Podcast
Questions and Answers
Which type of hepatitis is caused by a virus with an RNA genome and is primarily transmitted orally?
Which type of hepatitis is caused by a virus with an RNA genome and is primarily transmitted orally?
What is a key characteristic of Hepatitis B in relation to chronicity and hepatocellular carcinoma (HCC)?
What is a key characteristic of Hepatitis B in relation to chronicity and hepatocellular carcinoma (HCC)?
Which of the following options is NOT an infectious cause of acute hepatitis?
Which of the following options is NOT an infectious cause of acute hepatitis?
What is the typical incubation period for Hepatitis C?
What is the typical incubation period for Hepatitis C?
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Which hepatitis virus lacks a vaccination option for prophylaxis?
Which hepatitis virus lacks a vaccination option for prophylaxis?
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Which of the following metabolic causes can lead to chronic hepatitis?
Which of the following metabolic causes can lead to chronic hepatitis?
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What characteristic is true of Hepatitis D regarding chronicity and its relationship to other hepatitis viruses?
What characteristic is true of Hepatitis D regarding chronicity and its relationship to other hepatitis viruses?
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Which hepatitis virus can cause severe complications in pregnant individuals?
Which hepatitis virus can cause severe complications in pregnant individuals?
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Which hepatitis virus is primarily transmitted through fecal-oral routes?
Which hepatitis virus is primarily transmitted through fecal-oral routes?
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Which hepatitis virus is associated with the risk of chronic disease and hepatocellular carcinoma (HCC)?
Which hepatitis virus is associated with the risk of chronic disease and hepatocellular carcinoma (HCC)?
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What is the incubation period for Hepatitis B Virus (HBV)?
What is the incubation period for Hepatitis B Virus (HBV)?
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Which statement about Hepatitis C Virus (HCV) is correct?
Which statement about Hepatitis C Virus (HCV) is correct?
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What is the primary method of prophylaxis for Hepatitis B Virus (HBV)?
What is the primary method of prophylaxis for Hepatitis B Virus (HBV)?
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What is a common characteristic of the acute attack of Hepatitis D Virus (HDV)?
What is a common characteristic of the acute attack of Hepatitis D Virus (HDV)?
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Which symptom is associated with the icteric stage of hepatitis?
Which symptom is associated with the icteric stage of hepatitis?
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Which hepatitis viruses are most likely to lead to complete recovery in most cases?
Which hepatitis viruses are most likely to lead to complete recovery in most cases?
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Hepatitis A Virus (HAV) is transmitted primarily through which method?
Hepatitis A Virus (HAV) is transmitted primarily through which method?
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What complication is characterized by the recurrence of jaundice and elevated serum bilirubin after an initial attack?
What complication is characterized by the recurrence of jaundice and elevated serum bilirubin after an initial attack?
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Which of the following statements about post-hepatitis syndrome is correct?
Which of the following statements about post-hepatitis syndrome is correct?
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Which hepatitis viruses are primarily associated with chronic sequelae?
Which hepatitis viruses are primarily associated with chronic sequelae?
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Which test result indicates chronic hepatitis B infection?
Which test result indicates chronic hepatitis B infection?
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Which extrahepatic complication is specifically associated with hepatitis B and C?
Which extrahepatic complication is specifically associated with hepatitis B and C?
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What laboratory finding might indicate cholestatic hepatitis associated with HAV?
What laboratory finding might indicate cholestatic hepatitis associated with HAV?
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What is the expected urine finding in a patient with hepatitis who has bilirubin present?
What is the expected urine finding in a patient with hepatitis who has bilirubin present?
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Study Notes
Hepatitis Overview
- Topics covered include acute/chronic hepatitis, active viral hepatitis (causes, clinical picture, sequelae, complications, investigations, and management), and chronic viral hepatitis (clinical picture, investigations, and treatment).
Acute Hepatitis
- Infections: Viral hepatitis (types A, B, C, D, and E), other viruses (EBV, CMV, HSV, yellow fever), and bacterial hepatitis (Neisseria meningitidis, gonorrhea, Salmonella, Brucella, and Campylobacter).
- Drugs and toxins: Alcohol, halothane, isoniazid, paracetamol.
- Metabolic disorders: Wilson's disease.
Chronic Hepatitis
- Duration: Inflammation of the liver lasting at least six months.
- Viral hepatitis: Types B, C, and D.
- Autoimmune hepatitis.
- Drugs and toxins: Alcohol, isoniazid (INH), and methyldopa.
- Metabolic disorders: Wilson's disease and a-1 antitrypsin deficiency.
Acute Viral Hepatitis
- Types: HAV, HBV, HCV, HDV, HEV
- Genomes: HAV (RNA), HBV (DNA), HCV (RNA), HDV (RNA), HEV (RNA)
- Transmission: HAV (oral), HBV (blood, sexual, vertical), HCV (blood, community acquired), HDV (blood, sexual, vertical), HEV (oral)
- Incubation periods/incidence: Vary based on the virus, some are sporadic or epidemic
- Age of affected population: Varies based on the virus
- Acute attack severity: Varies based on the virus, some are mild, some are severe, and some are characterized by jaundice
- Chronicity/HCC relation: Varies based on the virus, some are more linked to chronicity and hepatocellular carcinoma (HCC).
