Hepatitis Overview Quiz
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Questions and Answers

Which mode of transmission is primarily associated with Hepatitis A?

  • Vector-borne transmission
  • Parenteral transmission
  • Airborne transmission
  • Faecal-oral transmission (correct)

    • What type of necrosis is typically observed in acute viral hepatitis?

  • Central necrosis only
  • Confluent bridging necrosis (correct)
  • Only minor necrosis
  • Apoptotic necrosis only

    • Which statement regarding Hepatitis A is true?

  • It is primarily spread through infected blood.
  • Jaundice can be prolonged in some cases. (correct)
  • It can cause a chronic carrier state.
  • Symptomatic infection is more common in children.

    • What immunological marker indicates a recent infection with Hepatitis A?

    <p>IgM anti-HAV</p> Signup and view all the answers

    Which of the following is NOT a characteristic of Hepatitis A?

    <p>Chronic disease can develop.</p> Signup and view all the answers

    Which laboratory finding is typically associated with chronic hepatitis?

    <p>High AST/ALT levels</p> Signup and view all the answers

    What is a common symptom that may lead to the investigation of chronic hepatitis?

    <p>Vague malaise</p> Signup and view all the answers

    Which condition is NOT categorized under chronic hepatitis?

    <p>Alcohol-related liver disease</p> Signup and view all the answers

    Which assessment is used to determine the stage of fibrosis in chronic hepatitis?

    <p>Biopsy</p> Signup and view all the answers

    Which of the following is a recognized cause of chronic hepatitis?

    <p>Chronic drug hepatitis</p> Signup and view all the answers

    What is the primary aim of treating chronic hepatitis?

    <p>Delay progression to cirrhosis</p> Signup and view all the answers

    What does piecemeal necrosis indicate in the context of chronic hepatitis?

    <p>Chronic damage with inflammatory response</p> Signup and view all the answers

    Which of the following describes a typical presentation of chronic hepatitis?

    <p>Routine health check revealing abnormal LFTs</p> Signup and view all the answers

    What is the primary inflammatory cell involved in hepatitis, regardless of its duration?

    <p>Lymphocyte</p> Signup and view all the answers

    Which of the following diseases is known to cause only acute hepatitis?

    <p>Hepatitis A virus (HAV)</p> Signup and view all the answers

    Which factor can influence the progression from acute hepatitis B virus (HBV) to chronic hepatitis?

    <p>Age of infection</p> Signup and view all the answers

    Which condition is NOT classified under conventional chronic hepatitis?

    <p>Alcohol-related liver disease</p> Signup and view all the answers

    What is a common consequence of severe acute hepatitis?

    <p>Acute liver failure</p> Signup and view all the answers

    Which of the following is a cause of chronic liver damage that does not fall under chronic hepatitis?

    <p>Non-alcoholic fatty liver disease</p> Signup and view all the answers

    Which hepatitis virus is most likely to progress to chronic infection?

    <p>Hepatitis B virus (HBV)</p> Signup and view all the answers

    What are the typical vague symptoms of acute hepatitis?

    <p>Nausea, anorexia, and malaise</p> Signup and view all the answers

    What histological finding is least likely to be associated with mild chronic hepatitis C?

    <p>Fibrous tissue proliferation</p> Signup and view all the answers

    Which extrahepatic manifestation is commonly associated with hepatitis C?

    <p>Cryoglobulinaemia</p> Signup and view all the answers

    Which genotype of hepatitis C is most prevalent in Europe?

    <p>Type 1b</p> Signup and view all the answers

    What describes the typical risk of cirrhosis development over the course of chronic hepatitis C?

    <p>20% over 20 years</p> Signup and view all the answers

    What is a method previously used to guide treatment based on histological damage in chronic hepatitis C?

    <p>Biopsy assessment</p> Signup and view all the answers

    What is the primary cause of acute liver failure (ALF) in South Asia?

    <p>Hepatitis E virus</p> Signup and view all the answers

    What factor increases the risk of more serious disease from Hepatitis E?

    <p>Pregnancy</p> Signup and view all the answers

    Which of the following statements about Hepatitis B is accurate?

    <p>Chronic HBV disease affects approximately 300 million worldwide.</p> Signup and view all the answers

    What is required for the replication of the Hepatitis D virus?

