Acute hepatitis

Question 1

What is acute hepatitis

Answer 1

Inflammation of the liver –> acute parenchymal liver disease

Question 2

How many people are affected by Hep B

Answer 2

1 mil/year - IV drug users, health workers, haemophiliacs

Question 3

What causes acute hepatitis

Answer 3

Viral Hep A-E

• Hep A (RNA) - most common cause ACUTE –> never causes cirrhosis
• Vaccination for Hep A+B
• hep C - no vaccine - IVDU
• Hep D - only in those w Hep B

Alcoholic hepatitis
- eventually cirrhosis

Drug induced
- Paracetamol overdose, TB Abx (rifampicin, isoniziad), statins, sodium valproate, halothane, MAOIs

Ischaemic hepatitis

• ass HF, shock, sepsis
• Bloods = high AST + ALT

Infectious mononucleosis, CMV, herpes, toxoplasmosis, yellow fever, WIlsons

Question 4

What is the pathophysiology of acute hepatitis

Answer 4

• Degenerative changes –> swelling, cytoplasmic granularity –> necrosis
• Collapse of reticulin framework between central veins
• Lobules infiltrated by lymphocytes
• fatty changes

Question 5

What are the risk factors for hepatitis

Answer 5

• Vertical transmission for Hep B
• Drug users, tattooists or acupuncturists
• male sex

Question 6

What are the symptoms of acute hepatitis

Answer 6

• Non-specific, flu like initially
• -> fever, headache, myalgia, N+V, diarrhoea, headache
• Loss of appetite
• Aversion to smoking
• Abdo discomfort

AFTER 2 WEEKS
- Jaundice, vom, nausea, mental confusion

Hep C mostly asymptomatic

Question 7

What are the signs of acute hepatitis

Answer 7

• Dark urine + pale stools (intrahepatic cholestasis)
• Tender lymphadenopathy
• Transient rash
• Hep B: resembles Hep A but extrahepatic signs more common – arthralgia, urticarial

Question 8

What are the investigations for acute hepatitis

Answer 8

Bloods
o Raised AST & ALT & LDH (lactate dehydrogenase)
o Prolonged PT

Hep B surface antigen test

Test for alpha 1 antitrypsin deficiency –> ++ protein in liver can –> inflammation

Leucopenia.
PT is prolonged.
ESR raised.
IgG for hepatitis A, B

Question 9

How do you treat hepatitis

Answer 9

• Hep A - no spec Tx
• Hep B - symptomatic Tx
• Hep C - interferon used to prevent chronic disease

Question 10

What is the prognosis

Answer 10

• Hep A - excellent
• Hep B - variable - flare ups, hepatocellular carcinoma risk high
• Hep C - 85-90% asymptomatic - develop chronic liver disease –> cirrhosis in 20-80%
• Hep D = poor - 70% get cirrhosis