Viral Hepatitis

Question 1

transmission of hep A

Answer 1

faecal-oral
poor hygiene
overcrowding 
gay men 
PWID

Question 2

clinical symptoms of hep A

Answer 2

acute hepatitis - no chronic infection

peak incidence of symptomatic disease in older children/young adults

Question 3

tests for hep A

Answer 3

laboratory confirmation;
clotted blood for serology
hep A IgM detected

Question 4

control of hep A

Answer 4

usually results in complete resolution 
hygiene 
vaccine prophylaxis - long term protection 
monitor for encephalopathy 
notify public health

Question 5

clinical symptoms of hep E

Answer 5

similar to hep A;
acute hepatitis - no chronic inaction
peak incidence of symptomatic disease in older children/young adults

Question 6

epidemiology of hep E

Answer 6

tropical continents
most common acute hep virus
tropical genotypes associated with severe disease in pregnant woman
immunocompromised humans can get chronic infection

Question 7

transmission of hep E

Answer 7

faecal-oral

Question 8

control of hep E

Answer 8

no vaccine available
monitor for encephalopathy
monitor for resolution
notify public health

Question 9

aetiology of hep E

Answer 9

animals can be infected and are source of infection

Question 10

epidemiology of hep D

Answer 10

only found with hep B - parasite of a parasite
exacerbates hep B infection
rare

Question 11

transmission of hep B

Answer 11

sex
mother to child - vertical (blood at delivery)
blood to blood

Question 12

chronic infection of hep B

Answer 12

occurs if first exposure is in childhood

relatively uncommon

Question 13

epidemiology of hep B

Answer 13

those born in areas of intermediate/high prevalence
multiple sexual partners
PWIDs
children of infected mothers

Question 14

tests for hep B

Answer 14

hep B surface antigen (HBaAg+)
anti-HB
IgM - differentiates acute from chronic infection

Question 15

what does anti-HB indicate in hep B

Answer 15

presents in immunity

Question 16

what does hep B IgM indicate

Answer 16

presents in recently infected cases

Question 17

what does HBaAg+ indicate in hep B

Answer 17

present <6 months is chronic infection (uncommon)
high titre amount seen in highly infectious individuals
predicts risk of chronic liver disease

Question 18

clinical course of chronic hep B infection

Answer 18

immune tolerance
immune clearance
immune control
immune escape

Question 19

describe immune clearance in hep B

Answer 19

high hep B DNA level
abnormal LFTs - increased ALT
hep B antien positive

Question 20

risks of immune clearance in hep B

Answer 20

progression to;
cirrhosis >20 years
hepatocellular carcinoma > 30 years (greater the patient’s HBV DNA load, greater risk of cancer)

Question 21

immune control in hep clearnace

Answer 21

low hep B DNA level
normal LFTs
hep B antigen negative

Question 22

immune escape in hep B

Answer 22

high hep B DNA level
abnormal LFTs - increased ALT
hep B antigen negative
hep B antibody antibody postive

Question 23

risks of immune escape in hep B

Answer 23

progression to;
cirrhosis >20 years
hepatocellular carcinoma > 30 years (greater the patient’s HBV DNA load, greater risk of cancer)

Question 24

control of hep B

Answer 24

treatment when ALT raised and high HBC DNA;
minimise exposure 
antivirals
2 pre-exposure vaccines 
post-exposure prophylaxis 
infection control
decrease alcohol intake 
hepatocellular carcinoma screening 

spontaneous cure

Question 25

how is exposure minimised in hep B

Answer 25

``` safe blood safe sex needle exchange prevention of meedlesticks screening of pregnant woman ```

Question 26

pre-exposure vaccines in hep B

Answer 26

1. all children | 2. adults at risk of exposure

Question 27

post exposure prophylaxis treatment in hep B

Answer 27

vaccine | hyperimune hep B immunoglobin (HBIG)

Question 28

transmission of hep C

Answer 28

similar to hep B; sex - less easily transmitted mother to child - vertical (blood at delivery) blood to blood

Question 29

control of hep C

Answer 29

``` treatment immediately; anti virals no vaccine minimise exposure infection control decrease alcohol intake hepatocellular carcinoma screening ```

Question 30

epidemiology of hep C

Answer 30

usually chronic infection (no spontaneous cure is seen) | most common chronic hep virus

Question 31

complications of hep A

Answer 31

acute liver failure - failure of resolution and so causes death

Question 32

clinical symptoms of hep C

Answer 32

asymptomatic until they develop chronic liver disease due to cirrhosis as a result of chronic infection

Question 33

tests for hep C

Answer 33

test hep C virus RNA by PCR | postive - active infection

Question 34

antivirals of hep B treatment

Answer 34

combination; those ending in -vir and used in combination mono therapy - first line; interferon alfa

Question 35

antivirals of hep C treatment

Answer 35

interferon alpfa - first line | others include those ending in -vir and are used in combination

Question 36

describe interfon alfa

Answer 36

human protein - part of immune response to viral infection | given as pegylated interferon

Question 37

side effects of interfon alfa

Answer 37

flu-like symptoms autoimmune disease psychosis thyroid disease