Acute Hepatitis

Question 1

Use the VITAMIN CDE surgical sieve to list the cuases of acute hepatitis?

Answer 1

VITAMIN CDE
1) Vascular = Ischaemic hepatitis (hypotension)

2) Infectious = Hep A, B, C, E, malaria, yellow fever, syphilis

3) Trauma =
- Paracetamol overdose
- alcohol abuse

4) Autoimmune

5) Metabolic
- Gall stone obstruction CBD

6) Iatrogenic
- Drugs e.g. amoxicillin

7) Neoplastic

8) Congenital
- Wilson’s disease
- haemochromatosis

9) Degenerative
- Cirrhosis

10) environement / endocrine

Question 2

Who is affected by hep A virus?

Answer 2

children and young adults

Question 3

What is the route of transmission of hep A

Answer 3

faecal-oral
shellfish
saliva

Question 4

What is the incubation period of Hep A

Answer 4

2-3 weeks

Question 5

What is the outcome of a hep A infection?

Answer 5

• cholestatic Jaundice

- DOES NOT progress to chronic hepatitis

Question 6

Where is Hep B found?

Answer 6

Hep B is more common in africa, middle east and asia.

Question 7

How is Hep B transmitted?

Answer 7

• blood products
• faecal-oral
• vertical (mother to child)
• sexual

Question 8

What is the incubation period of Hep B?

Answer 8

1-5 Months (long)

Question 9

Who is at risk of a Hep B infection

Answer 9

• men who have sex with men
• low socio-economic
• IVDU
• learning difficulties
• health workers
• prison workers
• traveller

Question 10

Hep B can lead to chronic hepatitis - what are the complications of this?

Answer 10

• Cirrhosis

- hepatocellular carcinoma

Question 11

What are the prodromal symptoms of viral hepatitis?

Answer 11

• fever
• malaise
• nausea
• anorexia
• arthralgia (hep B)

Question 12

How is Hep C transmitted?

Answer 12

• mainly via blood products
• saliva
• sex

Question 13

What is the incubation period of hep C?

Answer 13

9 weeks (long)

Question 14

Who is at risk of a Hep C infection?

Answer 14

• haemophiliacs
• thalassaemics
• haemodialysed
• IVDU
• transplant

Question 15

What % of hep C patients develop chronic hepatitis?

Answer 15

• 50%

Question 16

What are the icteric symptoms of hepatitis?

Answer 16

• Jaundice
• Hepatic encephalopathy
• Pruritis
• Steatorrhea
• Dark urine
• Transient rash

Question 17

Which hepatitis viruses progress to be chronic?

Answer 17

• Hep B
• Hep C
• Hep D

(Hep A , and Hep E not chronic)

Question 18

What are the examination signs of hepatitis?

Answer 18

• liver flap
• Jaundice in sclera
• tenderness RUQ
• Hepatomegaly
• Splenomegaly

Question 19

What investigations are done for acute hepatitis?

Answer 19

• LFTs
• Coagulation screen
• FBC
• U+Es
• CRP / ESR
• Coomb’s +ve haemolytic anaemia

VIRAL MARKERS:

• IgM
• Anti- HAV IgM
• HBsAg surface antigen
• HBeAg antigen

Question 20

What do the LFTs in acute hepatitis show?

Answer 20

• raised serum bili
• raised AST
• Low ALP
• raised ALT

Question 21

What does the coagulation screen show in acute hepatitis?

Answer 21

• Increased prothrombin time

Question 22

What does the FBC show for acute hepatitis?

Answer 22

• raised MCV (alcohol)
• ## reduced WBC

Question 23

What antibodies will be raised in acute hepatitis?

Answer 23

• IgM

Hep A:
- Anti-HAV Igm +ve (shows acute infection)

Hep B:

• HBsAg surface antigen
• HBeAg antigen

Question 24

What hep viruses can you get vaccinated against?

Answer 24

Hep A and B

Question 25

What are the pre hepatic causes of jaundice?

Answer 25

- malaria - sickle cell - thalassaemia

Question 26

What are the intrahepatic causes of jaundice?

Answer 26

- EBV - CMV - paracetamol overdose - Gilbert's syndrome (can't conjugate bilirubin) - liver cancer

Question 27

What are the post hepatic causes of jaundice?

Answer 27

- gallstones - pancreatitis - pancreatic cancer - primary sclerosing cholangitis

Question 28

What is the treatment for viral hepatitis?

Answer 28

- interferon - Iamivudine - entecavir - adefovir

Question 29

What are the complications viral hepatitis?

Answer 29

- hepatic failure - cirrhosis - liver cancer (Hep B, C, D) - arteritis - vasculitis - AKI - hepatic encephalopathy - liver abscess