Viral Hepatitis

Question 1

What is the causes of viral hepatitis?

Answer 1

Caused by 5 types of viruses:

A, B, C, D and E

Question 2

Which viruses cause self limiting acute infections?

Answer 2

A and E

Question 3

Which viruses cause chronic disease?

Answer 3

B, C and D

Question 4

What type of viruses are A and E?

Answer 4

Enteric viruses: get through water
A: faecal-oral route or shellfish
E: water or undercooked pork

Question 5

What type of viruses are B, C and D?

Answer 5

Parenteral viruses: blood

Question 6

What do the viruses do to the liver?

Answer 6

Viruses cause inflammation of the liver

Liver cell damage and death of individual liver cells

Question 7

What is the outcome of the acute inflammation they cause?

Answer 7

Resolution (liver returns to normal): hepatitis A, E
Acute liver failure if severe damage to liver: hepatitis A, B, E
Progression to chronic hepatitis and cirrhosis: hepatitis B, C

Question 8

What can cirrhosis cause?

Answer 8

Liver failure (chronic liver failure)

Question 9

What percentage of the Scottish population has hepatitis C?

Answer 9

1%

Question 10

Does hepatitis C cause acute liver failure?

Answer 10

Rarely causes acute liver failure

Question 11

What is the pathway of the disease?

Answer 11

After 6 months, 70-85% of those infected will have failed to clear the virus spontaneously, after this period the hepatitis C virus enters what is known as the chronic phase (85% chronic HCV infection)
It is now highly unlikely that the virus will be cleared without treatment
It is usually possible to cure the infection (90% = cured/cleared) with treatment

Question 12

What happens in patients who develop chronic hepatitis C are not treated?

Answer 12

Disease varies: some people will have minimal liver damage with no scarring, while others can progress to cirrhosis (extensive scarring of the liver)
Cirrhosis can lead to hepatocellular carcinoma/liver failure

Question 13

What type of virus is hepatitis C?

Answer 13

RNA virus

Question 14

How is hepatitis C transmitted?

Answer 14

IV drug abuse (contaminated needles)
Sexual contact (not as common)
Vertical transmission (occasionally)

Question 15

What is the presentation of hepatitis C?

Answer 15

10% of patients report acute jaundice

Most asymptomatic until cirrhotic (i.e. significant damage)

Question 16

What are the investigations?

Answer 16

May have normal LFTs

Question 17

What is HBV?

Answer 17

Hepatitis B virus: DNA virus

Question 18

How is hepatitis B transmitted?

Answer 18

Vertical
Contaminated needles (IVDU)
Sexual intercourse (more common with hepatitis B than C)

Question 19

What are some at risk groups for hepatitis B?

Answer 19

IVDU and their sexual partners/carers
Health workers
Men who have sex with men
Staff or residents of prisons
Babies of HBsAg +ve mothers

Question 20

What does HBsAg in the blood suggest?

Answer 20

Hepatitis surface antigen
Presence of virus: HBsAg (surface antigen) is present 1-6 months after exposure, HBsAg persisting for >6 months defines carrier status and occurs in 5-10% of infections

Question 21

What percentage of adults recover and therefore do not become chronically infected with hepatitis B?

Answer 21

95%

After infection 5% of patients remain chronic carriers (HBsAg carrier) and are therefore infectious

Question 22

What does HBeAg in the blood mean?

Answer 22

Active replication

Question 23

What does HBV DNA in the blood mean?

Answer 23

Active replication

Question 24

What is HBcAg?

Answer 24

Hepatitis core antigen: active replication (not detected in blood)

Question 25

What does anti-HBs in the blood mean?

Answer 25

Protection: antibodies to HBsAg alone imply vaccination

Question 26

What does the presence of IgM anti-HBc mean?

Answer 26

Acute infection

Question 27

What does the presence of IgG anti-HBc mean?

Answer 27

Chronic infection

Question 28

What does the presence of anti-HBe mean?

Answer 28

Inactive virus

Question 29

How is hepatitis B treated/managed?

Answer 29

Treatment for HBV depends on how long you have been infected for: - If you have been exposed to the virus in the past few days, emergency treatment can help stop you becoming infected - If you have only had the infection for a few weeks or months (acute hepatitis B), you may only need treatment to relieve your symptoms while your body fights off the infection - If you have had the infection for more than 6 months (chronic hepatitis B), you may be offered treatment with medicines that can keep the virus under control and reduce the risk of liver damage - chronic hepatitis often requires long-term or lifelong treatment and regular monitoring to check for any further liver problems

Question 30

What are the 2 main treatments for chronic HBV?

Answer 30

Pegylated interferon | Oral antiviral medicines

Question 31

What are the complications of hepatitis B?

Answer 31

Chronic hepatitis B Cirrhosis Hepatocellular carcinoma End-stage liver disease (liver failure)

Question 32

Do all patients with chronic hepatitis B develop liver cirrhosis?

Answer 32

No, some patients have no further progression (not all patients have progressive disease) Approximately 15-40% of chronic hepatitis B patients will progress to cirrhosis, HCC or liver failure

Question 33

What is the treatment option for ESLD?

Answer 33

Liver transplant: HBV-related ESLD or HCC are responsible for 5-10% of cases of liver transplantation

Question 34

What do we give to at risk groups for hepatitis B?

Answer 34

Hepatitis B vaccination

Question 35

What is the presentation of hepatitis B patients?

Answer 35

Many people with hepatitis B will not experience any symptoms and may fight off the virus without realising they had it If symptoms do develop, they tend to happen 2-3 months after exposure to the hepatitis B virus:  Flu-like symptoms, including tiredness, a fever, and general aches and pains  Loss of appetite  Feeling + being sick  Diarrhoea  Abdominal pain  Arthralgia  Urticaria

Question 36

What is hepatitis A?

Answer 36

RNA virus

Question 37

What is the presentation of patients with hepatitis A?

Answer 37

Asymptomatic cases very common

Question 38

When does hepatitis A it occur?

Answer 38

Occurs sporadically or in epidemic form | Prevalence decreasing worldwide

Question 39

How is HAV transmitted?

Answer 39

Faecal-oral Sexual Blood

Question 40

What is the commonest age group that HAV affects?

Answer 40

5-14 years

Question 41

How is HAV diagnosed?

Answer 41

Acute disease diagnosed by IgM antibodies (recent infection) | IgG is detectable for life

Question 42

Who is the HAV immunisation given to?

Answer 42

``` Travellers Patients with chronic liver disease (e.g. IDU - especially with HCV or HBV) Haemophiliacs Occupational exposure e.g. lab workers Men who have sex with men (MSM) ```

Question 43

What is HDV?

Answer 43

RNA virus: does not code for its own protein coat, enveloped by HBsAg

Question 44

What does HDV occur?

Answer 44

Only occurs in people with hepatitis B: co-infection or super-infection with HBV

Question 45

How is it HDV transmitted?

Answer 45

As for HBV

Question 46

How is HDV treated?

Answer 46

Very resistant to treatment

Question 47

What is HEV?

Answer 47

RNA virus

Question 48

What is the commonest cause of acute hepatitis in Grampian?

Answer 48

Hepatitis E

Question 49

What is the treatment of HEV?

Answer 49

No specific treatment

Question 50

Is there a HEV vaccine?

Answer 50

No effective vaccine currently available

Question 51

What are the complications of hepatitis E?

Answer 51

Fulminant hepatic failure in pregnancy