Hepatitis Dr. Meg-angela Christi M. Amores

Hepatitis Inflammation of the liver Acute Viral Hepatitis Toxic and Drug-induced Hepatitis Chronic Hepatitis

Acute Viral Hepatitis Almost all cases of acute viral hepatitis are caused by one of five viral agents: – hepatitis A virus (HAV) – hepatitis B virus (HBV) – hepatitis C virus (HCV) – HBV-associated delta agent or hepatitis D virus (HDV) – hepatitis E virus (HEV)

Hepatitis A Non-enveloped RNA virus in the hepatovirus genus of the picornavirus family Inactivation of viral activity can be achieved by boiling for 1 min, by contact with formaldehyde and chlorine, or by ultraviolet irradiation

Hepatitis A incubation period of ~4 weeks replication is limited to the liver viral shedding in feces, viremia, and infectivity diminish rapidly once jaundice becomes apparent

Hepatitis A diagnosis of hepatitis A is made during acute illness by demonstrating anti-HAV of the IgM class After acute illness, anti-HAV of the IgG class remains detectable indefinitely patients with serum anti-HAV are immune to reinfection

Hepatitis A

transmitted almost exclusively by the fecal- oral route Person-to-person spread of HAV is enhanced by poor personal hygiene and overcrowding contaminated food, water, milk, frozen raspberries and strawberries, green onions and shellfish Declining incidence in developed countries

Hepatitis B DNA virus hepadnaviruses (hepatotropic DNA viruses) Mode of transmission: – Percutaneous inoculation – intimate (especially sexual) contact and perinatal transmission – Oral ingestion - potential but inefficient route of exposure

Hepatitis B

Hepatitis C Linear, single stranded RNA Virus genus Hepacivirus in the family Flaviviridae Cell-mediated immune responses and elaboration by T cells of antiviral cytokines contribute to the containment of infection and pathogenesis of liver injury associated with hepatitis C

Hepatitis C Mode of transmission: – Percutaneous inoculation Transfusions other percutaneous routes, such as injection drug use occupational exposure to blood – studies have failed to identify sexual transmission – chances of sexual and perinatal transmission have been estimated to be ~5%

Symptoms and Signs occurs after an incubation period that varies incubation periods for: – hepatitis A range from 15–45 days – hepatitis B and D from 30–180 days – hepatitis C from 15–160 days – hepatitis E from 14–60 days

Symptoms and Signs Prodromal Phase symptoms: systemic, variable – anorexia, nausea and vomiting, fatigue, malaise, arthralgias, myalgias, headache, photophobia, pharyngitis, cough, and coryza may precede the onset of jaundice by 1–2 weeks – low-grade fever between 38° and 39°Cmore often present in hepatitis A and E than in hepatitis B or C – Dark urine and clay-colored stools 1-5 days before jaundice appears

Symptoms and signs clinical JAUNDICE phase liver becomes enlarged and tender right upper quadrant pain and discomfort

jaundice Yellow coloration of skin, sclera, palms visible in the sclera or skin when the serum bilirubin value is >43 mol/L (2.5 mg/dL) Bilirubin levels >340 mol/L (20 mg/dL) extending and persisting late into the course of viral hepatitis – severe disease

Symptoms and Signs Recovery phase – constitutional symptoms disappear – some liver enlargement and abnormalities in liver biochemical tests are still evident – Complete clinical and biochemical recovery is to be expected 1–2 months after all cases of hepatitis A and E and 3–4 months after the onset of jaundice in three-quarters of uncomplicated, self-limited cases of hepatitis B and C

Lab Features serum aminotransferases aspartate aminotransferase (AST) and ALT (previously designated SGOT and SGPT) – variable increase during the prodromal phase – does not correlate well with the degree of liver cell damage – Peak levels at time of clinical jaundice High bilirubin levels Serologic tests

Diagnosis

Treatment antiviral therapy – not recommended in all cases of Hep B – due to complete recovery acute hepatitis C, recovery is rare, progression to chronic hepatitis is the rule interferon monotherapy 24-week course (beginning within 2–3 months after onset) of the best regimen identified for the treatment of chronic hepatitis C

Treatment most cases of typical acute viral hepatitis, specific treatment generally is not necessary patients will feel better with restricted physical activity high-calorie diet is desirable Intravenous feeding when necessary

Prevention Hep A: – gloves should be worn when the bedpans or fecal material of patients Hep B and C: – blood precautions, i.e., avoiding direct, ungloved hand contact with blood and other body fluids hand washing Vaccination: Hep A, Hep B

Prognosis all previously healthy patients with hepatitis A recover completely hepatitis B, 95–99% of previously healthy adults have a favorable course and recover completely advanced age and with serious underlying medical disorders may have a prolonged course prolonged PT, low serum albumin level, hypoglycemia, and very high serum bilirubin values suggest severe hepatocellular disease