PanchajaniR HEPATITIS Means inflammation of liver It is most commonly caused by viruses but also be caused by drugsalcohol chemicals autoimmune diseases and metabolic abnormalities Aetiology ID: 999162
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1. HEPATITISPrepared by Dr. Panchajani.R
2. HEPATITIS Means inflammation of liver. It is most commonly caused by viruses but also be caused by drugs(alcohol), chemicals, autoimmune diseases and metabolic abnormalities. Aetiology of hepatitis ;- Viral hepatitis ,Alcoholic hepatitis ,Autoimmune hepatitis ,Non- alcoholic steatohepatitis(NASH
3. Symptoms of hepatitis Dark urineAbdominal painYellowing of skin or eyesPale or clay-colored stoolLow-grade feverLoss of appetiteFatigueNausea , vomiting
4. VIRAL HEPATITIS Five types of hepatitis have been identified: Hepatitis A, B, C, D , E. Hepatitis A is always an acute, short-term disease, while hepatitis B, C, and D are most likely to become ongoing and chronic. Hepatitis E is usually acute but can be particularly dangerous in pregnant women. The hepatitis A and E viruses typically cause only acute, or short-term, infections.
5. Viral hepatitis Other less common viruses can also cause liver disease. These include Cytomegalovirus(CMV), Herpes virus, Rubella virus, Epstein-barr virus(EBV
6. Viral hepatitisViral hepatitis is a major world health problem. In addition to the well-recognised acute and chronic liver diseases produced by hepatitis A, B and C, other hepatitis viruses have been isolated, including hepatitis D, which is usually detected only in patients with hepatitis B virus (HBV) infection, and hepatitis E, which produces a self-limiting hepatitis due to faeco-oral spread similar to hepatitis A
7. Risk factors for viral hepatitis, including hepatitis B virusSubstance abuse (injection drug use, snorting cocaine)· High-risk sexual activities (eg, rectal intercourse)· Multiple sexual partners· A sexual partner with viral hepatitis· Persons coming from or travelling to high-risk hepatitis endemic areas or exposure to a local outbreak· Household contact or sharing of personal items with an infected person· Attendance at daycares· History of a transfusion-dependent illness· Needle-stick injury or other occupational exposure (eg, nonimmune health care workers)· Newborns of infected mothers· Tattoos and/or body piercing using nonsterile techniques
8. Hepatitis AHepatitis A presents with anorexia, weakness and general malaise for several weeks prior to the development of clinical jaundice, often accompanied by tenderness on palpation of an enlarged liver. The condition is spread by the faeco-oral route and often spreads rapidly in closed communities. Incubation period is 3-5 weeks with an average of 28 daysLiver function tests will be compatible with an acute hepatitis, with elevation of bilirubin and transaminases.
9. Hepatitis ADiagnosis is confirmed by the antibody titre to hepatitis 2 kinds of antibodies to the virus. IgM antibodies and IgG antibodies. IgM antibodies show acute infection. IgG antibodies show previous infection or immunization. The condition is always self-resolving, although rarely the viral hepatitis can lead to fulminant liver failure. Once the clinical condition resolves, the liver tends to recover fully, with no functional deficit and no long-term sequelae.
10. MANAGEMENT -HAThere are no drug therapies for the treatment of acute hepatitis A. Rest &Hospitalization. a high calorie, low fat diet, proteins are restricted. Vit K injection if PT is prolonged. I.V. fluid and electrolyte replacement
11. HEPATITIS BIncubation period is 2-5 months. Hepatitis B virus is a complex structure with 3 distinct antigens: 1. HBcAg- Hepatitis B core antigen. 2. HBsAg- Hepatitis B surface antigen. 3. HBeAg- An independent protein circulating in the blood.
12. HEPATITIS BHepatitis B virus can cause acute and chronic infection.Mode of transmission is mainly sexual contact. Recognized as STD. It is much more infectious than HIV.Further mode of transmission are Parenteral or permuscosal exposure to blood or blood products, perinatal transmission. Sources of infection are Contaminated needles, syringes, blood products. Homosexual men, Tattoo or body piercing with contaminated needles. Occurrence is for all ages, but mostly affects young adults worldwide. It is the main cause of cirrhosis and hepato cellular carcinoma .
