Paeds Vivas · gastroenterology-hepatology-and-nutrition
Viral, autoimmune and metabolic hepatitis — branching viva
Branching viva from the aetiological classification of paediatric hepatitis through the faecal-oral acute viruses, the perinatally infected hepatitis B child and the immune-tolerant phase, the curable hepatitis C, the adolescent with autoimmune hepatitis and the simplified score, and the child with acute liver failure and Coombs-negative haemolysis who is a Wilson disease transplant emergency.
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Study tools
Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the paediatric registrar in a hepatology clinic. The consultant asks you to talk through five children referred with hepatitis: a school-age child with jaundice after overseas travel, a perinatally infected boy with a high viral load and normal transaminases, an adolescent cured of hepatitis C, a girl with fatigue and a positive antinuclear antibody, and a child in acute liver failure with a Coombs-negative haemolytic anaemia.
Station opening
Examiner: "Classify paediatric hepatitis and outline how the cause sets the management." [1]
Strong candidate (must-hit)
- Classifies paediatric hepatitis into viral, autoimmune and metabolic causes, and by the acute-versus-chronic split: hepatitis A and E are faecal-oral and acute-only, hepatitis B, C and D are parenteral and perinatal and become chronic, autoimmune hepatitis is a chronic loss of tolerance, and the metabolic diseases Wilson and alpha-1-antitrypsin deficiency are chronic; frames the management as supportive care for the acute viral causes, phase-based antiviral suppression for chronic hepatitis B, direct-acting antiviral cure for hepatitis C, immunosuppression for autoimmune hepatitis, and chelation or transplant for the metabolic diseases. [1] [2]
Weak candidate
- "Hepatitis is a liver infection; I would test the liver function and refer to gastroenterology." [1]
References6ShowHide
- [1]Abutaleb A; Kottilil S; Wilson E Hepatitis A: Epidemiology, Natural History, Unusual Clinical Manifestations, and Prevention. Gastroenterol Clin North Am, 2020.PMID 32389358
- [2]Indolfi G; Gramenzi A; Degasperi E; Lorini FL; De Santis A; Saccardi F Hepatitis B virus infection in children and adolescents. Lancet Gastroenterol Hepatol, 2019.PMID 30982722
- [3]Terrault NA; Lok ASF; McMahon BJ; Chang KM; Hwang JP; Jonas MM Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology, 2018.PMID 29405329
- [6]Indolfi G; Hierro L; Debray D; D'Antiga L; Nossova N; Arenas JI Direct-acting antivirals for children and adolescents with chronic hepatitis C. Lancet Child Adolesc Health, 2018.PMID 30169301
- [8]Mieli-Vergani G; Vergani D; Baumann U; Czubkowski P; Debray D; Dezsofi A Diagnosis and Management of Pediatric Autoimmune Liver Disease: ESPGHAN Hepatology Committee Position Paper. J Pediatr Gastroenterol Nutr, 2018.PMID 29356770
- [11]Schilsky ML; Roberts EA; Ala A; Allen KR; Almeida MP; Anand MK A multidisciplinary approach to the diagnosis and management of Wilson disease: 2022 Practice Guidance from the American Association for the Study of Liver Diseases. Hepatology, 2025.PMID 36151586