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Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
Hepatic Infections
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Hepatic Infections

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  • 1. HEPATITIS B, HEPATITIS C AND HIV Jane Minton Consultant in Infectious Diseases & Tropical Medicine Leeds Teaching Hospitals Trust
  • 2. HEPATITIS B
    • HOW DO YOU GET IT?
    • WHAT ARE THE SYMPTOMS?
    • HOW DO YOU MAKE THE DIAGNOSIS?
    • CAN IT BE TREATED?
    • HOW CAN IT BE PREVENTED?
  • 3. HOW DO YOU GET HEPATITIS B?
    • EXPOSURE TO BODY FLUIDS
        • IVDA
        • NEEDLESTICKS ETC.
        • AMATEUR BODYPIERCING ETC.
        • BLOOD TRANSFUSION
        • SEX
        • PERINATAL
  • 4. WHAT ARE THE SYMPTOMS OF ACUTE HEPATITIS B?
    • FATIGUE AND MALAISE
    • NAUSEA AND VOMITING
    • FEVER
    • RUQ PAIN AND MYALGIA
    • JAUNDICE
  • 5. HOW DO YOU TEST FOR ACUTE HEPATITIS B?
    • LIVER FUNCTION TESTS
      • transaminases in 1000s
      • deranged blood coagulation
    • SEROLOGY
      • HBV Core IgM
      • HBV surface antigen
      • HBV e antigen
  • 6. HOW DO YOU TREAT ACUTE HEPATITIS B ?
    • SYMPTOMATIC
      • ANALGESIA
      • ANTIEMETICS
      • ANALGESIA
    • SUPPORTIVE
      • HYDRATION
      • NUTRITION
      • COAGULATION
      • (TRANSPLANTATION)
    • EDUCATION
      • TRANSMISSION
  • 7. WHAT ARE THE COMPLICATIONS OF CHRONIC HEPATITIS B?
    • CHRONIC LIVER DAMAGE
    • CIRRHOSIS
    • CANCER
    • TRANSMISSION TO OTHERS
  • 8. CAN YOU TREAT CHRONIC HEPATITIS B?
    • INTERFERON
    • LAMIVUDINE
    • LIVER TRANSPLANT
  • 9. PREVENTION OF HEPATITIS B
    • EDUCATION
      • SAFE SEX, NOT SHARING NEEDLES ETC
    • SCREENING
      • CASE CONTACTS
      • ANTENATAL
      • IVUs
    • VACCINES
      • ACTIVE (HBV sAg)
      • PASSIVE (HBIG)
    • PROVISION OF CLEAN NEEDLES ETC.
  • 10. Case History: Mr HB age 42
    • Unwell for 10 days: malaise, nausea, vomiting, abdo pain, dark urine & jaundice
    • Previously fit, no medication
    • Recently separated, has 2 sons age 8 &10
    • Girl friend for 4 months, pregnant
    • Fireman
    • Travel to Majorca last year
    • Alcohol 10U/week, non smoker & no other recreational drug use
  • 11. Mr HB
    • Examination: deeply jaundiced, enlarged tender liver
    • Investigations:
      • LFTs - acute hepatitis
      • Serology - acute hepatitis B
    • Treatment
      • symptomatic
      • follow-up
    • Public health issues
      • notifiable
      • screening +/- investigation of contacts
      • vaccination of non-immune contacts
  • 12. HEPATITIS C
    • HOW DO YOU GET IT?
    • WHAT ARE THE SYMPTOMS?
    • HOW DO YOU MAKE THE DIAGNOSIS?
    • CAN IT BE TREATED?
    • HOW CAN IT BE PREVENTED?
  • 13. HOW DO YOU GET HEPATITIS C?
    • BLOOB-BORNE
        • IVDA
        • NEEDLESTICKS ETC.
        • AMATEUR BODYPIERCING ETC.
        • BLOOD TRANSFUSION
    • [SEX]
    • [VERTICAL]
  • 14. WHAT HAPPENS WHEN YOU GET HEPATITIS C?
    • OFTEN ASYMPTOMATIC TO START WITH
    • MOST PEOPLE REMAIN INFECTED
    • [CHRONIC HEPATITIS C]
  • 15. WHAT ARE THE SYMPTOMS OF CHRONIC HEPATITIS C?
    • NOTHING
    • MALAISE AND FATIGUE
    • LIVER FAILURE
      • CIRRHOSIS
        • ASCITES
        • JAUNDICE
        • BLEEDING
        • ENCEPHALOPATHY
  • 16. WHAT ARE THE COMPLICATIONS OF CHRONIC HEPATITIS C?
    • CHRONIC LIVER DAMAGE
    • CIRRHOSIS
    • CANCER
    • TRANSMISSION TO OTHERS
  • 17. HOW DO YOU TEST FOR CHRONIC HEPATITIS C?