    <p>Presence of Hepatitis B virus</p> Signup and view all the answers

    Which of the following best describes the typical progression of Hepatitis C infection?

    <p>Most cases progress to chronic infection (&gt;80%).</p> Signup and view all the answers

    What does the presence of anti-HCV antibodies indicate?

    <p>Exposure to Hepatitis C virus.</p> Signup and view all the answers

    In which population is Hepatitis D most commonly found?

    <p>Intravenous drug users (IDUs)</p> Signup and view all the answers

    What is a notable characteristic of Hepatitis C compared to other hepatitis viruses?

    <p>It is often asymptomatic during acute infection.</p> Signup and view all the answers

    What is the main characteristic of acute hepatitis as observed histologically?

    <p>Spotty focal necrosis of individual hepatocytes</p> Signup and view all the answers

    In Hepatitis A infections, which of the following is true regarding its common transmission scenarios?

    <p>Contaminated water or shellfish can lead to outbreaks.</p> Signup and view all the answers

    What is the significance of IgM anti-HAV in a patient suspected of Hepatitis A?

    <p>It confirms a recent acute infection.</p> Signup and view all the answers

    Which viral hepatitis is most likely to result in a chronic state following infection?

    <p>Hepatitis B</p> Signup and view all the answers

    What histological feature is frequently observed in acute hepatitis cases?

    <p>Cholestasis with significant periportal inflammation</p> Signup and view all the answers

    Which diseases are classified as causing chronic hepatitis?

    <p>Wilson’s disease and autoimmune hepatitis</p> Signup and view all the answers

    Which statement correctly describes the relationship between hepatitis viruses and their potential for chronic infection?

    <p>HBV has a high likelihood of becoming chronic depending on age.</p> Signup and view all the answers

    What are common symptoms experienced by patients with acute hepatitis?

    <p>Nausea, anorexia, and malaise</p> Signup and view all the answers

    Which of the following is a distinct characteristic of flares in chronic hepatitis?

    <p>They can mimic acute hepatitis.</p> Signup and view all the answers

    What is a significant consequence of severe acute hepatitis?

    <p>Acute liver failure</p> Signup and view all the answers

    What role does inflammation play in hepatitis diagnosis?

    <p>Inflammation is crucial regardless of hepatitis duration.</p> Signup and view all the answers

    Which type of hepatitis is known to rarely lead to acute liver failure?

    <p>Hepatitis E virus-related hepatitis</p> Signup and view all the answers

    What are the distinctive features of liver diseases not included in conventional chronic hepatitis?

    <p>They have unique inflammatory profiles.</p> Signup and view all the answers

    What is the typical duration for persistent abnormality to classify as chronic hepatitis?

    <p>More than 6 months</p> Signup and view all the answers

    Which of the following is an indicator of potential chronic hepatocellular damage?

    <p>Viral load of HBV or HCV</p> Signup and view all the answers

    Which of the following results from chronic hepatitis might signal an increase in the risk of hepatocellular carcinoma (HCC)?

    <p>Significant liver fibrosis</p> Signup and view all the answers

    Which of the following conditions is always classified as chronic hepatitis?

    <p>Auto-immune hepatitis</p> Signup and view all the answers

    What non-invasive technique is utilized for assessing fibrosis in chronic hepatitis?

    <p>FibroScan</p> Signup and view all the answers

    What type of inflammation is typically observed in chronic hepatitis?

    <p>Interface inflammation with piecemeal necrosis</p> Signup and view all the answers

    Which of the following is a common symptom indicating the need for chronic hepatitis investigation?

    <p>Unexplained malaise</p> Signup and view all the answers

    In the assessment of chronic hepatitis, which scoring system helps in guiding prognosis and treatment?

    <p>Child-Pugh score</p> Signup and view all the answers

    What is a common extrahepatic manifestation associated with Hepatitis C?

    <p>Cryoglobulinaemia plus glomerulonephritis</p> Signup and view all the answers

    Which factor is NOT associated with an increased risk of progression in chronic Hepatitis C?

    <p>Family history of hypertension</p> Signup and view all the answers

    What is the primary genotype of Hepatitis C that shows the least response to interferon treatment?

