Hepatitis Etiology, Symptoms and Treatments

Hepatitis Etiology, Symptoms and Treatments

  • 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.

Hepatitis Etiology

  1. Viral hepatitis
  2. Alcoholic hepatitis
  3. Autoimmune hepatitis
  4. Non-alcoholic steatohepatitis (NASH)

Viral hepatitis

  • 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.

 Hepatitis-A

  • 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

Hepatitis Symptoms

  • Fatigue
  • Fever
  • Abdominal pain
  • Nausea
  • Jaundice
  • Weight loss
  • Itching
  • Anorexia
  • Sharp pain of abdomen

Hepatitis Diagnosis

  • Blood tests → 2 kinds of antibodies to the virus. IgM antibodies & IgG antibodies.

Management

  • There are no drug therapies for the treatment of acute hepatitis A.
  • Rest according to patient’s level of fatigue
  • Hospitalization
  • Small, frequent feedings of a high calorie, low fat diet, proteins are restricted.
  • Vitamin K injection if PT is prolonged.
  • Antiemetic drug.

Hepatitis-B

  • 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.

Hepatitis Symptoms

  • Abdominal pain
  • Dark urine
  • Fever
  • Joint pain
  • Loss of appetite
  • Nausea/Vomiting
  • Fatigue
  • Jaundice

Hepatitis Diagnosis

  • 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

Management 

  • Treatment of acute hepatitis B is indicated only in patients with severe hepatitis & liver failure, rest, vitamin supplements.

Hepatitis-C

  • 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.

Diagnosis

  • Hepatitis C antibody
  • HCV genotyping

Management

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

  • 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.

Diagnosis

  • Anti-HDV
  • HDV- antigen

Treatment

  • Interferon

Hepatitis-E

  • 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.

Diagnosis

  • Anti-HEV IgM & IgG
  • HEV RNA quantification.

Treatment

  • 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.

Hepatitis-F

  • Hypothetical virus linked to hepatitis.
  • An infection found in the far east.
  • Consist of double stranded DNA.

Hepatitis Pathophysiology

  • 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.

Complications

  • Dehydration, hypokalemia
  • Chronic carrier hepatitis
  • Cholestatic hepatitis
  • Fulminant hepatitis
  • Liver cirrhosis
  • Hepatocellular carcinoma

Hepatitis Precautions

1)Hepatitis A

  • Hand washing
  • Proper personal hygiene
  • Environmental sanitation
  • Acute immunization: HAV vaccine
  • Use of immune globulin

2)Hepatitis B&C

  • Hand washing
  • Avoid sharing toothbrush & razers
  • Active immunization: HBV vaccine
  • Condoms use for sexual intercourse
  • Reduce contact with blood
  • Dispose of needle & syringes

Alcoholic Hepatitis

  • 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…….
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