Session 8 Lecture 2

Question 1

Define hepatitis

Answer 1

Inflammation of the liver

Question 2

Which systemic viruses cause ‘collateral’ liver damage?

Answer 2

EBV, CMV, VZV

Question 3

Where do hepatitis viruses replicate?

Answer 3

Replication specifically in hepatocytes

Question 4

What are the most common type of hepatitis?

Answer 4

B and C

Question 5

Which hepatitis cause chronic infection?

Answer 5

B and C

Question 6

What causes jaundice?

Answer 6

The build up of bilirubin attaches the skin and the sclera

Question 7

What is bilirubin?

Answer 7

The breakdown of haem

Question 8

What are the different types of jaundice?

Answer 8

Prehepatic, intrahepatic and post hepatic.

Question 9

What causes prehepatic jaundice

Answer 9

Haemolysis, sickle cell anaemia or haemolytic anaemia

Question 10

What is intrahepatic jaundice?

Answer 10

Disruption happens inside the liver

Question 11

What are the causes of intrahepatic jaundice?

Answer 11

Viral hepatitis, drugs, aprganncy, cirrhosis

Question 12

What is post hepatic jaundice?

Answer 12

Disruption prevents the bile (and the bilirubin) from draining out of the gallbladder and into the digestive system

Question 13

What causes post hepatic jaundice?

Answer 13

Duct stones, carcinoma of bile duct, biliary stricture

Question 14

What is the purpose of liver function tests?

Answer 14

They tell you the cellular integrity - not how the liver is functioning

Question 15

What are measured in liver function tests?

Answer 15

Bilirubin, liver transaminase, alkaline phosphate, albumin and tests for coagulation

Question 16

What do liver transaminases show?

Answer 16

Hepatocytes damage/cellular integrity

Question 17

What do alkaline phosphatase (ALP) show?

Answer 17

Biliary tract cell damage/cholestasis

Question 18

Why do you do test of coagulation when testing the liver function?

Answer 18

Clotting factors are synthesised in the liver

Question 19

Who is at risk of hepatitis B?

Answer 19

Vertical transmission (75% of cases globally)
Sexual contact
IV drug users

Question 20

What are the symptoms of acute hep B?

Answer 20

Jaundice, fatigue, abdominal pain, anorexia/vomiting/nausea and arthralgia

Question 21

What is the incubation period of hep B?

Answer 21

6wks to 6 months

Question 22

What happens if you acquire Hep B in childhood?

Answer 22

You are more likely to get chronic infection

Question 23

What are antigens are detectable in Hep B serology?

Answer 23

HBsAg, HBeAg and HBcAg

Question 24

What antibodies are detected in hep B serology?

Answer 24

HBsAb, HBeAb, HBcAb - IgM and IgG

Question 25

What is the definition of chronic Hep B infection?

Answer 25

Persistence of HBsAg after 6 months.

Question 26

What does chronic Hep B lead to?

Answer 26

25% of chronic infections lead to cirrhosis and 5% will develop hepatocellular carcinoma

Question 27

What is the treatment for Hep B?

Answer 27

No cure | Life long anti-virals to suppress viral replication

Question 28

Why is there no cure for Hep B?

Answer 28

Virus integrates into host genome

Question 29

Why are life long antivirals not needed by everyone who has Hep B?

Answer 29

Some people are inactive carriers - low VL, normal LFTs and no liver damage

Question 30

What does the hep B vaccination contain?

Answer 30

Genetically engineered surface antigen . 3 doses + boosters if required. Effective in most people

Question 31

Who is at risk of hepatitis C?

Answer 31

IV drug user Sexual contact Infants

Question 32

Describe the disease progression of Hep C?

Answer 32

~80% become chronically infected. Of these, some will develop chronic liver disease/cirrhosis.

Question 33

What percentage of people with Hep C suffer from symptoms?

Answer 33

80% have no symptoms (acute or chronic) | 20% have symptoms

Question 34

What are the symptoms of Hep C?

Answer 34

Fatigue, anorexia, nausea and abdominal pain

Question 35

What blood tests can be done for Hep C?

Answer 35

Serology - anti-hep C antibody only | Viral PCR - if positive confirms on-going/chronic infection

Question 36

Can hep C be cured?

Answer 36

Yes

Question 37

What is the treatment for Hep C?

Answer 37

Directly acting antiviral drug combo | 8-12 weeks

Question 38

Is there a vaccine available for hep C?

Answer 38

No

Question 39

What is the risk of transmission from a needle stick injury with HIV?

Answer 39

1/300

Question 40

What is the risk of transmission from needle stick injury with Hep C?

Answer 40

1/30

Question 41

What is the risk of transmission from needle stick injury with Hep B?

Answer 41

1/3 - much lower if the recipient has been vaccinated