    <p>Type 1a</p> Signup and view all the answers

    What histological finding is characteristic of mild chronic hepatitis?

    <p>Bile duct infiltration by lymphocytes</p> Signup and view all the answers

    What is a sustained virological response (SVR) a determinant of in patients with Hepatitis C?

    <p>Lower risk of cirrhosis and HCC progression</p> Signup and view all the answers

    What is the primary characteristic that differentiates Hepatitis D from other hepatitis viruses?

    <p>It requires the presence of Hepatitis B virus for replication.</p> Signup and view all the answers

    Which population is at the highest risk of developing serious disease from Hepatitis E?

    <p>Pregnant women</p> Signup and view all the answers

    Which statement best explains the prevalence of Hepatitis B globally?

    <p>It can range from 0.1% to over 10% depending on geographical location.</p> Signup and view all the answers

    What is the common progression of infection for most individuals who contract Hepatitis C?

    <p>More than 80% progress to chronic infection.</p> Signup and view all the answers

    What is a defining feature of Hepatitis A infections compared to other hepatitis viruses?

    <p>Most infections are subclinical or mild.</p> Signup and view all the answers

    Which of the following best describes the relationship between Hepatitis B and chronic disease?

    <p>Up to 30% of chronic HBV patients may develop cirrhosis or liver cancer.</p> Signup and view all the answers

    Which test confirms ongoing Hepatitis C infection more definitively than serology alone?

    <p>HCV RNA test in blood</p> Signup and view all the answers

    What is the relationship between Hepatitis E and water-borne outbreaks?

    <p>Hepatitis E mainly occurs in developing countries with inadequate water supply.</p> Signup and view all the answers

    Study Notes

    Hepatitis

    • Acute hepatitis: Abnormal liver function lasting less than 6 months.
    • Chronic hepatitis: Persistent liver abnormality for more than 6 months.
    • Hepatotropic viruses: Viruses that specifically target the liver, like Hepatitis A, B, C, and E.
    • Causes of Acute Hepatitis:
      • Viral infections (HAV, HBV, HCV, HEV, EBV, CMV, rubella)
      • Drugs
      • Rare: Acute liver failure
    • Signs of Acute Hepatitis:
      • Enlarged and tender liver
      • Jaundice (yellowing of the skin) may occur, especially in adults
      • Blood tests: High AST/ALT (liver enzymes), elevated bilirubin, normal albumin, prolonged PT (prothrombin time).
    • Causes of Chronic Hepatitis:
      • Chronic viral hepatitis (B, C, B+D or unknown)
      • Chronic drug hepatitis (rare)
      • Auto-immune hepatitis (always chronic)
      • Wilson’s disease (very rare, always chronic)
      • Alpha-1-antitrypsin deficiency (very rare)
    • Assessment of Chronic Hepatitis:
      • Blood tests: ALT/AST levels.
      • Viral load (e.g., HBV, HCV) or genotype (HCV).
      • Liver biopsy: Determines the "grade" of inflammation and the "stage" of fibrosis (from normal to cirrhosis).
      • Non-invasive assessments like FibroScan to assess fibrosis.
    • Chronic Liver Diseases Not Classified as Chronic Hepatitis:
      • Alcohol-related liver disease
      • Non-alcoholic fatty liver disease (NAFLD)
      • Chronic inflammatory biliary tract diseases (PBC, PSC)
      • Hereditary haemochromatosis

    Hepatitis A

    • Transmission: Faecal-oral route, commonly through contaminated water, food, or personal contact.
    • Clinical Features:
      • Usually subclinical or mild illness.
      • More symptomatic in adults (jaundice, fever)
      • Silent infection in childhood is common.
      • Rarely causes acute liver failure (ALF)
    • No chronic state or carrier state.
    • Lifelong immunity develops after contracting the virus, with IgM anti-HAV indicating an acute infection.
    • Vaccination: Available for protection.
    • Histology:
      • Periportal inflammation with plasma cells
      • Cholestasis
      • Acidophil bodies, apoptosis, “councilman body"

    Hepatitis E

    • Similar illness and epidemiology to Hepatitis A:
      • Mainly in developing countries, water-borne outbreaks.
      • Commonest cause of ALF in South Asia (genotype 1).
      • Sporadic cases in non-endemic countries (zoonotic, genotype 3).
    • Serological and molecular tests available.
    • Mostly subclinical or mild: Rarely causes acute liver failure.
    • Higher risk of severe disease in pregnant women.
    • No chronic state or carrier state.
      • Chronic disease described in immunosuppressed individuals.
    • Histology: Resembles Hepatitis A.

