Viral Hepatitis Flashcards by Jenna Paterson

Define acute hepatitis.

Inflammation of the liver causing increased ALT/AST, jaundice and clotting derangement.

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Define chronic hepatitis.

Hepatits present for more than 6 months, causing variable changes in liver function.

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What are the causes of hepatitis?

Infection (hep A-E, CMV (herpes), toxo (parasitic), malaria, syphilis)

Toxins

Drugs

Alcohol

Autoimmune

Haemochromatosis

Wilson’s (increased copper).

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What type of virus is hep A?

RNA virus.

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How is hep A transmitted?

Faecal-oral
Person to person
Contaminated water/food (virus can survive for months in contaminated water).

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What is the immunity of hepatitis A post infection?

Very good - no chronic carriage.

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What are the clinical features of hep A?

Fever
Abdominal discomfort
Diarrhoea
Jaundice
Itch
Muscle Pain

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What is the incubation period of hep A?

Around 30 days.

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How can hep A be treated?

Generally self-limiting with little treatment.

Avoid alcohol and stay hydrated.

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How is hep A diagnosed?

Antibody counts.

If acute hep A - IgM positive or RNA in blood/stool.

If previous infection/vaccination - IgG positive.

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How can hep A be prevented?

Good hygiene
Methods to prevent food/water contamination
Vaccines

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What are the two types of hep A vaccine, what are their features and who would they be offered to?

Havrix vaccine - inactivated virus given to everyone without contraindication.

Hepatits A immune globulin - collect blood from people who have had previous vaccination/infection and pools IgG.

Vaccines are given to people before travelling, homosexual men, chronic liver disease patients and IV drug users.
They are also given post-exposure to control outbreaks.

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How many doses of the Havrix vaccine have to be given?

1st dose gives protection for 4 weeks.

2nd dose gives life protection.

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What is the death rate for hep A?

Very low

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What type of virus is hep E?

RNA

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Is hep A or hep E more common in the UK?

Hep E

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How is hep E transmitted?

Faecal-oral
Pork products
Minimal person-to-person transmission.

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How many genotypes of hep E are there?

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What is the incubation period for hep E?

Around 40 days

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What are the clinical features of hep E?

Similar to hep A

(abdo pain, jaundice, itch, diarrhoea, muscle pain and fever) however also some rare reported neurological effects.

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What is the death rate for hep E?

1-3%, and higher in pregnant woman for some genotypes, including GT1.

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How is hep E treated?

Supportive treatment

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Is there a vaccine for hep E?

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What is the immunity of hepatitis E post infection?

None

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What group of patients are prone to hep E? How is this treated?

Very immunosuppressed patients. | Treat with ribavirin (anti-viral).

What are the neurological manifestations of hep E? What genotype are they thought to be associated with?

GT 3. Gullian Barre syndrome (autoimmune muscle weakness) Encephalitis (brain inflammation) Ataxia (can't coordinate muscles) Myopathy (muscle weakness)

Is a patient is positive for hep B or hep C, what should you also test for and why?

HIV, as they have the same transmission pattern.

What type of virus is hep B?

Hepadnavirus DNA virus.

Is there a vaccine for hep B?

Yes - not currently part of UK vaccination programme.

How is hep B transmitted?

Transfusion - blood, blood products. Mother to baby - vertical transmission, usually at birth. Contaminated needles and syringes. Fluids - semen, blood Organs/tissue transplantation Child to child

What is the most common form of transmission in the UK?

95% are immigrants. | New sexual infections in th UK are rare.

What are the most common forms of transmission in the tropics?

Vertically or during childhood between children. Sexual Iatrogenic (medical exam/treatment)

What is the incubation period of hep B?

2-6 months.

What are the clinical features of hep B?

``` Fever Fatigue Jaundice Myalgia Joint pains ```

What is the significance of age at the time of infection of hep B?

Determines severity of illness and risk of chronic hep B infection.

Is infection at birth or in adulthood asymptomatic?

At birth - usually leads to chronic infection however.

What are the complications of hep B?

Chronic liver disease - cirrhosis, decompensation, hepatocellular carcinoma leading to death. ``` Signs of this: Weight loss Cachexia (wasting syndrome) Mass in abdomen Blood ascites (cancer?) ```

What is sAg?

Surface antigen - marker of infection.

What is sAb?

Surface antibody - marker of immunity.

What is cAb?

Core antibody - shows if a person has seen the infection at some point (past or present).

What is eAg?

e antigen - suggests high infectivity.

What is eAb?

e antibody - suggest low infectivity.

What does the presence of HBV DNA in the blood suggest?

Suggests current infection.

How is hep B diagnosed?

Presence of sAg or DNA.

What two groups can hep B carriers widely be divided into?

eAg+ve - early disease - high viral load with high risk of CLD (chronic liver disease) and HCC. - highly infectious. eAg-ve - late disease - low viral load and lower risk of CLD and HHc. - less infectious

How can acute and chronic hep B be treated?

Acute - no treatment Chronic - Treat those with liver inflammation (LFT and biopsy) - No cure, just suppression of viral replication to make patients less infective.

What drug therapies can be given to those with hep B?

Immunological - pegylated interferon alpha - many side effects - one year course Antiviral Drugs - suppress viral replication - tenofoir and entecavir

How can hep B be prevented?

Education Screening of high risk groups Immunisation

What methods of immunisation are available for hep B?

Active (HBV sAg vaccine) - high risk groups in UK Passive (HBIG) - for babies born to some HBV+ mothers - post exposure in non-immune.

What interventions occur in pregnancy to prevent HBV transmission?

HBV vaccination to all newborn. HBV IG if eAg or high virus level. Tenofovir during last trimester if high virus level.

What type of virus is hep D?

Single stranded RNA virus.

What other virus is needed to allow hep D replication?

Hep B

How is hep D acquired?

Co-infection with hep B or super-infection of chronic HBV carriers (infection at a later date than hep B).

What complications may arise with hep D infection?

Chronic liver disease.

How can hep D be treated?

Peg IFN only.

Give the 3 main transmission methods of hep B and D.

Blood, sex and needles.

How is hep C transmitted?

Injecting drugs Transfusion and transplant Sexual/vertical transmission are rare.

Is there a vaccination for hep C?

Are there any treatments to prevent infection post-exposure?

What is the immunity of hepatitis C post infection?

No reliable immunity.

What are the most common genotypes of hep C in the UK?

1 and 3.

What is the incubation period of hep C?

6-7 weeks

How many people are symptomatic in hep C?

25%

How many people go onto develop chronic infection in hep C?

70%

What are the complications of chronic hep C?

Cirrhosis and HCC.

How can hep C be diagnosed if the majority of patients are asymptomatic?

Usually by screening high risk groups such as drug users and immigrants (from high prevalence countries).

What tests are done to diagnose hep C?

First - check for anti hep C IgG. If positive then suggestive of a chronic or cleared infection. Therefore a PCR or antigen test should be done. If positive then current infection or viraemia.

How can HVC be treated?

Direct-acting antivirals - regimen dependent on genotype and degree of fibrosis/cirrhosis - often giving alongside methadone to ensure compliance.

Viral Hepatitis Flashcards

(68 cards)