GI and General surgery > Hepatitis > Flashcards

Hepatitis Flashcards

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1
Q

How is hepatitis A spread?

A
  • Faecal oral - faecally contiminated water
  • Shellfish
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2
Q

What is the incubation period for hepatitis A?

A

2-6 weeks

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3
Q

What are non-viral infections which can cause hepatitis?

A
  • Toxoplasma gondii
  • Leptospira
  • Coxiella burnetii (Q fever)
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4
Q

What are viral causes of hepatitis?

A
  • Hep A - E
  • EBV
  • CMV
  • Yellow fever
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5
Q

What drugs can cause hepatitis?

A
  • Paracetamol
  • Alcohol
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6
Q

What are symptoms of hepatitis A?

A
  • Fever
  • Malaise
  • Anorexia
  • Nausea
  • Athralgia
  • Jaundice
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7
Q

What are signs of hepatitis A?

A
  • Hepatomegaly
  • Lymphadenopathy
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8
Q

How is HBV spread?

A
  • Blood products
  • IVDU
  • Sexual
  • Direct contact
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9
Q

What groups are most at risk of HBV infection?

A
  • IVDU and sexual partners
  • Health workers
  • Haemophiliacs
  • MSM
  • Haemodialysis/CKD
  • Sexually promiscuous
  • Foster carers
  • Close family memebers of carrier
  • Staff/residernts of institutions/prisons
  • Babies of HBsAg +ve mothers
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10
Q

What is the incubation period HBV?

A

1-6 months

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11
Q

What are features of acute HBV infection?

A
  • Anorexia
  • Lethargy
  • Nausea
  • Fever
  • Abdominal Discomfort
  • Arthralgia
  • Urticarial skin lesions
  • Jaundice + Dark coloured urine
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12
Q

What is HBsAg, and what does its presence indicate?

A

Hepatitis B surface antigen - acute or chronic infection

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13
Q

What is HBeAg, and what does it indicate?

A

Pre-core antigen for HBV - Acute hepatitis B

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14
Q

What is Anti-HBs, and what does its presence indicate?

A

Antibodies against HB surface protein - immunity to HBV, previous epxosure or vaccination

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15
Q

What is Anti-HBe, and what does it’s presence indicate?

A

Antibodies against E-protein - Seroconversion

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16
Q

What is HBc-IgM, and what does its presence indicate?

A

IgM produced against HB core protein - indicates acute hepatitis B in high titres, and chornic hepatitis B with low titres

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17
Q

What is Anti-HBc IgG, and what does its presence indicate?

A

Past exposure to hepatitis B

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18
Q

What hepatitis virology and LFT results would indicate that someone has an acute HBV infection?

A
  • Markedly increased LFT
  • Positive HBsAg
  • Positive HBeAg
  • Positive Anti-HBc IgM
  • Positive Anti-HBc IgG
  • Anti-HBs negative
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19
Q

What hepatitis virology and LFT results would indicate that someone is a carrier of HBV?

A
  • Raised LFTs
  • Positive HBsAg
  • Positive/Negative HBeAg
  • Anti-HBe positive/negative
  • Anti-HBc IgM positive/negative
  • Anti-HBc IgG positive
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20
Q

What hepatitis virology and LFT results would indicate that someone has been vaccinated?

A
  • Normal LFTs
  • HBsAg negative
  • Anti-HBc negative
  • Anti-HBs positive
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21
Q

What viral component is looked at first before doing a full HBV screen?

A

HBsAg, or Anti-HBc IgM in acute infection

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22
Q

What does HBsAg presisting for > 6 months imply?

A

The person is a carrier

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23
Q

What proportion of those with hepatitis B fully recover following acute infection?

A

90-95%

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24
Q

What proportion of those with hepatitis B develop chornic hepatitis?

