acute viral hepatitis 27.06

8/6/2019 Acute Viral Hepatitis 27.06

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Acute Viral Hepatitis

Under Kind Guidance of

Dr. (Prof.) G.G. MansharamaniPrep. By Dr. Rahul Arora


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Liver


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Liver (Gen. Information)

Largest organ of body-1-1.5 Kg, 1.5-2.5% of body mass

Recieves dual blood supply-20%From Hepatic artery (O2 rich) and

80% (nutrient rich) from portal vein Majority of Cells- Hepatocytes,

remaining-Kupferr cells, stellatecelss, endothelial cells, bloodvessels.

Organized in lobules with portalareas at the periphery and centralveins in centre


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Liver Diseases

Classified as

Hepatocellular

(Viral hep, Alcoholic Hepatitis)

Cholestatic (Obstructive)- Gall stone diseases, malig

obstruction, Billiary cirrhosis)

Mixed


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Clinical Manifestations

Fatigue- most characterisiticand most common symptom.Typically arises after activity or

exercise Nausea, vomitings

Right upper quadrant discomfort

Itching can be there in laterstages


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Clinical Manifestations

Jaundice- hall mark ofLiverdisease

Usually reported darkening of

urine by the patients.

Color of stool golden yellow

Jaundice clinically detectable

at bilirubin level of 2.5 mg/dland above.


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Clinical history

Food habits

Sexual activeness

Drug history

Blood transfusions

Alcohol intake


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Physical Examination

Icterus

Hepatomegaly with tenderness

Palmar erythema

Itching marks

Fetor hepaticus (Later stages)

Ascites, edema, hepatic failure(in fulminant hepatitis)


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Jaundice


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Caput medusae


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Ascites with inverted

umbilicus


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Gynaecomastia


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Spider Naevus/Angioma


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Blood Investigations done

Liver function tests

Fractions- conjugated (30%) andunconjugated

Uconjugated (increased inhemolysis and genetic disorders)

Urine bilirubin (conjugatedbilirubin)

Blood ammonia levels


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Investigations done

Serum enzymes

Aminotransferases representhepatocellular injury

AST (Aspartate aminotrasferase),usually present in liver cardiacmuscle, skeltal muscle, kidneys,brain, pancreas, lungs, leucocytes

ALT (Alanine transferase), manly inliver


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Investigations done

In acute Hepatitis, ALT higher thanAST ratio >2:1

In alcoholic hepatitis ratio >3:1

Alkaline phosphotase, Glutamyltranspeptidase, 5 nuclitidaseraised in cholestatic jaundice

Ultrasonography

Urine bile salts and pigments

Coagulation profile


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Types of Viral Hepatitis

Hepatitis A - enteric

Hepatitis B - parenteral

Hepatitis C - parenteral

Delta hepatitis-parenteral

Hepatitis E - enteric


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Types of Viral Hepatitis

Generally causes are 5 types OfHepatitis A,B,C,D,E.

Other transfusion transmitted

viruses identified- Hep.-G virusand TT virus

All viruses RNA viruses except

Hep. B- DNA virus


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Viral Hepatitis A

RNA virus Most common cause of Hepatitis

worldwide

30% of viral hepatitis caused byHAV in US

Faeco-oral route of transmission

Large outbreaks due tocontamination of food and water.


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Viral Hepatitis A

Incubation period- 1to 4 weeks.

Diagnosis by anti HAV antibodies.

May be silent (subclinical) Starts by

mild fever, fatigue and few loosestools

All cases resolve in 4-6 weeks

No chronic hepatitis or cirrhosisseen

Treatment- supportive


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Viral Hepatitis B

DNA virus

Incubation period- 30-180 days.

Blood Transmission Blood tansfusion,

syringes, drug abusers;Vertical, Sexual,Body secretions

About 300-350 million chronic carriers

worldwide. 75% of all cases occur in Asia.

An estimated 40 million carriers are in

India, Incidence -3-4%


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Diagnosis of HBV

History- Blood transmission

Viral markers

Acute IgM anti-HBc, HBeAg.HBsAg, HBV DNA

Chronic- IgG antiHBc, HBeAg, antiHBe, HBsag, HBV DNA


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Complications of Chronic HBV

Infection

Cirrhosis

Decompensated liver disease

Hepatocellular carcinoma

Death


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Treatment of HBV

Interferons

Lamivudine

Adefovir

Entecavir

Telbivudine

Liver transplantation


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Hepatitis C Virus

200 million carriers worldwide

Incidence In US has decreasedto 18000 cases per year

$ million infected in US withHCV and 10,000 die each yearof HCV related chr. Liverdiseases

HCV- frequent cause ofhepatocellular carcinoma


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Hepatitis C Virus

Mode of transmission paraenteraly, vertical and sexual

Clinical features Symptoms vary

from mild to fulminant hepatic failure Incubation period 15-150 days

15% have spontaneous resolutionand 85% go into chronic HCV.HCC

devlops in 1-2% of patients


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Hepatitis C

Diagnosis by Anti HCV ab, HCVRNA

Treatment

Interferons

Ribavarin

Liver transplantation


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Hepatitis D Small RNA virus

Presents as coinfection withHep. D

Diagnosis by HDV RNA or HDVantigen

Chronicity same as hepatitis B

Mode of transmision- paraentral

Treatment Interferons


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Hapatitis E

RNA virus

Most commonly seen in India

Feco-oral mode of transmission,

causes epidemics No chronic infection with Hep. E

No prophylaxis known

Treatment is supportive. High fatality in pregnant

women.


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acute viral hepatitis 27.06

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