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Gastrointestinal Conditions > Viral Hepatitis > Flashcards

Flashcards in Viral Hepatitis Deck (46):
1

The commonest cause of viral hepatitis?

HepA

2

High risk areas of HepA:

* Africa
* S. America

3

Structure of HepA virus?

Unenvoloped

RNA virus

4

Transmission of HepA?

* Faeco-oral
* Shellfish

5

Incubation period of HepA?

2-6 weeks

6

Risk factors for HepA?

* Contact with infected person
* Employment at residential institution
* Sewage workers
* MSM
* Travel to endemic areas
* IVDUs
* Coagulopathy requiring FVIII/IX concentrates
* Multiple sexual partners

7

Phases of HepA infection:

1. Anicteric prodrome (14-21 days post infection)

2. Icteric phase (21+ days)

VERY RARELY

3. Fulminant hepatic failure

8

Symptoms of Hep A infection:

Anicteric prodrome (14-21d)
- Fever
- Malaise
- Anorexia
- Arthralgia
- Nausea

Icteric phase (21+ d)
* Jaundice (rare in children)
* Dark urine
* RUQ pain
* Pruritus

9

Features of viral hepatitis-associated fulminant hepatic failure:

* Encephalopathy (-> coma)
* Coagulopathy (e.g. DIC)
* Renal failure (HRS)
* Ascites/oedema

10

Signs of HepA infectionL:

* Fever
* Jaundice
* Hepatomegaly
* Splenomegaly
* Adenopathy
* RUQ tenderness

11

Jaundice with hepatitis A is rare in this group of patients:

Children

12

Differential diagnosis of acute viral hepatitis:

* Other viral hepatitis
* Acute HIV seroconversion
* Drugs
Hypersensitivity
Toxicity
* CMV infection

13

Investigations for HepA infection:

1. LFTs: ALT rises more than AST

2. FBC: low grade haemolysis, lymphocytosis

3. Serology: IgM (rises from day 25), IgG (detectable for life)

14

Management of HepA:

Supportive

Avoid alcohol

Fulminant hepatitis: Interferon alpha

15

Prevention of HepA

Vaccination
Inactivated viral protein

1 IM dose = 1 year protection

6-12 month booster = 20 year protection

16

Complications of Hepatitis A:

* Relapsing infection
* Cholestatic hepatitis
* Fulminant hepatic failure
* Pure red cell aplasia
* Guillain-Barre syndrome
* Pancreatitis

17

Most important prognostic factor in HepA:

Advancing age

Worse prognosis

18

Hepatitis B structure:

DNA virus

19

High prevalence areas of hepatitis B:

* Sub-saharan africa
* Asia
* Pacific

20

Spread of HepB:

* Infected blood products
* Sharing IVDU equipment
* Sexual
* Vertical (M->infant)

21

Incubation period of HepB:

1-6 months

22

Risk factors for HepB infection:

* IVDU
* Multiple sexual partners
* Family members of HBV infected
* MSM
* Healthcare workers
* Travel to endemic areas
* Haemodialysis
* Foster carers

23

Symptoms of HepB infection:

Anicteric prodrome
Fever
Malaise
Anorexia
Arthralgia
Nausea

Icteric phase
Jaundice (10% children, 30-50% adults)
Dark urine
Pruritus

Fulminant hepatic failure (rare)

24

Which symptoms of HepB infection are more prominent than in HepA infection?

Anicteric
* Arthralgia

Icteric
* Jaundice (10% children)
* Pruritus

25

Signs of HepB infection:

* Fever (mild)
* Jaundice
* Hepatomegaly
* Splenomegaly
* Adenopathy
* RUQ tenderness

26

Investigations in HepB infection:

1. Bloods: FBC, LFTs, Clotting, lipids, autoantibodies, ferritin, caeruloplasmin

2. HBV serology

3. HCV RNA

4. HBV genotype: if considering interferon

5. HDV serology

27

HBV Serology

HBsAg
Detected first 3-5 weeks

HBeAg
High infectivity

anti-HBe
anti-HBs
Alone imply vaccination

anti-HB core
Past infection

28

Serological marker implying high infectivity of HepB:

HBeAg

29

Carrier status of HepB is defined as:

HBsAg serology persisting >6 months

30

What percentage of individuals will develop HepB carrier status?

5-10%

Less common in those infected in childhood

31

Management of HepB:

* Avoid alcohol
* Immunise sexual partners
* Antivirals

32

Indications for antiviral Rx:

* High HBV DNA (>2000)
* Cirrhosis
* Chronic liver inflammation

33

Prevention of HepB:

HepB vaccine 1mL into deltoid

Repeat at 1&6 months

Immunity depends on Anti-HBs levels:

- >1000 - retest in 4 years
- 100-1000 - if approaching 100 retest in 1 year
<100 - give booster and retest
<10 - give another set of 3

34

Complications of HepB

* Fulminant hepatic failure
* Cirrhosis
* HCC
* Cholangiocarcinoma
* Mebranous nephropathy
* Cryoglobulinaemia
* PAN

35

Hepatitis C viral structure:

RNA Flavavirus

36

Transmission of HepC:

* Infected blood products
* IVDU
* Sexual contact
* Vertical

37

Incubation period of HepC:

6-7 weeks

38

What percentage of people clear the HepC virus with no sequelae:

* 15-25%

* 75-85% develop chronic infection

39

Most common genotypes of HepC in England and Wales?

1 and 3

1 carries worse prognosis

40

Risk factors for HepC:

* IVDU (main risk Fx)
* HIV
* unclean piercing/tattoo
* Blood transfusion pre 1992
* Haemodialysis
* Child of HCV infected mother
* Prison

41

Symptoms of HepC:

Often asymptomatic

* Malaise
* Weakness
* Anorexia

42

Signs of HepC infection:

Signs of chronic liver disease:

* Leukonychia
* Clubbing
* Palmar erythema
* Dupuytren's contracture
* Spider naevi
* Axillary hair loss
* Gynaecomastia
* Dilated umbilical veins
* Hyperdynamic circulation

43

Investigations of HepC:

1. Bloods

3. Anti-HCV antibodies: Confirms exposure

3. HCV-PCR: confirms ongoing infection

4. Liver biopsy/non-invasive elastography: If HCV positive, to assess liver damage

44

Management of HepC:

Quit alcohol

Antivirals (complex but often curative)

45

Complications of HepC:

* Membranous nephropathy
* Cryoglobulinaemia
* Thyroiditis
* AI Hepatitis
* PAN
* Polymyositis
* Porphyria cutanea tarda
* Lichen planus
* ITP

46

Risk factors for more rapid progression of HepC:

* Male
* Advancing age
* High viral load
* EtOH use
* HIB
* HBV