What type of virus is hepatitis A and how is it transmitted?
it is an RNA virus
it is transmitted via the faecal-oral route
this is usually via contaminated food
What are the risk factors for hepatitis A infection?
What are its specific features?
- travelling (e.g. Africa / Asia)
- contaminated food and/or water
- it commonly has an acute presentation
What type of virus is hepatitis B?
How is it transmitted?
it is a DNA virus
it can be transmitted parentally, sexually or vertically
parenteral transmission means that it is transmitted by any mechanism outside of the alimentary canal
e.g. subcutaneous, intravenously, intramuscularly
What are the risk factors and specific features for hepatitis B?
- bodily fluids and contaminated blood (e.g. IVDU)
- it is commonly an acute presentation
What type of virus is hepatitis C?
How is it transmitted?
it is an RNA virus
transmission is mainly parenteral
What are the risk factors for hepatitis C infection?
What are its specific features?
- contaminated blood (e.g. IVDU)
- this infection is usually asymptomatic and chronic
What type of virus is hepatitis D and how is it transmitted?
it is an RNA virus
it is transmitted parentally or sexually
What are the risk factors and specific features of hepatitis D?
- bodily fluids and contaminated blood
- it only co-infects with hepatitis B
if you are negative for hepatits b, then you cannot get hepatitis d
What type of virus is hepatitis E and how is it transmitted?
it is an RNA virus
it is transmitted via the faecal-oral route
What are the risk factors and specific features for hepatitis E?
- contaminated food and/or water
- it has a very high mortality with pregnant women
What are the symptoms of viral hepatitis?
- RUQ pain
- pruritis
- nausea and/or vomiting
- anorexia
- joint pain
What are the clinical signs of viral hepatitis?
- RUQ tenderness
- jaundice
What blood tests are done when viral hepatitis is suspected?
- Liver function tests (LFTs)
- raised AST and ALT > 1000 IU/L
- low albumin
- prothrombin time will be raised
- serology is performed to identify specific antibodies
- acute damage to the liver is shown through high bilirubin, low albumin and prolonged PTT
What is looked for when performing hepatitis B serology?
- HBsAg is a marker of active infection
- HBsAb is a marker of immunity
- this indicates the person has had an infection in the past
- Anti-HBc IgM (core IgM) indicates there is an acute infection
- Anti-HBc IgG (core IgG) indicates a PAST acute infection
When performing hepatitis B serology, what does the presence of HBeAg and HBV DNA suggest?
- HBeAg suggests active replication indicating infectiousness
- HBV DNA suggests active replication and is used to monitor response to treatment
What are the 3 most important risk factors for chronic liver disease (cirrhosis)?
- alcohol
- hepatitis B and C
- obesity / non-alcoholic fatty liver disease
What are less common risk factors for chronic liver disease / cirrhosis?
- autoimmunity in the liver and biliary tract
- e.g. PSC / PBC
- genetic conditions
- Wilson’s disease
- haemochromatosis
- cystic fibrosis
- alpha-1 antitrypsin deficiency
What are the symptoms of chronic liver disease?
- malaise
- fatigue
- anorexia
- nausea
- weight loss
- abdominal pain
What are the clinical signs that are present in all chronic liver disease?
i.e. compensated or decompensated
Hands:
- leukonychia
- palmar erythema
- clubbing
- Dupuytren’s contracture
- > / = 4 spider naevi on the chest / back
- splenomegaly
- tattoos may be present - this indicates possible site of hepatitis infection
What clinical signs are present in decompensated chronic liver disease?
- asterixis
- jaundice
- bruising
- peripheral oedema
- ascites
What will blood tests show for someone with chronic liver disease?
- FBC will show low platelets
- LFTs will be deranged
- coagulation studies will show prolonged PT or INR
What is the main consequence of chronic liver disease and what complications does this result in?
portal hypertension
- oesophageal varices
- caput medusae
- distended / engorged superficial epigastric veins seen radiating from the umbilicus across the abdomen
- haemorrhoids
- splenomegaly & thrombocytopenia
What functions of the liver are disrupted in chronic liver disease and what complications can this lead to?
Detoxification:
- results in hepatic encephalopathy
Synthetic function:
- results in bruising and ascites
Metabolism:
- results in jaundice
What are other possible complications of chronic liver disease?
- hepatocellular carcinoma
- spontaneous bacterial peritonitis
- this is infection of the ascitic fluid
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Acute Hepatitis25
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Acute & Chronic Pancreatitis63
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Gallstones & Biliary Colic75
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Bilirubin Metabolism & Types of Jaundice47
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Alcoholic Hepatitis31
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Cirrhosis & its Consequences76
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Interpretation of Liver Function Tests (LFTs)34
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Hepatology Extras38
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GI Key OSCE Overview111
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Acute Abdomen144
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Liver & Biliary Overview118
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Renal & Urology Overview118
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GI Bleeding0