    Hepatitis B

    • Worldwide burden: 300 million people with chronic HBV disease.
    • Leading cause of: Chronic hepatitis, cirrhosis, and liver cancer worldwide.
    • High-prevalence areas:

      • 8% Southeast Asia, China, Africa

      • 2-8% South Asia, Middle East
      • <2% Western countries.
    • Transmission:
      • Blood-borne, mainly through parenteral routes (e.g., needlestick injuries, blood transfusions).
      • Sharing personal items (razors, toothbrushes).
      • Vertical transmission (mother to child)
    • Risk Factors:
      • IDUs (injecting drug users)
      • Frequent sexual partners/MSM (men who have sex with men)
      • Contacts of infected individuals
      • Children of parents from high-prevalence areas.
    • Clinical Features:
      • Acute infection: Often silent, rarely recognized.
      • Chronic infection: Can lead to cirrhosis and liver cancer.
      • **Pregnant women: **Infants need HBV vaccination and HBIG (Hepatitis B Immunoglobulin)
    • Pathogenesis:
      • HBV integrates into the host's DNA, leading to chronic infection and liver inflammation.
    • Serology:
      • Anti-HBs antibody: Indicates immunity to HBV.
      • HBsAg: Present during both acute and chronic infection
      • **HBeAg: ** Present in patients with high viral loads, indicating active viral replication and a higher risk of infection.

    Hepatitis D

    • Delta agent, a "passenger" RNA Virus:
      • Requires the presence of HBV for replication.
    • Transmission: Blood-borne via the same routes as HBV.
    • Co-infection: Simultaneous HBV and HDV infection.
    • Superinfection: HDV infection in individuals with pre-existing HBV.
    • Increases risk of chronic disease associated with HBV.
    • Typically seen in intravenous drug users.
    • Rare in Ireland.

    Hepatitis C

    • Major cause of: Chronic hepatitis, cirrhosis, and liver cancer worldwide.
    • Worldwide burden: Estimated 180 million people chronically infected.
    • Prevalence: Varies widely depending on geographic location and risk factors.
    • Transmission:
      • Blood-borne, commonly through IDUs.
      • Can occur from contaminated medical equipment, sharing of personal items, or accidental needle sticks.
    • Genotypes: Six genotypes of HCV, influencing disease progression and response to treatment.
    • Clinical Features:
      • Acute infection: Mostly silent and seldom recognized.
      • Chronic infection: Develops in >80% of cases, often identified incidentally.
      • Vague symptoms: Fatigue, arthralgia (joint pain).
    • Pathogenesis:
      • Not fully understood, likely involves prolonged inflammation and immune system dysfunction.
    • Diagnosis:
      • Serology: Anti-HCV antibody indicates exposure, but does not confirm active infection.
      • HCV RNA in blood: Confirms ongoing infection.
      • Genotyping to identify specific genotypes. - Histology
      • Mild chronic hepatitis: Portal tract lymphoid aggregates and follicles, bile duct infiltration by lymphocytes, fatty change, portal and lobular granulomas, giant cell formation.
    • Extra-Hepatic Manifestations:
      • Arteritis
      • Cryoglobulinaemia plus glomerulonephritis
      • Porphyria cutanea tarda (PCT)
      • Higher incidence of diabetes
      • Association with lichen planus, Sicca syndrome and non-Hodgkin lymphoma.
    • Treatment:
      • Direct-acting antiviral agents (DAAs): Highly-effective treatments for HCV infection that target specific viral proteins, leading to sustained virologic response (SVR) in most cases.
    • Sustained virologic response: Leads to reduced risk of progressing to cirrhosis, liver cancer, and better long-term outcomes.

