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Medicine Phase 2a GI > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

What is hepatitis?

A

Inflammation of the liver

Viral hepatitis = inflammation of the liver as a result of direct viral infection

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2
Q

Define acute hepatitis

A

Hepatitis within last 6 months

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3
Q

Define chronic hepatitis

A

Any hepatitis lasting for longer than 6 months

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4
Q

Possible symptoms of acute hepatitis

A

General malaise
Myalgia
GI upset
Abdominal pain (particularly in the right upper quadrant)
With/without cholestatic jaundice (pale stools, dark urine)
Tender hepatomegaly

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5
Q

Infective causes of acute hepatitis

A

Viral - Hepatitis A and E
-Herpes viruses e.g. EBV (Epstein Barr Virus), CMV (Cytomegalovirus), VZV (Varicella Zoster Virus)

Non-viral - Leptospirosis

  • Toxoplasmosis
  • Coxiella (Q fever)
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6
Q

*Non-Infective causes of acute hepatitis

A 
Alcohol
Drugs
Toxins/poisoning
Pregnancy
Autoimmune
Hereditary metabolic
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7
Q

Signs of Chronic liver disease

A

Clubbing
Palmar erythema
Dupuytren’s contracture (one or more fingers bending into palm of hand)
Spider naevi

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8
Q

Infective causes of chronic liver disease

A 
Hepatitis B (+/- D)
Hepatitis C
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9
Q

Non-infective causes of chronic liver disease

A

Alcohol
Drugs
Autoimmune
Hereditary metabolic

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10
Q

Describe genetic appearance of Hepatitis A

A

Small, undeveloped RNA virus

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11
Q

Clinical presentation of Hepatitis A

A

Incubation period of 28 days.
Nausea, anorexia and distaste for cigarettes.
After 2 weeks, jaundice, with dark urine and pale stool.
Sometimes hepatomegaly

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12
Q

Pathophysiology of Hepatitis A

A

Picornavirus
Viral replication occurs in infected hepatocytes
>Destruction of hepatocytes due to immune response and viral life cycle
>Hepatitis
>Hepatic symptoms
Virus particles shed through biliary tree into faeces. Most infectious just before jaundice

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13
Q

How is Hepatitis A spread?

A

Faecal-oral route

Associated with shellfish

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14
Q

Epidemiology of Hepatitis A

A

Most common viral hepatitis in the UK

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15
Q

Diagnosis of Hepatitis A

A 
Blood = ALT rises (Alanine transaminase)
IgM = Antibody to HAV
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16
Q

Treatment of Hepatitis A

A

Prevention by vaccine

Treatment includes treating symptoms and avoiding alcohol

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17
Q

Complications of Hep A

A

Cholestatic hepatitis

Rarely, liver failure and death

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18
Q

Clinical presentation of Hep B (also D)

A

Flu like symptoms
Fever
Jaundice in 10% of younger and 50% of adults

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19
Q

Pathophysiology of ACUTE Hep B

A

Infected Hepatocyte
>Strong cellular immune response
>usually clearance of infection
>Still presents elevated liver enzymes and antibodies to HBV antigen
Possible to not be cleared -> fulminant liver failure (1% chance)

20
Q

Pathophysiology of CHRONIC Hep B

A

HBsAg (Hep B surface Antigen) levels persist for 6 months.
(Due to the virulence of the strain or the immunocompetence and age of the patient.)
In cases of vertical transmission there is an immune tolerance of HBV antigens that precedes a stage of immune clearance after 2-3 decades.
This is when hepatitis and cirrhosis present.

21
Q

Spread of Hep B

A

Parental route
Infected blood or bodily fluids
Mostly intercourse or vertical transmission

22
Q

What is the most common viral hepatitis in the UK

A

Hepatitis A

23
Q

What is most common cause of hepatitis worldwide

A

Infection by Hep B

24
Q

Diagnosis of Hep B (also D)

A

Blood - ALT rises
HBaAg, HBcAb, HBsAb, IgM HBcAb (antibodies)

HBsAg is present 1-6 months after exposure. Presence for me than 6 months implies carrier status

25
Q

Treatment of Hep B

A

Avoid unprotected sex and alcohol
Treatment - treat symptoms
Fulminant hepatitis - antivirals

26
Q

Complications of Hep B

A

Fulminant Hepatic failure (rare)

Chronic HBV infection and Cirrhosis can lead to hepatocellular carcinoma

27
Q

Clinical presentation of Hep C

A

Incubation period of 6-9 weeks
Often asymptomatic in acute infection
Chronic infection may present with malaise, weakness and anorexia

28
Q

What is Hepatitis B virus (what kind of genetic material is it)

A

Enveloped dsDNA reverse transcription virus

29
Q

What is Hepatitis C virus (what kind of genetic material is it)

A

Enveloped RNA virus

30
Q

Pathophysiology of Hep C

A

Acute infection: can resolve spontaneously, or progress to chronic.
Chronic: sustained infection of hepatocytes -> damage to the cells -> cirrhosis and liver disease

Blood borne virus

31
Q

How is Hep C spread

A

Blood borne

Mostly transmitted by poorly sterilised instruments/shared needles

32
Q

Hep C Epidemiology

A

Six numbered genotypes of which:
1 makes up 50% of cases
2 and 3 make up 40% of cases

33
Q

Diagnosis of Hep C

A

Liver enzymes show rise
Antibodies to HCV (or HCV RNA diagnoses acute infection)
(antibodies present within 4-6 wks)

34
Q

Treatment of Hep C

A

Antivirals - weekly subcut (SC) pegylated interferon alpha-2a and daily oral Ribavirin
Information = advise on not sharing neddles

35
Q

Complications of Hep C

A

Liver failure

If cirrhosis was found, could get hepatocellular carcinoma

36
Q

Describe Hep E virus

A

RNA virus

similar to Hep A - acute only

37
Q

How is Hep E spread and how is it prevented

A

Faeco-oral route
usually spread by contaminated water, rodents, dogs and pigs
Prevention by good sanitation and hygiene

38
Q

True or False:

You can only get infected with Hep E once

A

True Once you’ve had Hep E then you cannot get infected again - 100% immunity

39
Q

Treatment of Chronic Hepatitis B

A

SC Pegylated Interferon-Alpha 2a (immunodilatory treatment) - also for Hep D
Nucleos(t)ide analogues (inhibit viral replication) e.g. Oral Tenofovir

40
Q

What is Hep D

A

Incomplete RNA virus enclosed in a shell of Hep B surface antigen (HBsAg)
Requires Hep B virus for assembly, allowing virus to replicate

41
Q

Transmission of Hep D

A

Blood-borne

42
Q

Epidemiology of Hep D

A

Common in Eastern Europe

43
Q

Risk factors of Hep D

A

IV drug users

all same as HBV

44
Q

Pathophysiology of Hep D

A

If acquired simultaneously with HBV (co-infection), causes increased severity of acute infection.
Co-infection:
Clinically indistinguishable from acute icteric (jaundice) HBV infection
Serum IgM anti-HDV confirms co-infection

Superinfection:
When someone with chronic HBV gets HDV
Results in secondary acute hep and increased rate of liver fibrosis progression

45
Q

Hep C prevention

A

No vaccine available
Previous infection DOES NOT confer immunity - can be re-infected
Screen blood products
Precaution with handling bodily fluids

Medicine Phase 2a GI (35 decks)

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