Viral Hepatitis

Question 1

what are the other infectious agenst (aside from hep A B C D E) that can cause hepatitis?

Answer 1

• delta agent
• EBV - this is called infective mononucleosis
• yellow fever virus
• CMV
• HSV
• toxoplasmosis

Question 2

hepatitis ___ causes damage to cells cytopathologically - i.e. the virus kills the liver cells

Answer 2

A

Question 3

interface hepatitis (piecemeal necrosis), portal inflammation, lobular inflammation and fibrosis are features of ____ viral hepatitis

Answer 3

chronic

Question 4

what is interface hepatitis

Answer 4

piecemeal necrosis) is a process of inflammation and erosion of the hepatic parenchyma at its junction with portal tracts or fibrous septa

Question 5

what is a councilman body (chronic viral hepatitis)

Answer 5

pink cells representing a dying hepatocyte surrounded by normal parenchyma

Question 6

which liver disease shows mallory bodies?

Answer 6

alcoholic liver disease

Question 7

There has been a decline in Hep ___due to vaccination and better housing
Hep B is now diagnosed mainly in _____ minorities who acquired it outside of the UK
Rise in Hep __ - it is now by far the most common cause of ACUTE hepatitis, since Hep __ and Hep __ present in the chronic phase and Hep __ is rare

Answer 7

There has been a decline in Hep A due to vaccination and better housing
Hep B is now diagnosed mainly in ethnic minorities who acquired it outside of the UK
Rise in Hep E - it is now by far the most common cause of acute hepatitis, since Hep C and Hep B present in the chronic phase and Hep D is rare

Question 8

how is hep A spread?

Answer 8

faecal oral

Question 9

how is hep B spread?

Answer 9

blood products, sexually, IVDU, mother to child

Question 10

how is hep C spread?

Answer 10

blood products, IVDU, uncommon for sex

Question 11

how is hep D spread?

Answer 11

blood products, sexually, IVDU, mother to child

same as B

Question 12

how is hep E spread?

Answer 12

faecal-oral - pork

Question 13

which are the RNA hepatitis viruses?

Answer 13

A, C, D, E

Question 14

which are the DNA hepatitis viruses?

Answer 14

B

Question 15

hep ___ and __ damages cells by triggering immune destrution?

Answer 15

B and C

Question 16

what is a co-infection of hep D?

Answer 16

get them both at the same time

Question 17

what is a super- infection of hep D?

Answer 17

hep b first then hep d

Question 18

which hep results in chronic infection in 75% of cases

Answer 18

hep C

Question 19

result in acute infection

Answer 19

hep A and E

Question 20

can lead to chronic infection

Answer 20

B, C, D

Question 21

which Hep have a vaccine?

Answer 21

A and B

Question 22

If infected as young children - unlikely to get symptoms.

The peak incidence of symptomatic disease in older children/young adults

Answer 22

hep A

Question 23

Chronic infection more likely if first exposure is in childhood - this is why the mother to child infection is important

Acute infection increases as age increases

Answer 23

hep B

Question 24

people who are immunocompromised might get chronic infection but usually doesnt cause chronic infection

Answer 24

Hep E

Question 25

diagnosed by IgM o virus ?

Answer 25

Hep A

Question 26

Hep B _____ present in blood of all infectious people and can indicate acute or chronic infection

Answer 26

Hep B surface antigen (HBsAg) present in blood of all infectious people

Question 27

HB _____ - usually present in highly infectious people

Answer 27

HB e Ag - usually present in highly infectious people

Question 28

Hep B _____ always also present in high titre in highly infectious people (more sensitive than ‘e’)

Answer 28

Hep B virus DNA always also present in high titre in highly infectious people (more sensitive than ‘e’)

Question 29

hep B ______ - present in immunity

Answer 29

Anti - HBsAg present in immunity

Question 30

Hep B ____ indicates more likely acute

Answer 30

Hep B IgM - more likely acute

Question 31

how is Hep C diagnosed?

Answer 31

test for Hep C antibody

Question 32

if hep C antibody present what does this indicate?

Answer 32

active or past infection

Question 33

if Hep C virus RNA negative

Answer 33

past infection

Question 34

if Hep C virus RNA positive

Answer 34

active infection

Question 35

how is Hep E diagnosed?

Answer 35

antibody to Hep E

Question 36

who gets the Hep B vaccine?

Answer 36

vaccination of at risk people (UK) | vaccination of all children / adolescents

Question 37

spontaneous cure not uncommon, even after many years of infection

Answer 37

hep B

Question 38

once chronic infection is established, spontaneous cure is not seen

Answer 38

hep C

Question 39

what is done in acute viral hepatitis?

Answer 39

- Symptomatic - No antivirals given - Monitor for encephalopathy - Monitor for resolution of Hep B or Hep C, or Hep E if immunocompromised - Notify Public Health - Immunisation of contacts - Test for other infections if at risk - Vaccinate against other infections if at risk

Question 40

what is done in chronic viral Hep

Answer 40

- antivirals - vaccination - alcohol down - hepaticellular carcinoma screening - AFP - cancer marker

Question 41

Genotype of Hep ___ V (1 to 6) important in deciding antiviral regime

Answer 41

Genotype of HCV (1 to 6) important in deciding antiviral regime

Question 42

how do you treat chronic hep B?

Answer 42

antivirals - adefovir, tenofivir, entacavir and peginterferon

Question 43

treatment for chronic hep b in HBsAg and HBe Ag positive patients and a predictin of a good cure?

Answer 43

peginterferon

Question 44

response in hep C is defined by what?

Answer 44

Response defined by loss of HCV RNA in blood sustained to 6 months after end of therapy - virological cure - known as Sustained Virological Response or SVR - relapse after SVR is rare - reinfection can occur

Question 45

antivirals used for all genotypes of hep C

Answer 45

peginterferon and ribavirin

Question 46

antivirals used for onyl genotype 1 of hep C

Answer 46

Telaprevir and Boceprevir