13. Hepatitis BHepatitis B is a more serious condition in most respects than hepatitis A. Although it can also produce an acute self resolving hepatitis, the virus is often not cleared and produces chronic hepatitis B causing long-term liver damage, with the development of liver cirrhosis and hepatocellular carcinoma.Therefore, patients may present acutely with malaise, anorexia, abdominal pain and clinical jaundice due to active hepatitis, or at a late stage owing to the complications of cirrhosis, most commonly ascites or variceal bleeding
14. Hapatitis BBlood tests: AST, ALT, ALP,GGT, Serum proteins, PT, Urinary bilirubin, Urinary Urobilinogen, Total serum bilirubin. Serological tests: HBsAg, Anti-HBs, HBeAg, Anti- HBe,Anti-HBe IgM, Anti- Hbe IgG, HBV genotyping. Liver ultrasound: Transient elastography can show the amount of liver damage Liver biopsy.
15. HBsAgHBsAg (Hepatitis B surface antigen) - A "positive" or "reactive" HBsAg test result means that the person is infected with hepatitis B. This test can detect the actual presence of the hepatitis B virus (called the “surface antigen”) in your blood. If a person tests “positive,” then further testing is needed to determine if this is a new “acute” infection or a “chronic” hepatitis B infection. A positive HBsAg test result means that you are infected and can spread the hepatitis B virus to others through your blood.
16. Anti HBsor HBsAbAnti-HBs or HBsAb (Hepatitis B surface antibody) - A "positive" or "reactive" anti-HBs (or HBsAb) test result indicates that a person is protected against the hepatitis B virus. This protection can be the result of receiving the hepatitis B vaccine or successfully recovering from a past hepatitis B infection. This test is not routinely included in blood bank screenings. A positive anti-HBs (or HBsAb) test result means you are “immune” and protected against the hepatitis B virus and cannot be infected. You are not infected and cannot spread hepatitis B to others
17. Anti-HBc or HBcAbAnti-HBc or HBcAb (Hepatitis B core antibody) – A "positive" or "reactive" anti-HBc (or HBcAb) test result indicates a past or current hepatitis B infection. The core antibody does not provide any protection against the hepatitis B virus (unlike the surface antibody described above). This test can only be fully understood by knowing the results of the first two tests (HBsAg and anti-HBs).
18. TreatmentTreatment for acute hepatitis is antivirals and supportive. In patients with cirrhosis, treatment is initially dictated by the specific complication at presentation ( Treatment of ascites in chronic liver disease).In established cirrhosis, liver transplantation may be considered if viral eradication or suppression can be achieved with anti-viral agents (e.g. lamivudine). Without viral suppression, death from re infection of the transplanted liver is common.
19. Hepatitis BThe hepatitis virus greatly increases the risk of primary liver cancer, which usually appears at the stage when the liver parenchyma has become cirrhotic. The assessment and management of HBV cirrhosis with hepatocellular carcinoma (HCC)
20. Hepatitis CHepatitis C has become one of the most common causes of chronic liver disease worldwide. In many countries, a large percentage of the population has been exposed; 1 per cent of potential blood donors worldwide are hepatitis C virus (HCV)positive. Transmission is often related back to blood transfusion ,and routine screening of blood for HCV has only recently been introduced in many countries. Chronic HCV infection is an important health problem because currently there is no vaccine available to prevent the disease and current anti-viral treatment has limitations.
21. Hepatitis DHepatitis D or Delta Hepatitis HDV is a defective single – stranded RNA virus that can not survive on its own. It requires 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
22. HEPATITIS E Hepatitis E virus(HEV) is an RNA virus and incubation period is 15-64 days. HEV has a fecal-oral transmission route. Source of infection is contaminated water, poor sanitation. More common in adults and severe in pregnant women. Hepatitis E usually resolves on its own within four to six weeks. Diagnosis ;- Anti-HEV IgM and IgG. Treatment :- usually self resolving , focuses on supportive care, rehydration and rest.
23. Alcoholic hepatitisAlcoholic hepatitis is a diseased, 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 needs to stop receive drinking.
24. Non-alcoholic steatohepatitis(NASH)Non-alcoholic steatohepatitis(NASH) is a part of Non-alcoholic fatty liver disease(NAFLD). NAFLD is condition where fat builds up in liver not due to alcohol consumption. NASH is the inflammation and liver cell damage along with fat in liver. NASH is a serious condition that results in cirrhosis, hepatocellular cancer, liver failure.
25. NASHRisk factors for NAFLD are obesity, DM, HTN, Hyperlipidemia. In Clinical findings Elevated liver enzymes, liver biopsy, liver scan ,CT scan, ultrasound. There is no definitive treatment and therapy is directed at reduction of risk factors. Treatment of diabetes, weight reduction and management of Hyperlipidemia