2 Tx strategies for HBV

pegylated IFNa (++SEs, rarely done) nucleoside / nucleotide analogues (main)

eg of nucleoside/nucleotide analogues used to treat HBV

entecavir tenofovir

when does Tx stop for HBV

once HbsAg lost (usually Tx for life)

how is HBV prevented

vaccination screening in preg blood screening from blood donors

when is hbv vaccination given

2 months 3 months 4 months

if mother is HbsAg + but eAg -, what Tx is given to baby

vaccine at birth then routine HBV vaccines on top

if mother is HbsAg + AND eAg +, what Tx is given to baby

vaccine at birth HBV IG within 48 hours routine vaccines

prevelance of hep C

1% of population

deaths from hep c

400,000 / year

what type of virus is hep c

flaviviridae RNA virus

transmission of hep C

blood products sharing needles sharing bank notes to snort drugs

incubation period of hep c

2 weeks to 6 months

sx of acute hep c infection

mostly none

what % of acute infections with hep c spontaneously clear it

20-40%

what % of acute infections with hep c progress to chronic infection

40-60%

how is chronic hep c diagnosed

usually incidentally from screen after derranged LFTs

complications of chronic hep c

chronic liver disease cirrhosis hepatocellular carcinoma

what increases the chances of getting complications from chronic hep C, especially hepatocellular carcinoma

co-infection with hep B / HIV

when does anti HCV AB become + after HCV infection

>4 weeks after

if acute infection with hep C is suspected, what Ix should be requested

HCV RNA

Tx of HCV

direct acting antivirals (DAA)

is HCV curable

YES - now it is, thanks to DAA

who should get Tx for HCV

EVERYONE with hcv

tx regime for hcv

daily pill for 12 weeks

prevention of hcv

NO vaccine :( screen blood needle exchanges for IVDU

how long does anti HCV stay reactive after infection with HCV

forever

how does hep D infect

only with co-infection of hep B

impact on liver of hep d

turns relatively benign chronic hep B into hepatocyte destructing virus

if someone gets hep b and d at the same time, what is the prognosis / risk of chronicity

severe acute disease low risk of chronic infection

if someone gets hep d when they're already chronicly infected with hep B what is the prognosis / risk of chronicity

high risk of severe liver disease chronicly

how is hep d prevented

prevent HBV ! - vaccination HBV - post exposure prophylaxis for HBV educate hbv pts re risky behaviours ie sex / needles

what type of virus is hep e

RNA hepeviridae

how many genotypes of hep e are there

which genotypes of hep e infect humans vs animals

1 and 2 = humans 3 and 4 = animals

how is hep e transmitted

faeco-oral

what animals are the natural host of hep e genotypes 3 and 4

pigs / wild boards

how can hep e genotypes 3 and 4 be passed to humans

undercooked meat - zoonotic organ transplant blood transfusion

incubation period of hep e

2-8 weeks

sx of hep e genotypes 1 and 2

brief, self limiting infection

who gets hep e genotypes 1 and 2

young adults going travelling

who has a high risk of mortality with hep e genotypes 1 and 2

pregnant women !! 30% mortality with genotype 1

where is hep e genotypes 3 and 4 endemic to

europe - esp france and italy

sx of hep e genotypes 3 and 4

usually none

who gets worse sx with hep e genotypes 3 and 4

older males

who gets chronic hep e infection

immunocompromised

sx of chronic hep e infection

none / mild mildly derranged LFTs some people (10%) get cirrhosis / death

Ix for hep e

HEV IgG and IgM (immunocompetent) HEV RNA (immunosuppressed)

extra hepatic manifestations of hep e (4 groups, 2 examples of each)

haematological - thrombocytopnaenia - red cell aplasia musclar - proximal myopathy - myositis neuro - encephalitis - GBS - ataxia renal - glomerulonephritis - IgA nephropathy

extra hepatic manifesations of hep b

polyarthritis nodosa rashes vasculitis (exam Q +++)

extra hepatic manifestation of hep c

cryoglobulinaemia

tx of hep e

supportive acute / severe - ribavirin chronic / immunocompromised - 3 months ribavirin

is there a hep e vaccine

only in china

prevention of hep e

screen blood products avoid undercooked pork / venison

which hep viruses are non enveloped

A and E

which viruses are foecal oral

A and E (same as the ones that are non enveloped)

Mi - Viral Hepatitis Flashcards

(110 cards)