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3A week 3 - the liver > viral hepatitis > Flashcards

viral hepatitis Flashcards

1
Q

how do viruses enter the liver to cause hepatitis (3)

A
  1. hepatitis viruses enter the bloodstream through the hepatic artery or portal vein
  2. hepatitis viruses infect the hepatocytes
  3. as the hepatitis viruses spread, the viral infection/immune response may cause damage to the liver such as scarring (cirrhosis) -> raise in ALT
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2
Q

what is the blood supply to the liver

A

75% hepatic portal vein, 25% hepatic arteries

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3
Q

Which pathogen is the main cause of viral hepatitis in the UK? (3)

A
  1. EBV - in the young
  2. Adenovirus - in immunosuppressed
  3. Hepatitis E (HEV) - can get from pigs
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4
Q

what is hepatitis

A

Acute or chronic parenchymal liver damage

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5
Q

what is the main symptom of hepatitis

A

jaundice [usually detectable when bilirubin >50];
Can be asymptomatic or Can develop symptoms later on in course of dx, e.g., Hep C infection

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6
Q

what blood abnormalitiy is associated w viral hepatitis

A

raised ALT

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7
Q

Histological features of parenchymal damage of hepatitis (3)

A
  1. Hepatocytes show degenerative changes (swelling, cytoplasmic granualtion,
    vacuolation)
  2. Hepatocytes undergo necrosis (become shrunken, eosinophilic councilman bodies)
  3. Necrosis maximal in zone 3 (adjacent to central vein).
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8
Q

causes of hepatitis

A
  1. viral infections
  2. Bacterial infections
  3. Drugs
  4. Alcohol
  5. Poisons
  6. Other (pregnancy, Wilson’s dx, circulatory insufficiency).
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9
Q

exmples of viral infections that can cause hepatitis

A
  1. EBV
  2. CMV
  3. HSV - usually immunocompromised
  4. VZV
  5. Yellow fever
  6. Viral haemorrhagic fevers
  7. Rubella
  8. Mumps
  9. Coxsackie B
  10. Adenovirus
  11. HIV
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10
Q

examples of bacterial infections that can cause viral hepatitis (4)

A
  1. Leprospira
  2. Coxiella
  3. Brucella
  4. Borrelia
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11
Q

what is the duration of disease of hep C

A

symptomless for decades but all the while slowly destroying the liver

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12
Q

what percentage of all acute hepatitis cases does HCV acount for

A

20%

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13
Q

what is the most common blood borne infection in the uk

A

HCV

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14
Q

what is the main presenting symptoms of HCV (if symptomatic)

A

jaundice

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15
Q

how to the majority of HCV pts present

A

with liver disease of liver cancer which develops many years later

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16
Q

what type of hepatitis increases the risk of liver cancer

A

Hep C

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17
Q

what are the risk factors for Hep C infection

A
  1. Transfusion abroad
  2. IV drug use
  3. Needle-stick injury if donor infected
  4. Including tattoos
  5. Haemodialysis (rare)
  6. Sexual / household exposure
  7. Multiple sexual partners
  8. Birth to HCV-infected mother
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18
Q

investigations for hep C (4)

A
  1. HCV antibody (anti-HCV) ->Takes 12 weeks after infection for antibody to appear so useful in chronic disease
  2. HCV RNA-> Used in acute infection and monitoring response to antiviral therapy
  3. HCV-antigen -> Also used in acute infection - less sensitive but easier to carry out
  4. ALT -> rises acutely
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19
Q

what are some chronic hep C manifestations (hepatic -3, extra hepatic -3)

A

Hepatic manifestations include:
1. Chronic persistent hepatitis
2. Cirrhosis
3. Hepatocellular carcinoma

Extrahepatic manifestations include:
2. Mixed essential cryoglobulinaemia
3. Glomerulonephritis
4. Sporadic porphyria cutanea tarda

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20
Q

how to prevent Hep C infections (5)

A
  1. Screening blood and its products and organs
  2. Infection control practices
  3. Occupational exposure - prevention and management of infected healthcare worker
  4. checking of sexual partners
  5. Mother-to-baby transmission
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21
Q

what are the 7 major genotypes distributed across the world of hep C

A

G1 + G2 - worldwide (G1 commonest in UK).
G3 - Southeast Asia.
G4 - Egypt, Africa, Middle East.
G5 - South Africa.
G6 + 7 - Far East.

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22
Q

hep C mgx (3)

A
  1. Protease inhibitors
  2. NS5A inhibitors
  3. NS5B inhibitors
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23
Q

what does the HDV virus require to be present in the body in order to complete its life cycle within human hepatocytes

A

HBV

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24
Q

routes of transfer for HBV and HDV (3)

A
  1. percutaneously through contact with infectious blood
  2. sexually through contact with infectious blood
  3. vertically
25
Q

what is HDV a coinfection with

A

HBV

26
Q

HDV coinfection vs superinfection

A

coinfection:
1. infection with both HBV and HDV in HBV-susceptible individuals
2. presentation resembles classic acute hepatitis B
3. usually self-limiting

superinfetion:
1. infection w HDV of a pt w chronic HBV infection
2. presents as severe acute hepatitis or exacerbation of chronic hep B
3. majority progress to chornic disease w severre morbidity and complications such as cirrhosis, clinical decompensation and HCC