    International Prevalence of Hepatitis Types

    • HAV:
      • Worldwide distribution, but prevalence higher in areas with poor sanitation and hygiene.
    • HEV:
      • Commonest cause of ALF in South Asia (genotype 1).
      • Sporadic cases in non-endemic countries (zoonotic, genotype 3).
    • HBV:
      • Highest prevalence in Southeast Asia, China, and Africa (>8% of the population).
      • Intermediate prevalence in South Asia and the Middle East (2-8%).
      • Lower prevalence in Western countries.
    • HCV:
      • Globally: Estimated 180 million people chronically infected with HCV.
      • Prevalence: Varies significantly based on geographic location and risk group.

    Hepatitis Overview

    • An abnormality present for longer than 6 months is considered chronic hepatitis
    • Some diseases only cause acute hepatitis, such as Hepatitis A and Hepatitis E
    • Other diseases, such as autoimmune hepatitis and Wilson's disease, only cause chronic hepatitis
    • Some causes of acute hepatitis may become chronic, including Hepatitis B and C
    • Acute hepatitis is characterized by diffuse liver damage and inflammation.
    • Prototypical inflammatory cell in hepatitis is the lymphocyte, regardless of the duration of the disease
    • Severe acute hepatitis can lead to acute liver failure
    • Chronic hepatitis is characterized by ongoing effects resembling acute hepatitis, including evidence of hepatocellular damage
    • Chronic hepatitis can be diagnosed through routine testing, investigation of symptoms, follow-up of acute hepatitis, or the presence of cirrhosis and decompensation.
    • Chronic hepatitis shares common risk factors with other chronic liver diseases for fibrosis, progression to cirrhosis, and risk of hepatocellular carcinoma (HCC).

    Causes of Hepatitis

    • Causes of Acute Hepatitis:
      • Viruses (HAV, HBV, HCV, HEV, EBV, CMV, Rubella)
      • Drugs
      • Alcohol (Rare, but can cause acute liver failure in adults)
    • Causes of Chronic Hepatitis:
      • Chronic viral hepatitis (B, C, B+D)
      • Chronic drug hepatitis (rare)
      • Autoimmune hepatitis (always chronic)
      • Wilson's disease (very rare, always chronic)
      • Alpha-1-antitrypsin deficiency (very rare)
    • Chronic Liver Diseases Not Categorized as Chronic Hepatitis:
      • Alcohol-related liver disease
      • Non-alcoholic fatty liver disease (NAFLD)
      • Chronic inflammatory biliary tract diseases (PBC, PSC)
      • Hereditary hemochromatosis

    Assessing Chronic Hepatitis

    • Blood tests (ALT/AST)
    • Viral load (HBV, HCV) or genotype (HCV)
    • Liver biopsy to determine:
      • Grade of necroinflammatory activity
      • Stage of fibrosis (from normal to cirrhosis)
    • Non-invasive assessments of fibrosis (FibroScan)
    • Effectiveness and tolerability of treatment
    • Aim: eliminate, reduce, or delay progression to cirrhosis and reduce the risk of HCC

    Viral Hepatitis

    • Hepatotropic Viruses:
      • Hepatitis A and E (infective hepatitis)
        • Faecal-oral transmission
        • No chronic state for HAV, very rare for HEV
      • Hepatitis B and C (serum hepatitis)
        • Parenteral transmission
        • Risk of chronic state
      • Yellow fever virus
        • Monkey-mosquito-man transmission
    • Other Viral Causes of Acute Hepatitis: EBV, CMV, Rubella
    • Coinfection/Superinfection is Possible: HCV and/or HBV and/or HIV, HBV+HDV

    Hepatitis A

    • Transmission:
      • Faecal-oral spread
      • Personal/sexual contact, epidemics (institutions)
      • Contaminated water/shellfish
    • Clinical Course:
      • Usually subclinical or mild illness
      • More often symptomatic in adults
      • Silent infection in childhood
      • Very rare cause of ALF, jaundice can be prolonged
      • No chronic disease/carrier state
    • Histology:
      • Appearance of acute hepatitis in general
      • Periportal inflammation with plasma cells
      • Cholestasis
      • Acidophil bodies, apoptosis, “Councilman body”
    • Serology: Anti-HAV antibody indicates lifelong immunity
      • IgM anti-HAV indicates acute infection
    • Immunization: Active immunization, especially for those at-risk

