Hepatitis

Question 1

What are the causes of hepatitis?

Answer 1

• Autoimmune
• NAFLD (NASH)
• Viral Hepatitis
• Alcoholic hepatitis
• Drug induced hepatitis (Paracetamol OD)

Question 2

How does hepatitis present?

Answer 2

Asymptomatic or Non-specific:

• Fatigue
• Abdo pain
• Pruritis
• Muscle and joint aches
• N&V
• Jaundice
• Fever

Question 3

What are the typical LFT findings in hepatitis

Answer 3

‘Hepatic Picture’:

• Raised transaminases
• ALP not as raised
• Raised bilirubin

Question 4

When are transaminases released?

Answer 4

When the liver is inflamed

Question 5

What is the most common viral hepatitis worldwide?

Answer 5

Hep A- but not very common in the UK

Question 6

How does HepA spread?

Answer 6

Faecal-Oral

Question 7

How does HepA present?

Answer 7

• N&V
• Anorexia
• Jaundice

Question 8

How does HepA resolve?

Answer 8

Self-resolves in 1-3 months

Question 9

How is HepA treated?

Answer 9

Analgesia

Question 10

What can HepA cause?

Answer 10

Cholestasis

• Pale stools
• Dark urine
• Mild hepatomegaly

Question 11

What should you do once discovering any viral hepatitis?

Answer 11

Notify public health

Question 12

How does HepB spread?

Answer 12

Vertically or with Bodily fluids:

• Sex
• IVDU
• Contaminated household products e.g. toothbrush

Question 13

How long does it take people to recover from HepB?

Answer 13

2 months

Question 14

How many HepB sufferers go on to be chronic carriers and why?

Answer 14

10%- virus’ DNA integrates into the host DNA, so viral proteins produced

Question 15

What does Surface antigen (HBsAg) indicate?

Answer 15

Active infection

Question 16

What does E antigen (HBeAg) indicate?

Answer 16

High infectivity

Question 17

What does Core antibodies (HBcAb) indicate?

Answer 17

Past infection (Or current)

Question 18

What does Surface antibody (HBsAb) indicate?

Answer 18

Vaccination (Or infection)

Question 19

What does Hepatitis B virus DNA (HBV DNA) indicate?

Answer 19

Viral load

Question 20

When screening for hepatitis, which tests are done first?

Answer 20

• Surface antigen
• Core antibody

(Current or previous infection)

Question 21

If the first hepatitis screen is positive, which tests follow?

Answer 21

• e Antigen
• Viral load

(Is it actively replicating and how much is there)

Question 22

Which immunoglobulin indicates active infection?

Answer 22

IgM

Question 23

Which immunoglobulin indicates previous infection?

Answer 23

IgG

Question 24

What is in the HepB vaccine?

Answer 24

Surface Antigen

Question 25

How is HepB treated?

Answer 25

- Education, alcohol abstinence - Low threshold for screening high risk Pts e.g. IVDUs - Test for complications e.g. FibroScan - Antivirals to slow progression and reduce infectivity

Question 26

How is HepC spread?

Answer 26

Bodily fluids

Question 27

What proportion will fight off the HepC virus vs become chronic carriers?

Answer 27

1/4 fight off 3/4 carry

Question 28

How is HepC treated?

Answer 28

Direct acting anti-virals

Question 29

How long are anti-virals taken for in HepC?

Answer 29

8-12 weeks

Question 30

How successful are HepC ant-virals?

Answer 30

90%

Question 31

How is HepD spread?

Answer 31

ONLY in co-infection with HepB

Question 32

How does HepD survive?

Answer 32

Attaches to HBsAg

Question 33

How does HepE spread?

Answer 33

Faecal-oral

Question 34

What is the disease course of HepE?

Answer 34

- Very mild, requires no treatment - Clears in a month - Very rare in the UK

Question 35

What can all hepatitis lead to?

Answer 35

Cirrhosis and Hepatocellular Carcinoma

Question 36

Which viral hepatitises are RNA?

Answer 36

A, C, D, E

Question 37

Which viral hepatitis is DNA?

Answer 37

B

Question 38

What are the two types of autoimmune hepatitis?

Answer 38

1- Only in adults (post-menopausal women) 2- Only in children/young adults

Question 39

Which type of AI hepatitis is more acute?

Answer 39

Type 2

Question 40

Which autoABs can cause type 1 AI hep?

Answer 40

- ANA - Anti-actin (Anti-SM) - Anti-soluble liver antigen (anti-SLA/LP)

Question 41

Which autoABs can cause type 2 AI hep?

Answer 41

- Anti-liver kidney microsomes-1 (anti-LKM1) | - Anti-liver cytosol antigen type 1 (anti-LC1)

Question 42

How is AI hepatitis diagnosed?

Answer 42

Biopsy

Question 43

How is AI hepatitis treated?

Answer 43

1- High dose prednisolone taper down, introduce 2- Azathioprine

Question 44

Can AI hepatitis be transplanted?

Answer 44

Yes but it may recur