    • SEROLOGY [HCV ANTIBODIES]
    • LIVER FUNCTION TESTS
    • HCV PCR
    • ULTRASOUND OF LIVER
    • LIVER BIOPSY
  • 18. CAN YOU TREAT CHRONIC HEPATITIS C?
    • INTERFERON WITH RIBAVIRIN
    • LIVER TRANSPLANT
  • 19. THE PROBLEMS WITH INTERFERON
    • LOW SUCCESS RATE
    • SUBCUTANEOUS INJECTION
    • LONG COURSE OF TREATMENT
    • LOTS OF SIDE EFFECTS
      • ‘FLU-LIKE
      • BONE MARROW
      • DEPRESSION
    • THE COST
  • 20. PREVENTION OF HEPATITIS C
    • EDUCATION
      • NOT SHARING NEEDLES ETC, SAFE SEX
    • SCREENING
      • CASE CONTACTS
      • IVUs
    • VACCINES
      • NONE
    • PROVISION OF CLEAN NEEDLES ETC.
  • 21. CASE HISTORY: MR HC AGE 33
    • Registers with GP asking for detox.
    • Complains of tiredness first thing in morning
    • PMH: jaundice age 26
    • 10 year history IVU, has shared equipment in the past
    • Lives with partner (also IVU) who is pregnant
    • Alcohol rarely, smokes 15/day
    • No foreign travel
  • 22. MR HC
    • Examination normal except needle tracks
    • Investigations
      • HCV Ab positive [HBV past infection, HIV negative]
      • LFTs: ALT 121
      • HCV PCR positive
      • ultrasound of liver normal
      • liver biopsy: moderate hepatitis
    • Treatment
      • candidate for interferon plus ribavirin (NB drug use)
    • Public health issues
      • notifiable
      • screening +/- investigation of contacts
  • 23. HIV
    • HOW DO YOU GET IT?
    • WHAT ARE THE SYMPTOMS?
    • HOW DO YOU MAKE THE DIAGNOSIS?
    • HOW DO YOU TREAT IT?
    • HOW CAN IT BE PREVENTED?
  • 24. HOW DO YOU GET HIV?
    • EXPOSURE TO BODY FLUIDS
        • IVDA
        • NEEDLESTICKS ETC.
        • AMATEUR BODYPIERCING ETC.
        • BLOOD TRANSFUSION
        • SEX
        • PERINATAL
  • 25. WHAT ARE THE SYMPTOMS OF HIV?
    • NON-SPECIFIC ILLNESS (SEROCONVERSION)
    • NOTHING
    • OPPORTUNISTIC INFECTIONS EG:
      • ORAL THRUSH
      • RECURRENT SHINGLES
      • PNEUMONIA (PNEUMOCYSTIS)
      • HEADACHES (MENINGITIS)
      • DIARRHOEA (CRYPTOSPORIDIUM)
  • 26. WHAT DOES HIV DO?
    • INFECTS AND DESTROYS KEY CELLS IN IMMUNE SYSTEM
    • ESPECIALLY CD4+ OR HELPER T CELLS
    • MAY INFECT OTHER TISSUES EG NERVE CELLS
    • MAKES PATIENTS MORE SUSCEPTIBLE TO INFECTIONS
      • COMMON INFECTIONS
      • OPPORTUNISTIC INFECTIONS
  • 27. HOW DO YOU TEST FOR HIV?
    • SEROLOGY [HIV ANTIBODIES]
    • CD4 COUNT [HELPER T CELLS]
    • HIV PCR [VIRAL LOAD]
  • 28. HOW DO YOU TREAT HIV?
    • COMBINATION ANTIRETROVIRAL DRUGS
      • AT LEAST 3
      • MAJOR CLASSES
        • REVERSE TRANSCRIPTASE INHIBITORS
        • NON-NUCLEOTIDE RTIs
        • PROTEASE INHIBITORS
    • PROPHYLACTIC DRUGS EG FOR PCP
    • EDUCATION
    • NUTRITION
    • SUPPORT
  • 29. PREVENTION OF HIV
    • EDUCATION
      • SAFE SEX, NOT SHARING NEEDLES ETC
    • SCREENING
      • CASE CONTACTS, ANTENATAL, IVUs
    • PROVISION OF CLEAN NEEDLES ETC
    • POST-EXPOSURE PROPHYLAXIS
    • NO VACCINES
  • 30. CASE HISTORY: MS HI AGE 26
    • Premature delivery at 28 weeks
    • PMH: anaemia & UTIs in pregnancy
    • Drugs: iron
    • Student from Zimbabwe in UK for 6 months
    • 1 child from previous marriage
    • Current partner well
    • Alcohol 2u/week, non-smoker, no recreational drug use
    • Baby HIV antibody positive
  • 31. MS HI
    • Examination: oral thrush
    • Investigations
        • HIV antibody positive
        • CD4+ count 21 (normal 500+)
        • HIV viral load > 100,000 virus per ml blood
    • Treatment
        • 3 antiviral drugs & septrin
        • Support
    • Counselling/testing for partner

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