A

5-10%

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25
What proportion of those with acute HBV infection develop fulminant hepatic necrosis?
1%
26
What are the different outcomes of chronic HBV infection?
* **Asymptomatic chronic infection (carrier)** * **Chronic active hepatits -\> Cirrhosis/Primary liver cancer**
27
What are features of chronic HBV infection?
* **Fatigue, anorexia, depression** * **Signs of advanced disease** * **Chronic liver disease** - jaundice, hepatoma, cirrhosis * **Membranous glomerulonephritis** * **Polyarteritis nodosa**
28
What investigations would you do if you suspected HAV?
* **LFTs** - raised due to hepatocellular injury * **Anti-HAV IgM** - acute * **Anti-HAV IgG** - previously infected
29
How would you manage someone with confirmed acute hepatitis A?
* **Conservative management** * **Avoid alcohol** * **Interferon alpha** - if fulminant hepatitis
30
What are complications that can occur in heptatitis A?
* **Cholestatic jaundice** * **Relapsing hepatitis (may be more severe than first episode)** * **Aplastic anaemia**
31
Is there a form of immunisation available for HAV? If so, what is it?
Yes - inactivated viral protein
32
Who would you consider giving HAV vaccination to?
* **MSM with multiple sexual partners** * **Sewage workers** * **Seronegative haemophiliacs** * **Travellers to endemic areas**
33
What does the presence of HBV DNA indicate?
Implies viral replication. Levels indicate response to treatment
34
What are complications of Hepatitis B?
* **Fulminant hepatic failure** * **cirrhosis** * **HCC** * **Cholangiocarcinoma** * **Cryoglobulinaemia** * **Membranous nephropthy** * **Polyarteritis nodosa**
35
How would you manage someone with hepatitis B?
**Conservative** * **Avoid alcohol** **Medical** * **Pegylated alpha-2a interferon** * **Nucleoside analgogues** - tenofovir, entecavir **Surgical** * **Liver transplantation**
36
What are indications for anti-viral therapy in hepatitis B?
* **Asymptomatic chronic HBV with raised ALT and HBeAg positive** * **Cirrhosis with evidence of ongoing viral replicaton** * **Those without cirrhosis, with 2/3 of following criteria** * HBV DNA \> 2000 IU/ml * Raised ALT * Significant liver inflammation/fibrosis
37
Is there a method of immunisation available for hepatitis B? If so, what is it?
**Yes** * Passive immunisation with specific anti-HBV * Active immunisation - HBsAg recombinant vaccine
38
What is the dose regimen used for the HBV vaccine?
One of: * **Three doses at 0, 1 and 6 months** * **Four doses at 0, 1, 2 and 12 months** * **Four doses at 0, 7, 21 days and 12 months** - rapid protection
39
How would you determine whether someone had a good response to active HBV vaccination?
Post vaccine anti-HBs levels
40
What public health measure would you want to take if someone was confirmed to have HBV?
Contact tracing
41
How is hepatitis C spread?
* **Blood** - transfusion, IV abuse * **Sexual contact**
42
What are risk factors for progression of hepatitis C to chronic disease?
* **Male** * **Older** * **Higher viral load** * **Use of alcohol** * **HIV** * **HBV**
43
What are features of acute HCV infection?
Most asymptomatic, but 10%: * **Mild flu-like symptoms** - malaise, anorexia, fatigue * **Jaundice**
44
What are features of chronic hepatitis C infection?
Asymptomatic, or: * **Variations in AST/ALT - over short time period** * **Cirrhosis** * **Hepatoma**
45
How would you investigate for HCV?
* **Bloods** - LFTs, Anti-HCV antibodies * **HCV-PCR**
46
What investigations would you perform in someone who you suspected had hepatitis B?
Bloods * **LFTs** * **HBsAg** - If positive, then full HBV screen * **HBeAg** * **Anti-HBs** * **Anti-HBe** * **Anti-HBc IgM** * **Anti-HBc Ig**M Liver Biopsy
47
How would you manage someone with HCV?
Conservative * **Alcohol cessation** Medical * **Pegylated interferon + Ribrivarin** * **Consider protease inhibitors** - genotype 1
48
What proportion of those with HCV infection progress to chronic infection?
60-80%
49
What proporrtion of those with chronic HCV progress without cirrhosis?
50-80%
50
