Hepatitis - A/B/C/D/E

Question 1

Definition

Answer 1

Inflammation in the liver. This can vary from a chronic low level inflammation to acute and severe inflammation that leads to large areas of necrosis and liver failure

Question 2

How each virus spreads

Answer 2

A - Faeco-oral routes
B - Blood products and bodily fluids
C- Blood products and bodily fluids
D- Blood products and bodily fluids
E- Faeco-oral routes

Question 3

Acute or chronic?

Answer 3

A - Acute
B - Acute + Chronic
C- Acute + Chronic
D- Acute + Chronic
E - Acute

Question 4

DNA or RNA

Answer 4

A: RNA
B: DNA
C: RNA
D: RNA - requires Hep B
E: RNA

Question 5

Hepatitis A

Answer 5

Risk Factors:
- Travel
- Selfish
- Living with others that have Hep A
- Homelessness
Features: 2-4 week incubation
- Flu-like prodrome: M+V, Fever, Malaise, RUQ pain
- Icteris phase: Jaundice, Dark urine, Pale stool, Pruritus, Tender hepatomegaly
Diagnosis:
- Deranged LFT
- Raised bilirubin
- Serology
Tx: Vaccine and booster 6-12 months later for people who:
- Travel or high prevalence area
- CLD
- MSM
- Drug injecting users
- Occupational risk

Question 6

Hepatitis B

Answer 6

Risk factors:
- IVDU,
- males to have sex with men,
- dialysis patients, healthcare workers
Features: 6-20 weeks incubation
- Fever
- Jaundice
- Elevated liver transaminases
Treatment:
- Immunisation schedule: 2,3,4 months of age
- Anti-HBs is only recommended for those at risk of occupational exposure: test Anti-HBs level
> 100: no further testing required, =10-100: additional dose
< 10: 3 doses
Complications:
- chronic hepatitis (5-10%). ‘Ground-glass’ hepatocytes: light microscopy
- fulminant liver failure (1%)
- hepatocellular carcinoma
- glomerulonephritis
- polyarteritis nodosa
- cryoglobulinaemia

Question 7

Hep B serology

Answer 7

• surface antigen (HBsAg) is the first marker to appear and causes the production of anti-HBs = acute disease (present 1-6 months)
  = If present > 6 months implies chronic disease
• Anti-HBs = immunity (exposure or immunisation)
• IgM Anti-Hbc = appears during acute or recent infection present for 6 months.
• IgG anti-HBc persists > 6m
• HbeAg = marker of HBV replication and infectivity

Example Results
- previous immunisation: anti-HBs positive, all others negative
- previous hepatitis B (> 6 months ago), not a carrier: anti-HBc positive, HBsAg negative
- previous hepatitis B, now a carrier: anti-HBc positive, HBsAg positive

Question 8

Hep C

Answer 8

Risk Factors
- Sharing needles (IVDU or tattoos)
- Vertical/Horizontal transmission
- Dialysis
Features: Incubation period: 6-9 weeks
- Prodromal phase (1-2 weeks): Asx or N+V, Fever, Malaise, RUQ
- Icteris phase (Upto 6m): Jaundice, dark urine, pale stools, Pruritus, joint paint
Diagnosis:
- LFTs: raised ALT
- Raised bilirubin
- Serology: Anti HCV antibodies
Treatment:
- Direct Acting antivirals + Ribavirin

Question 9

Chronic hep C

Answer 9

Persistence of HCV RNA in the blood for 6 months:
Complications:
- rheumatological problems: arthralgia, arthritis
- eye problems: Sjogren’s syndrome
- cirrhosis
- hepatocellular cancer
- cryoglobulinaemia
- membranoproliferative glomerulonephritis
Treatment:
- protease inhibitors (e.g. daclatasvir) with or without ribavirin are used
- HCV RNA (viral load) is used to monitor response to treatment: aim of treatment is sustained virological response (SVR), defined as undetectable serum HCV RNA six months after the end of therapy
Complications of Tx:
- ribavirin - side-effects: haemolytic anaemia, cough, teratogenic
- interferon alpha - side-effects: flu-like symptoms, depression, fatigue, leukopenia, thrombocytopenia

Question 10

Hepatitis D

Answer 10

Co-infection: Hepatitis B and Hepatitis D infection at the same time.
Superinfection: A hepatitis B surface antigen positive patient subsequently develops a hepatitis D infection.
- Associated with high risk of fulminant hepatitis, chronic hepatitis status and cirrhosis.
Diagnosis: Reverse PCR of Hep D RNA
Treatment: Interferon

Question 11

Hepatitis E

Answer 11

Risk Factors:
- Pork consumption
- Shellfish
- Contaminated water
Features: Incubation 3-8 weeks Asymptomatic
Diagnosis: Serology
Treatment: Self limiting resolves in 2-6 weeks