Hepatitis A Virus (HAV)
- Transmission: Fecal-oral
- Affected population: Children and young adults
- Incidence: Sporadic or epidemic
- Incubation period: 2-6 weeks
- Acute attack: Usually mild; no chronicity or HCC
- Prophylaxis: Vaccination or immunoglobulins
Hepatitis E Virus (HEV)
- Transmission: Fecal-oral
- Affected population: Children and young adults
- Incidence: Sporadic or epidemic
- Incubation period: 2-6 weeks
- Acute attack: Usually mild, except in pregnant females
- Chronicity/HCC relation: Not associated with chronic hepatitis or HCC
- Prophylaxis: None available
Hepatitis B Virus (HBV)
- Transmission: Blood, sexual, vertical (mother to child)
- Affected population: Any age
- Incidence: Sporadic
- Incubation period: 1-6 months
- Acute attack: Usually severe; associated with chronicity and HCC
- Prophylaxis: Vaccination or immunoglobulins
Hepatitis C Virus (HCV)
- Transmission: Blood, community acquired
- Affected population: Any age (more common in adults)
- Incidence: Sporadic
- Incubation period: 1-6 months
- Acute attack: Usually mild or unnoticed; associated with chronicity and HCC
- Prophylaxis: None available
Hepatitis D Virus (HDV)
- Transmission: Blood, sexual, vertical
- Affected population: Any age
- Incidence: Sporadic
- Incubation period: 1-6 months
- Acute attack: Potentially severe (co-infection), and associated with chronicity when it's a super-infection
- Prophylaxis: Vaccination against HBV
Clinical Picture
- Anicteric hepatitis: Often overlooked; mild cases with influenza-like symptoms without jaundice.
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Icteric hepatitis: Jaundice is prominent.
- Pre-icteric stage: (3 days-2 weeks) symptoms include fever, anorexia, nausea, and vomiting, and accompanied by dull, aching pain in the right hypochondrium (upper right abdomen) or epigastrium (upper central abdomen)
- Icteric stage: (1-4 weeks) improvement in fever, symptoms, and signs. Symptoms include dark urine, and pale stools with an enlarged liver that's painful and soft to the touch.
- Convalescence stage: gradual improvement and disappearance of symptoms. Full liver recovery can take up to 6 months.
Sequelae
- Complete recovery (common in HAV, HEV, less frequent in HBV/HDV. Very infrequent in HCV)
- Hepatic Complications: relapse (attack recurs), cholestatic hepatitis (prolonged cholestasis resulting in elevated ALP, pruritus, and jaundice that may last 8-28 weeks)
- Fulminant hepatitis (rare; massive liver necrosis)
- Post-hepatitis syndrome (transaminitis; abnormal liver enzymes, and fatigue, anorexia).
Extrahepatic complications
- Arthritis
- Aplastic Anemia
- Guillain-Barré syndrome
- Glomerulonephritis
- Polyarteritis nodosa
- Cryoglobulinemia
Investigations
- Liver function tests
- Abdominal ultrasound
- Urine analysis
- Stool analysis
- Blood picture
- Hepatitis markers (antibodies and markers in blood)
- PCR (polymerase chain reaction)
Management
- Bed rest until symptom and liver tenderness cease, and serum bilirubin levels decrease (<1.5 mg/dL)
- Diet: high carbohydrate, low fat; protein restriction only with liver failure
- Symptomatic treatment (for nausea, domperidone; for pruritus, cholestyramine)
- Treatment of complications (e.g., corticosteroids for cholestatic hepatitis)
Chronic Viral Hepatitis
- Asymptomatic or non-specific symptoms (fatigue, anorexia, general ill health)
- Hepatomegaly (firm liver), Jaundice, Right hypochondrial pain, splenomegaly, complications to cirrhosis, LCF, PH, and HCC
- Extra-hepatic symptoms (cryoglobulinemia, glomerulonephritis, arthritis), notably in autoimmune cases
Investigations for Chronic Hepatitis
- Liver Function Tests (liver enzymes, albumin, bilirubin)
- Abdominal Ultrasound (liver size, cirrhosis, etc.)
- Liver Biopsy (tissue examination for inflammation, fibrosis, etc.) - can detect inflammation, and fibrosis, specific for different viruses (e.g. "ground glass" appearance in HBV
- Hepatitis markers (antibodies and markers in blood)
- PCR to detect viral replication
- Auto-antibodies for autoimmune hepatitis (ANA, ASMA, ALKMA)
Treatment of Chronic Hepatitis
- Chronic HBV: Immune modulator drugs (e.g., interferon) and antiviral drugs (e.g., entecavir, tenofovir, lamivudine)
-
Chronic HCV: Direct-acting antiviral (DAA) therapy; treatment goals include preventing complications, improving quality of life, and preventing transmission of HCV
- Therapy endpoint (SVR): undetectable serum HCV RNA (<15 IU/ml) at 12 or 24 weeks post-treatment
- Treatment protocols in genotype 4 patients and cases requiring special considerations (e.g., liver failure, existing complications) are needed
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Description
Test your knowledge on hepatitis with this comprehensive quiz covering acute and chronic hepatitis. Explore the causes, clinical features, complications, and management strategies associated with various types of viral hepatitis. Perfect for medical students and healthcare professionals seeking to reinforce their understanding of liver diseases.
