- Hepatitis is a broad term that means inflammation of liver.
- It is most commonly caused by viruses but also be caused by drugs (alcohol), chemicals, autoimmune disease & metabolic abnormalities.
- Viral hepatitis
- Alcoholic hepatitis
- Autoimmune hepatitis
- Non-alcoholic steatohepatitis (NASH)
- Six types of hepatitis have been identified i.e. Hepatitis A,B,C,D,E,F.
- Hepatitis A is always an acute, short-term disease, while hepatitis B,C & D are most likely to become ongoing & chronic.
- Hepatitis E is usually acute but can be particularly dangerous in pregnant women.
- Hepatitis A & E viruses typically cause only acute or short term infections.
- Viral Hepatitis is major public health concern, 10 millions cases occur worldwide.
- It is nearly universal during childhood in developing countries.
- Worldwide 170 million people are infected with the Hepatitis C virus.
- Highly contagious liver infection caused by the Hepatitis A virus. this virus is a RNA virus of enterovirus family.
- It can cause acute hepatitis with jaundice also cause acute liver failure. it does not cause long term infection.
- The incubation period is 3-5 weeks with an average of 28 days.
- It is transmitted primarily through the faecal oral route.
- Source of infection is
- a)Crowded condition
- b)Poor personal hygiene
- c)Poor sanitation
- d)Contaminated food, water
- e)Subclinical infections
- Abdominal pain
- Weight loss
- Sharp pain of abdomen
- Blood tests → 2 kinds of antibodies to the virus. IgM antibodies & IgG antibodies.
- There are no drug therapies for the treatment of acute hepatitis A.
- Rest according to patient’s level of fatigue
- Small, frequent feedings of a high calorie, low fat diet, proteins are restricted.
- Vitamin K injection if PT is prolonged.
- Antiemetic drug.
- Hepatitis B virus can cause acute & chronic infection.
- Acute hepatitis BB infection may last up to 6 months & infected persons are able to pass these virus during these time.
- Incubation period 2-5 months.
- Hepatitis B virus is a complex structure with 3 distinct antigens.
1)HBc Ag →Hepatitis B core antigen
2)HBs Ag →Hepatitis B surface antigen.
3)HBe Ag →An independent protein circulating in the blood.
- Mode of transmission is mainly sexual contact recognised as STD. it is such more infectious than HIV.
- Further mode of transmission are parenteral/permucosal exposure to blood/blood products. perinatal transmission.
- Source of infection are contaminated needles, syringes, blood products, homosexual men, tattoo piercing with contaminated needles.
- Occurrence is for all ages, but mostly affects young adults worldwide.
- Abdominal pain
- Dark urine
- Joint pain
- Loss of appetite
- Blood tests :- AST, ALT, ALP, GGT, Serum proteins, Urinary bilirubin, Total serum bilirubin.
- Serological tests :- HBsAg, anti-HBs, HBe AG, Anti-Hbe, Anti-HBe IgM, Anti-Hbe IgG.
- Liver ultrasound
- Liver biopsy
- Fibro tests
- Treatment of acute hepatitis B is indicated only in patients with severe hepatitis & liver failure, rest, vitamin supplements.
- Hepatitis c virus is an RNA virus.
- Incubation period is 14-180 days (average 56)
- In most cases it is transmitted through blood/ blood products, prior to 1992. it is also transmitted through unprotected sex & contaminated or unsterile needles.
- It is found in I.V. drug users & renal dialysis patients.
- It can results in both acute & chronic illness.
- Chronic HCV infection results in liver cirrhosis.
- There is no vaccine for HCV.
- Hepatitis C antibody
- HCV genotyping
In a patient with acute hepatitis C, treatment with PEGylated interferon within the 12-24 weeks of infection reduce the development of chronic hepatitis C.
- Hepatitis D is a defective single- stranded RNA virus that can not survive on its own. it require hepatitis B to replicate.
- Incubation period is 2-26 weeks.
- Chronic carriers of HBV always at risk for transmission.
- Source of infection are same as HBV.
- HDV infection is only possible if a person is already infected with hepatitis B or a person can be infected with both viruses at the same time.
- HDV- antigen
- Hepatitis E virus (HEV) is an RNA virus & incubation period is 15-64 days.
- HEV has a faecal-oral transmission route.
- Source of infection is contaminated water, poor sanitation found in Asia, Africa & Mexico.
- More common in adults and severe in pregnant women.
- Hepatitis E usually resolves on its own within 4 to 6 weeks. treatment focuses on supportive core, rehydration & rest.
- Anti-HEV IgM & IgG
- HEV RNA quantification.
- There is no specific treatment capable of altering the course of acute hepatitis E.
- As the disease is usually self-limiting, hospitalization is generally not required. hospitalization is required for people with fulminant hepatitis.
- Hypothetical virus linked to hepatitis.
- An infection found in the far east.
- Consist of double stranded DNA.
- During an acute hepatitis, liver damage is mediated by cytotoxic Cytokines & NK cells.
- CK & cytokines causes lysis of infected hepatocytes it leads to cholestasis.
- Liver cells can regenerate after acute infection.
- Chronic viral infection causes chronic inflammation & causes fibrosis over decades.
- Abrosis can lead to cirrhosis.
- Dehydration, hypokalemia
- Chronic carrier hepatitis
- Cholestatic hepatitis
- Fulminant hepatitis
- Liver cirrhosis
- Hepatocellular carcinoma
- Hand washing
- Proper personal hygiene
- Environmental sanitation
- Acute immunization: HAV vaccine
- Use of immune globulin
- Hand washing
- Avoid sharing toothbrush & razers
- Active immunization: HBV vaccine
- Condoms use for sexual intercourse
- Reduce contact with blood
- Dispose of needle & syringes
- This is inflammatory condition of the liver caused by heavy alcohol consumption over an extended period of time.
- Diagnosis are CBC, liver function tests, ultrasound, CT scan, blood clotting tests, liver biopsy.
- Patients need to stop receive drinking…….