Hepatitis

Question 1

What is hepatitis?

Answer 1

Inflammation of the liver in children + may be acute (recent onset) or chronic (e.g., chronic hepatitis B) (lasting >6 months)

MC - HepA

Question 2

Viral causes of hepatitis

Answer 2

1. HAV
2. HBV
3. HCV
4. HDV
5. HEV

Other viruses:

• EBV (Epstein-Barr Virus)
• CMV (Cytomegalovirus)
• HSV (Herpes Simplex Virus, especially neonates)
• Adenovirus (rare, acute hepatitis)
• Other systemic viruses (e.g., enteroviruses, parvovirus B19)

Question 3

Non-viral causes of hepatitis

Answer 3

1. Autoimmune (type 1 or 2)
2. Metabolic (ATAD, Wilson’s, or galactosemia)
3. Paracetamol overdose
4. Hepatotoxic drugs (valproate or TB drugs)
5. Biliary atresia

Question 4

6 sx of hepatitis in children

Answer 4

1. Jaundice
2. Dark urine + pale stools
3. Abdominal pain
4. RUQ tenderness
5. Fatigue
6. N+V

May also have hepatomegaly (+ raised liver enzymes)

Question 5

Ix for hepatitis

Answer 5

1. LFTs (ALT, AST, Alkaline phosphatase, GGT)
2. Total bilirubin
3. Conjugated bilirubin
4. Viral serology
5. Abdominal US ± Doppler of hepatic vessels if severe/unclear cause

Question 6

Mx of acute hepatitis

Answer 6

1. Supportive care - hydration
2. Nutrition
3. Avoid hepatotoxins
4. Monitor for liver failure

Question 7

For chronic HBV in children…

Answer 7

Specialist referral, antiviral therapy considered depending on age, viral load, liver damage

Question 8

2 complications of acute and chronic hepatitis

Answer 8

Acute:
1. Acute liver failure
2. Hepatic encephalopathy

Chronic:
1. Liver cirrhosis
2. Portal HTN

Question 9

Key complication in chronic HBV?

Answer 9

Hepatocellular carcinoma

Question 10

Hepatitis screening

Answer 10

• HepB has universal newborn screening
• HepC has screening for high-risk children
• HepD has screening if the child is HBsAg positive (co-infection)
• No routine screening for HepA/HepE

Question 11

3 factors that result in high-risk children for HepC

Answer 11

1. Born to HCV-positive mothers
2. Transfusions
3. High-risk exposure

Question 12

Transmission and onset of HAV

Answer 12

Transmission: faecal–oral

Onset: acute, self-limiting

Chronic: never

Paediatric note: often asymptomatic in children

Question 13

Transmission and onset of HBV

Answer 13

Transmission: vertical (mother → baby), blood, sexual

Onset: acute → may become chronic

Paediatric note: newborns have a high risk of chronic infection

Prevention: birth vaccination

Question 14

Transmission and onset of HCV

Answer 14

Transmission: vertical (mainly), blood

Onset: usually asymptomatic in children

Chronic: common (majority develop chronic infection)

Paediatric note: risk of long-term liver disease

Question 15

Transmission and onset of HEV

Answer 15

Transmission: faecal–oral

Onset: usually acute

Chronic: rare (mostly immunocompromised children)

Question 16

What 2 substances are raised in all acute hepatitis cases?

Answer 16

ALT/AST: raised in all acute hepatitis

Bilirubin: may rise, causing jaundice

ALP: raised mainly in cholestatic cases (less specific in growing children due to bone)

Question 17

Rare complication in HepA/B/E

Answer 17

Fulminant hepatitis - rapid onset of severe liver failure within 8 weeks of symptom onset in someone without pre-existing liver disease

Key features:
1. Jaundice
2. Coagulopathy (INR ≥1.5)
3. Encephalopathy (confusion, drowsiness)

Paediatric note: Rare but life-threatening; may need urgent liver transplant

Question 18

Hepatitis B vaccine programme

Answer 18

At birth: only if the baby is at high risk (e.g., mother HBsAg-positive)

Routine schedule:
8 weeks: 1st dose (part of hexavalent vaccine)
12 weeks: 2nd dose (hexavalent)
16 weeks: 3rd dose (hexavalent)

Additional doses: sometimes given at 1–12 months if the baby is high-risk (preterm, HBsAg-positive mother)