What proportion of those with chronic HCV infection progress to cirrhosis within 30 years?
20-50%
51
What proportion of those with chronic HCV progress to hepatoma?
10%
52
How is hepatitis D spread?
Parenteral infection - related to IVDU Little vertical/sexual transmission
53
What is needs to be present for HDV infection to spread?
**Hepatitis B** - needs to be there in order for HDV to spread - HBV used for HDV assembly
54
How does HDV present?
Clinically indistinguishable from HBV infection
55
How would you investigate for HDV infection?
* **LFTs** * **HDV** - IgM/IgG * **HDV RNA** - IgM/IgG * **HDAg** - IgM, IgG
56
How would you manage someoen with HDV?
* **Consider interferon alfa** * **Liver transplantation**
57
What complications can occur in those with HDV?
Severe chronic hepatitis
58
How is Hepatitis E spread?
Enterally transmitted * **From pork meat** - sausages * **Blood exposure** - abattoir workers
59
How does HEV present?
Subclinical or mild illness in woman and young people Most severe illness in elderly * **Liver failure** * **Arthritis** * **Anaemia** * **Neurological manifestations**
60
What blood test would you do to look for HEV?
HEV-RNA - IgG, IgM
61
How would you manage someone with HEV?
Most is self limiting + No licensed treatment * **Consider ribrivarin therapy**
62
What sex does autoimmune hepatitis occur most commonly in?
Women
63
What are features of autoimmune hepatitis?
* **Acute hepatitis with jaundice** * **Clinical features of cirrhosis** - hepatosplenomegaly, cutaneous striae, acne, hirsutes, bruises and, sometimes, ascites. * **Features of an autoimmune disease** - fever, urticarial rash, migratory polyarthritis, glomerulonephritis, pleurisy, pulmonary infiltration or lung fibrosis. * **Can have amenorrhoea**
64
What are infective causes of hepatitis?
* **EBV** * **CMV** * **Leptospirosis** * **Malaria** * **Q fever** * **Syphilis** * **Yellow fever** * **Hep A-E**
65
What investigations would you do if you suspected autoimmune hepatitis?
* **Bloods** - LFTs, FBC, ANA, ASMA, Soluble liver antigenAnti-LKM1, CYP2D6 * **Liver biopsy**
66
How would you manage autoimmune hepatitis?
* **Steroids** - induce remission * **Azathioprine** - Maintenance * **Immunosuppressants** - Mycophenolate, ciclosporin, tacrolimus
67
What are complications of autoimmune hepatitis?
* **Cirrhosis** * **Complications fo drug therapy**
68
What diseases are associated with atuoimmune hepaititis?
* **Penicious anaemia** * **UC** * **GN** * **Autoimmune thyroiditis** * **Autoimmune haemolysis** * **Diabetes mellitus** * **PSC** * **HLA A1, B8, DR3 haplotype**
69
What age range does autoimmune hepaitits most commonly affect?
**Bimodal distribution** - 10-30 years, then \> 40 years
70
What is chronic hepaptitis defined as?
Hepatitis lasting \> 6 months
71
What proportion of individuals who chronically misuse alcohol develop alcoholic hepatitis?
\<20%
72
What are the signs/symptoms of alcoholic hepatitis?
**Alcohol use, plus:** * **Asymptomatic, or** * **Symptomatic** * Tender hepatomegaly +/- Jaundice * Ascites * D+V * Encephalopathy * Malnutrition -\> Anorexia/Malaise * Bleeding * Decompensated hepatic function
73
What factors determine whether an individual with alcoholic hepatitis will develop alcoholic liver cirrhosis?
* **Drinking behaviour** * **Gender** * **Severity of histiological lesions**
74
What might you see on blood panel in someone with alcoholic hepatitis?
* **Increased WCC** * **Decreased platelets** * **Increased INR** * **Increased AST** * **Increased MCV** * **Increased Urea**
75
What might jaundice indicate in someone with alcoholic hepatitis?
Hepatitis is severe
76
What might encephalopathy in someone with alcoholic hepatitis indicate?
Severe hepatitis
77
How would yoiu manage someone with acute alcoholic hepatitis?
Admit * **Catheterise** * **Screen for infection +/- ascitic tap looking for SBP** * **Stop alcohol and manage DTs** * **Pabrinex + Vit K** * **Optimise nutrition** * **Steroids in severe disease** * **Monitoring** - weight, Bloods (FBC, LFTs, U+E's, INR)
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