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    Viral Hepatitis 1

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    beherapankaj048

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    Viral Hepatitis 1

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    1 views29 pages

    Viral Hepatitis 1

    Uploaded by

    beherapankaj048

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 29

    VIRAL HEPATITIS

    BY: DR PANKAJ
    • Infection of hepatocytes Necrosis and inflammation of the liver

    • Causes of viral hepatitis


    Hepatitis caused by common Nonhepatotrophic viruses
    (hepatotropic) viruses

    Hepatitis A CMV
    Hepatitis B EBV
    Hepatitis C HSV
    Hepatitis D Yellow fever virus
    Hepatitis E Adenovirus
    (All except HBV are RNA viruses)
    Hepatitis A

    • RNA virus
    • MC type of viral hepatitis
    • Occurs in epidemics
    • Commonly affects children and young adults
    • Overcrowding and poor sanitation facilitates the spread
    • Source of infection: acutely infected persons
    • Mode of spread: fecal-oral route
    • Incubation period: 15-45 days ( 4 wk)
    Hepatitis E

    • RNA virus
    • Occurs primarily in young to middle aged adults
    • Source of infection : Zoonotic disease with animal reservoirs
    • Mode of transmission: Enterically transmitted, water brone infection ( contamination of water supplies)
    • IP: 5-6 wks
    Outcome of infection:
    • Clinically similar to hepatitis A ( self-limiting acute hepatitis)
    • High mortality rate among Pregnant women ( fulminant hepatitis)
    Prevention and control
    Good sanitation and hygiene
    vaccination
    CLINICAL FEATURES OF VIRAL HEPATITIS

    PREICTERIC ICTERIC CONVALESCENCE (RECOVERY)

     Lasts for 1-2 wks before the onset  Prodromal symptoms usually  Prodromal symptoms disappear
    of jaundice. diminish and appetite improves
     Prodromal symptoms:  Clinical jaundice  Jaundice decrease
    Anorexia/nausea/vomiting/ poor  Liver—enlarge and tender  Stool and urine become normal
    appetite/ fatigue/ malaise/headache.  Pruritus----due to bile salt  Liver size decrease
     Low grade fever reteintion  Complete biochemical recovery:
     Upper vague abdominal pain  Dark urine and pale stool hep A/E (1-2 months) and Hep B/C
     Dark urine (conjugated (3-4 months)
    hyperbilirubinemia)
     Clay colour stool
    INVESTIGATIONS

    Hematological: Leucopenia with relative lymphocytosis


    • Increase in prothrombin time (PT)---In cases of extensive hepatocellular damage
    LFT:
    • Aminotranferases (AST, ALT): Raised and max level observed during prodromal phase (400-4000)
    • Bilirubin: Both conjugated and unconjugated equally raised
    • Alkaline phosphatase: may be raised but less than 2 times the normal
    • Blood sugar: may be low
    URINE: Increased urinary urobilinogen
    SEROLOGICAL MARKERS

    • IgM anti-HAV----acute infection


    • IgG anti HAV---Recovery phage and immunity phase ( provides lifelong immunity)
    • Raised AST and ALT
    TREATMENT AND PREVENTION

    • Supportive symptomatic management


    • No specific treatment
    • Active immunization: HAV vaccine
    • Passive immunization: Immunoglobulins ( exposure to HAV is < 2 wk) and can protect
    from HAV infection for 3 Months
    HEPATITIS B
    What Are The Hepatitis B Virus (HBV) Antigens And Antibodies?
    1.Dane particle (Virion) has a double-shell structure containing several antigens (antigenic
    material).
    1. The outer envelope is called a surface antigen (HBsAg), the Australian antigen.
    2. The inner core contains HBV-core antigen (HBcAg), and HBV-e antigen (HBeAg).
    3. Within the core is double-stranded DNA (double-stranded viral deoxyribonucleic
    acid).
    4. There is an enzyme called DNA polymerase.
    2.There are three antigens:
    1. HBsAg
    2. HBcAg
    3. HBeAg
    3.There are three Antibodies:
    1. Anti-HBsAb
    2. Anti-HBcAb
    3. Anti-HBeAb
    How will you discuss Chronic viral hepatitis due to HBV or (Chronic carrier)?
    1.Chronic hepatitis is defined when >6 months surface antigen (HBsAg) is present with
    normal liver function tests and normal microscopic findings on the liver biopsy.
    2.2 to 10 % develop chronic disease.
    3.Chronic hepatitis is divided into:
    1. Chronic persistent hepatitis where abnormal liver function tests, relatively normal
    microscopic findings on liver biopsy. This condition is seen in 6% of the patients.
    2. Chronic active hepatitis where abnormal liver function tests and abnormal microscopic
    findings on liver biopsy. This condition may be seen in 3% of the patients.
    4.These patients may develop cirrhosis.
    5.Cirrhotic patients have more chances of cancer, which almost increased 500 times.
    6.Lab findings are:
    1. HBsAg positive.
    2. HbcAb-IgG (Total) is positive.
    7.HBeAg positive indicates a highly infective stage and poor prognosis
    How Will You Treat The Hepatitis B Virus (HBV)?
     In the case of fulminant hepatitis, liver transplantation is needed.
     Treatment of chronic HBV infection is indicated when HBV-DNA
    >2000 IU/L and serum SGPT is raised.
     Antiviral medications are Lamivudine (Epivir), Adefovir (Hepsera),
    Telbivudine (Tyzeka), and Entecavir (Baraclude).
     Interferon alpha-2 is used mainly for young patient
    How will you diagnose the Hepatitis C Virus (HCV)?
    1.Interpretation of HCV profile:
    2.Acute infection = Anti-HCV antibody will be positive and quantitative HCV RNA
    3.Clinical features of chronic HCV infection
    •Usually asymptomatic. Positive HCV-Ab indicates present or past
    infection
    Laboratory workup
    1.Anti-HCV is positive
    2.PCR positive
    3.HBs-antigen is negative Test Normal Early Acute Chronic Carrier Recovery
    4.HAV-IgM is negative infection

    Anti- Negativ Negative Positive Positive Positive Positive


    HCV e

    PCR Negativ Positive Positive Positive Positive Negative


    e
    What Are The Complications Of Hepatitis C Virus (HCV) Infection?
    1.Fulminant hepatitis is seen in 1% to 2% of the patients.
    2.Cirrhosis is seen in 5% of the cases.
    3.Liver failure.
    4.Liver cancer risk is 15%.
    5.HCV infection is unlike HBV because this gives rise to more than 60% as a
    chronic disease.
    (some references say chronicity is from 50% to 80%)

    How Will You Prevent The Spread Of The Hepatitis C Virus


    (HCV)?
    •There is no vaccination available for HCV.
    •Proper testing of the blood donors for transfusion for HCV has
    decreased the incidence.
    HEPATITIS
    • Dliver caused by the hepatitis D virus (HDV), which requires HBV
    Hepatitis D is an inflammation of the
    for its replication.
    • Hepatitis D infection cannot occur in the absence of hepatitis B virus.
    • HDV-HBV co-infection is considered the most severe form of chronic viral hepatitis due to more rapid
    progression towards hepatocellular carcinoma and liver-related death.

    •Hepatitis D infection can be prevented by hepatitis B immunization, but treatment success rates are low.

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