    Hepatitis E

    • Clinical Course:
      • Similar illness/epidemiology to Hepatitis A
      • Mostly subclinical/mild, rarely acute liver failure
      • Commonest cause of ALF in South Asia (genotype 1)
      • Sporadic cases in non-endemic countries (zoonotic, genotype 3)
      • Higher risk in pregnant women of more serious disease
      • In general, no chronic disease/carrier state
      • Chronic disease described a/w immunosuppression
    • Histology: Resembles Hepatitis A
    • Serological & Molecular Tests: Now available

    Hepatitis B

    • Prevalence: 300 million worldwide have chronic HBV disease
    • Leading Cause: Chronic hepatitis, cirrhosis, liver cancer
    • Deaths: Up to 1 million deaths annually
    • Transmission: Parenteral
    • Risk Factors:
      • High prevalence in SE Asia, China, Africa
      • Intermediate prevalence in S Asia, Middle East
      • Low prevalence in other parts of the world
      • Children (20-30% get chronic HBV)
      • Adults (2% prevalence)
      • Pregnant women
      • Patients on immunosuppression
      • High-risk groups (IDUs, frequent sex partners/MSM, contacts, children of parents from >8% areas)

    Hepatitis D

    • Delta Agent: RNA virus that requires HBV for replication
    • Transmission: Co-infection with HBV or superinfection on existing chronic HBV
    • Clinical Course: Increases the risk of chronic disease associated with HBV
    • Prevalence: Typically in IDUs, rare in Ireland

    Hepatitis C

    • Major Cause: Major cause of blood or blood-product associated hepatitis (“non-A, non-B hepatitis”)
      • Major burden of chronic infection worldwide (?180m)
      • 6 genotypes
    • Transmission: Blood, IDUs, sporadic
    • Clinical Course: - Acute infection typically silent - Most cases (>80%) progress to chronic infection - Chronic infection often identified incidentally - Chronic HCV vague symptoms (fatigue, arthralgia) - Small % develop extra-hepatic manifestations

    Hepatitis C Diagnosis

    • Serology: Anti-HCV antibody indicates exposure
      • Most with anti-HCV will have active chronic infection
      • Anti-HCV not protective
    • HCV RNA in blood: Confirms ongoing infection
      • Amount of viral RNA is used for treatment decisions
    • Genotype:
      • Type 1a commonest in US, least responsive to interferon
      • Type 1b commonest in Europe
      • Types 2, 3 elsewhere
      • Polymorphism in IFNL3/IL28B gene predicts response in type 1
    • Treatment Response: Nil/minimal RNA after 12 or 24/52 weeks = SVR
      • Sustained virological response (SVR) reduces progression, risk of cirrhosis, HCC

    Hepatitis C Histology

    • Mild chronic hepatitis
    • Portal tract lymphoid aggregates and follicles
    • Bile duct infiltration by lymphocytes
    • Fatty change
    • Sometimes portal and lobular granulomas
    • Giant cell formation

    Hepatitis C Extra Hepatic Manifestations

    • Arteritis
    • Cryoglobulinaemia plus glomerulonephritis
    • Porphyria cutanea tarda (PCT)
    • Higher incidence of diabetes
    • Association with lichen planus, Sicca syndrome and non Hodgkin lymphoma

    Clinical Course of Hepatitis C

    • Chronic HCV:
      • Risk of progression varies (men, age>50, +HIV or HBV alcohol obese worse)
      • May take 20-30 years
      • 20% cirrhosis over 20 years is typical estimate
    • Histology: Indication of damage, requires biopsy
      • Predicts risk of progression
      • Up to recently: guidance to treatment (esp.genotype 1) for interferon-based regimens
      • Now: non-invasive assessments of fibrosis (FibroScan)
    • Biochemistry: May be normal, clinically may be silent

    Clinical Course of Un-Treated HCV

    • Progresses through different stages
    • May ultimately lead to cirrhosis and HCC

    Piecemeal Necrosis/Interface Inflammation

    • Shows inflammation blurring the sharp boundary between the portal tract and the liver parenchyma, with associated damage to liver cells
    • This is a prototypical pattern of chronic hepatitis, especially HBV and autoimmune hepatitis
    • Note that inflammation is often concentrated within the portal tract (center and bottom right)

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