27
Q

why can HDV only be found as a co-infection with HBV

A

HDV uses HVsAg as an envelope in replication

28
Q

what is the most severe form of viral hepatitis in human

A

HDV

29
Q

what is the incubation period for HDV

A

2wks - 6 months

30
Q

2 complications of HDV

A

cirrhosis; hepatocellular carcinoma

31
Q

investigations for HDV

A
  1. anti-HDV IgG (in all HBsAg +ve pts)
  2. anti-HDV IgM (shows disease activity)
  3. HDV RNA quantitative
  4. HDV genotypes
  5. HBsAg quantification
  6. liver biopsy (staging of liver disease)
32
Q

HDV mgx

A
  1. PegIFN
  2. nucleoside/nucleotide analogues (NAs) therapy e.g. entecavir
  3. experimental treatments
33
Q

what organisms do the 5 genotypes of HEV affect

A

1 + 2 - humans
3 + 4 - humans and swine
5 - avian

34
Q

how is HEV transmitted

A

blood in faeces

35
Q

hep E presentation (6)

A
  1. Mild fever
  2. Jaundice
  3. Reduced appetite
  4. N&V
  5. Abdo pain
  6. Hepatomegaly
36
Q

investigations for HEV

A
  1. anti-HEV IgM - acute phase
  2. anti-HEV IgG
  3. PCR virus load
37
Q

how long after infection do symptoms tend to present

A

6 weeks

38
Q

prevention measures for HEV (3)

A
  1. Avoid drinking water (and drinks with ice) of unknown purity
  2. Avoid uncooked shellfish and uncooked fruit / vegetables not peeled or prepared by
    traveller
  3. In UK - avoid eating inaequately cooked pork meat
39
Q

apart from tobacco what is the most important carcinogen

A

HBV

40
Q

HBV transmission (4)

A
  1. Sexual: Sex worker and men who have sex with men
  2. Parenteral: PWID, health workers are at increased risk
  3. Perinatal: Antenatal women chronically infected with HBV
  4. Transfusion: Screening and viral inactivation have eliminated this in Europe
41
Q

HBV presentation

A

Many asymptomatic.
Can be jaundiced, tired, abdo pain, N&V.
If severe, can lead to liver failure → death.

42
Q

acute hep B mgx

A

usually self limiting

43
Q

what are the 5 major phases of chronic Hep B

A
  1. HBeAg +ve chronic HBV infection
  2. HBeAg +ve chronic hepatitis B
  3. HBeAg -ve chronic HBV infection
  4. HBeAg -ve chronic hepatitis B
  5. HBeAg -ve phase
44
Q

serological tests for HBV (7)

A
  1. HBsAg - general marker of infection
  2. anti-Hbs - used to document recovery and/or immunity
  3. anti-HBc IgM - acute infection marker
  4. anti-HBc - current or past infection
  5. HBeAg - active replication of virus and marks high infectivity
  6. Anti-HBe - coincides with significant reduction in replication
  7. HBV-DNA
45
Q

Hep B prophylaxis (2)

A
  1. pre exposure - vaccine
  2. post exposure - accelerated active immunisation, together with HBIg (for some)
46
Q

when should HBV pts be treated

A

when they enter the immune elimination phase and develop active hepatitis (ALT elevation, biopsy evidence of chronic hepatitis and fibrosis)

47
Q

hep B mgx (3)

A
  1. immunomodulators - IF alfa-2b, pegylated IF alfa-2a;
  2. nucleoside analogues - lamivudine, telbivudine etc.
  3. nucleotide analogue - adefovir, tenofovir
48
Q

what is the mgx for contacts of acute HPV infection

A

Test contact for surface antigen.
If not detected, give vaccine and immunoglobulin

49
Q

mgx for babies with mothers of acute HBV

A

Baby will get vaccine and immunoglobulin immediately in different arms, Then at 1 year, another jab
Then normal immunisation programme.

50
Q

what does hep A NEVER result in

A

chronic liver disease

51
Q

what is hep A

A

an acute, self-limiting infection of the liver

52
Q

what is a complication of hep A

A

fulminant hepatitis - severe liver function impairment, which causes hepatic coma and the decrease in synthesizing capacity of liver

53
Q

HAV trasmission routes (5)

A
  1. close personal contact (househols, sexual, child day care)
  2. poor hygeine (e.g. in homeless)
  3. drug use (poor hygiene)
  4. contaminated food/water
  5. blood exposure (rare)
54
Q

hep A presentation (6)

A
  1. Jaundice
  2. N&V
  3. Dark urine
  4. Abdo pain
  5. Fever
  6. Loss of appetite
55
Q

HAV incubation period

A

2-4 wks

56
Q

HAV detection (3)

A
  1. Acute infx → diagnosed by detection of IgM anti-HAV by Elisa
  2. Genome or antigen detection in stool may be used
  3. To detect immunity to HAV (i.e. prior infection) → +ve total anti-HAV in serum
57
Q

hep A prevention measures (4)

A
  1. good hygiene
  2. pre exposure active immunisation vaccine (travellers, staff and residents of homes, lab staff, pts who exhibit risky behaviours)
  3. post exposure - vaccine and immunoglobulin HNIG (withing 14 days of onset)
  4. contact tracing - testing, vaccination and immunoglobulin (just Igs if young no vaccine)
58
Q

which hepatitis strands result in chronic liver disease

A

HCV; HBV

3A week 3 - the liver (9 decks)

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