Viral Hepatitis

Category: Entertainment

Presentation Description

No description available.


Presentation Transcript

Viral Hepatitis:

Viral Hepatitis

Viral Hepatitis:

Viral Hepatitis A  E (B – DNA) CMV / EBV / Herpes Simplex

Clinical Features:

Clinical Features Prodromal Few days to 2 weeks Fever, Headache, Myalgia, Arthralgia, Photophobia, Vomiting, Diarrhoea, Distaste for cigarretes Serum sickness like syndrome – Hepatitis B

Clinical Features:

Clinical Features Abdominal pain Jaundice Dark urine Hepatomegaly Splenomegaly Cervical Lymphadenopathy

Clinical Features:

Clinical Features Cholestatic phase  dark urine, paler stools,  jaundice, pruritis Recovery – prolonged in hepatitis B & C Relapse in Hepatitis A Chronic Liver Disease Chronic Hepatitis / Cirrhosis / HCC in Hepatitis B & C


Investigations WBC – Neutropenia, Lymphopenia, Relative lymphocytosis, atypical lymphocytes Urine – Bilirubinuria LFT Total Bilirubin (Conjugated + Unconjugated) AST, ALT (400 to 4000) ALP (< 2 times elevation) Prothrombin time (elevated) Serology


Complications Fulminant Hepatic Failure Relapsing hepatitis, Cholestatic Hepatitis Chronic Hepatitis Cirrhosis HCC Aplastic Anemia Renal Failure HSP PAN


Management Supportive Care Avoid sedatives, narcotics Avoid alcohol No specific dietary modifications Elective surgery should be avoided – risk of post operative liver failure

Hepatitis A:

Hepatitis A RNA virus Highly infectious Source – Patients who are Incubating Suffering from the disease Route Faeco – oral route

Hepatitis A:

Hepatitis A Serology Anti HAV IgM- Acute infection Anti HAV IgG Presence indicates immunity to HAV Past infection

Hepatitis A:

Hepatitis A Specific Features Acute Liver Failure 0.1 % Cholestatic phase with increased ALP (Adults) Relapsing hepatitis Serious / life threatening in patients with Chronic Liver Disease No carrier state / chronic infection

Hepatitis A:

Hepatitis A Prevention Boiling water – 10 minutes Immunization Active Inactivated vaccine, IM, 2 doses – 0 & 6 months ( ~ 20 years) Indication – Chronic Hepatitis B & C infection Travel to endemic area Passive Immune serum globulin , immediate protection

Hepatitis B:

Hepatitis B

Hepatitis B:

Hepatitis B Source – Humans are the only source Saliva, (Urine) Semen, Vaginal secretion Route Mother – Child Blood Sexual Injections / Tattoos / Acupuncture needles

Hepatitis B:

Hepatitis B Acute – 90% Chronic – 10% (90% with vertical transmission) Acute Failure - < 1%

Hepatitis B - Serology:

Hepatitis B - Serology HBsAg Active infection Chronic infection (> 6 months) HBeAg – Viral replication Anti HBeAg – Decreased viral replication HBV DNA – viral load (10 5 ) Anti HBsAg (3 to 6 months) Anti HBcAg – IgM, IgG

Hepatitis B:

Hepatitis B Chronic Hepatitis HBsAg > 6 months Anti HBC IgG HBeAg or Anti HBeAg

Prevention of Hepatitis B:

Prevention of Hepatitis B Most infectious HBeAg HBV DNA Least infectious Anti HBeAg Low level of virus Hepatitis B > Hepatitis C > HIV (10 times)

Prevention of Hepatitis B:

Prevention of Hepatitis B Active – 0, 1, 6, IM, deltoid Booster dose not routinely recommended Pregnancy is not a contraindication Passive Hepatitis B immunoglobulin (HBIg) Reduces frequency of clinical illness and not in preventing infection Within 24 hours / week

Prevention of Hepatitis B:

Prevention of Hepatitis B Vaccine and immunoglobulin given together in neonates born to Hepatitis B infected mothers

Management of Hepatitis B:

Management of Hepatitis B Acute Hepatitis – Supportive Management Chronic Hepatitis - Not possible to eradicate hepatitis B Alpha Interferon Lamivudine Adefovir Liver Transplantation

Indications for Alpha Interferon:

Indications for Alpha Interferon Low viral load and serum transaminase 33% lose eAg after 4 to 6 Response rates lower in HBeAg negative patients Contraindicated in Cirrhosis Rise in transaminase levels Precipitates Liver Failure


Lamivudine Nucleoside analogue Inhibits DNA polymerase and suppresses HBV – DNA levels Useful in improving liver function in decompensated cirrhosis and may prevent transplantation Complications Development of HBV – DNA polymerase mutants


Adefovir Nucleotide analogue Inhibits DNA polymerase Contraindicated in Renal Failure  less risk of mutants Treatment of Lamivudine induced mutants

Slide 25:

Liver Transplantation Combination drugs HIV + HBV

Hepatitis B course:

Hepatitis B course Acute liver failure – 1% Infection 90 to 95% recover 5 to 10% develop (6 months) chronic infection (recovery) Vertical Transmission, Downs, HIV Cirrhosis 15 to 20% over 5 to 20 years HBeAg + ve --- HCC HBV + HDV  Aggressive disease

Hepatitis D:

Hepatitis D Incomplete RNA virus IV drug abuse / sexual / Vertical Co-infection Superinfection Antidelta IgM Prevention – Prevent Hepatitis B

Hepatitis C:

Hepatitis C RNA Blood transfusion - commonest Other routes - rare Acute symptomatic infection – rare 80% develop chronic infection Chronic Liver Disease Males Immunosuppression (HIV coinfection) C 2 H 5 OH


Prevention Serology HCV RNA – 2 to 4 weeks after infection Anti HCV – 6 to 12 weeks No immunization available Genotypes – 6 No effect on progression Affects response to treatment

Management of Hepatitis C:

Management of Hepatitis C Aim – to eradicate infection Pegylated  - interferon (SC) + oral Ribovarin   Flu like symptoms Hemolytic Anemia Irritability Depression Cure – loss of virus from blood – 6 months after completing therapy Liver Transplantation

Hepatitis E:

Hepatitis E RNA virus Faecal – oral route Self limiting Acute Hepatitis Infection during pregnancy – Acute liver failure with high mortality No carrier / Chronic Liver Disease Anti HEV IgM No active / passive immunization

Drugs and the Liver:

Drugs and the Liver Acute and self limiting Chronic Liver Disease - rare


Patterns Cholestasis Chlorpromazine High dose eostrogens Cholestatic hepatitis NSAIDs Co-amoxiclav Statins Acute hepatitis INH, Rifampicin Non-alcoholic steatohepatitis Amiodarone Tetracycline, Sodium Valproate Venous outflow obstruction Busulfan / Azathioprine Fibrosis Methotrexate


Recovery Hepatic – LFTs – 2 months Cholestatic / Mixed – 6 months

Drugs to be avoided in Cirrhosis:

Drugs to be avoided in Cirrhosis NSAIDs ACE inhibitors Codeine Narcotics Anxiolytics

Slide 36:

Thank You

authorStream Live Help