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Submitted by C.Nagaraju B.Pharm Under the Guidance of Mrs.Umarunnisha Abdulkader M.Pharm . Asst.Professor Saastra College of Pharmaceutical Education and Research,Nellore , Andrapradesh . HEPATITIS


Hepatitis Hepatitis is swelling and inflammation of the liver .




TYPES TYPES Acute Hepatitis : Short-term hepatitis. Body’s immune system clears the virus from the body within 6 months Chronic Hepatitis: Long-term hepatitis. Infection lasts longer than 6 months because the body’s immune system cannot clear the virus from the body


CAUSES Immune cells in the body attacking the liver and causing autoimmune Hepatitis Infections from viruses( such as Hepatitis A,B, or C) Liver damage from alcohol, poisonous mushrooms, or other poisons Over dose medications

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Healthy Liver Cirrhosis Liver

Hepatitis Types :

Hepatitis Types Alcoholic hepatitis Autoimmune hepatitis Drug-induced hepatitis Hepatitis A Hepatitis B Hepatitis C


SYMPTOMS Abdominal pain Breast development in males Dark urine and pale or clay-colored stools Fatigue Fever, usually low grade General itching

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Jaundice ( yellowing of skin or eyes) Loss of appetite Nausea and vomiting Weight loss

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Hepatitis A Virus

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Close personal contact (e.g., household contact, sex contact, child day care centers) Contaminated food, water (e.g., infected food handlers, raw shellfish) Blood exposure (rare) (e.g., injecting drug use, transfusion) Hepatitis A Virus Transmission

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Endemicity Disease Rate Peak Age of Infection Transmission Patterns High Low to High Early childhood Person to person; outbreaks uncommon Moderate High Late childhood/ young adults Person to person; food and waterborne outbreaks Low Low Young adults Person to person; food and waterborne outbreaks Very low Very low Adults Travelers; outbreaks uncommon Global Patterns of Hepatitis A Virus Transmission

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Vaccination Good hygiene Sanitation Hepatitis A Prevention Method

Hepatitis A:

Hepatitis A Diagnosis Blood test Detection of the HAV specific IGM antibody only present in the blood Initial one to two week’s up to 14 week’s

Treatment :

Treatment No medicine or treatment to make it go away Avoided a rest fatty food & alcohol Eat well – balanced diet DRUGS acetaminophan(anti pyretic) Metoclopramide (anti emetics)

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Hepatitis B Virus

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Incubation period: Average 60-90 days Range 45-180 days Clinical illness (jaundice): <5 yrs, <10% 5 yrs, 30%-50% Acute case-fatality rate: 0.5%-1% Chronic infection: <5 yrs, 30%-90% 5 yrs, 2%-10% Premature mortality from chronic liver disease: 15%-25% Hepatitis B - Clinical Features

Spectrum of Chronic Hepatitis B Diseases:

Spectrum of Chronic Hepatitis B Diseases 1.Chronic Persistent Hepatitis - asymptomatic 2.Chronic Active Hepatitis - symptomatic exacerbations of hepatitis 3.Cirrhosis of Liver 4.Hepatocellular Carcinoma

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High Moderate Low/Not Detectable blood semen urine serum vaginal fluid feces wound exudates saliva sweat tears breastmilk Concentration of Hepatitis B Virus in Various Body Fluids

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Sexual - sex workers and homosexuals are particular at risk. Parenteral - IVDA, Health Workers are at increased risk. Perinatal - Mothers who are HBeAg positive are much more likely to transmit to their offspring than those who are not. Perinatal transmission is the main means of transmission in high prevalence populations. Hepatitis B Virus Modes of Transmission


Diagnosis A battery of serological tests are used for the diagnosis of acute and chronic hepatitis B infection. HBsAg - used as a general marker of infection. HBsAb - used to document recovery and/or immunity to HBV infection. anti-HBc IgM - marker of acute infection. anti-HBcIgG - past or chronic infection.


Treatment Interferon - for HBeAg +ve carriers with chronic active hepatitis. Response rate is 30 to 40%. Lamivudine - a nucleoside analogue reverse transcriptase inhibitor. Well tolerated, most patients will respond favorably. However, tendency to relapse on cessation of treatment. Another problem is the rapid emergence of drug resistance. Successful response to treatment will result in the disappearance of HBsAg, HBV-DNA, and seroconversion to HBeAg.


Prevention Vaccination Hepatitis B Immunoglobulin Other measures

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Incubation period: Average 6-7 wks Range 2-26 wks Clinical illness (jaundice): 30-40% (20-30%) Chronic hepatitis: 70% Persistent infection: 85-100% Immunity: No protective antibody response identified Hepatitis C - Clinical Features

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Transfusion or transplant from infected donor Injecting drug use Hemodialysis (yrs on treatment) Accidental injuries with needles/sharps Sexual/household exposure to anti-HCV-positive contact Multiple sex partners Birth to HCV-infected mother Risk Factors Associated with Transmission of HCV

Laboratory Diagnosis:

Laboratory Diagnosis Serological test Liver function test


Treatment Interferon - may be considered for patients with chronic active hepatitis. The response rate is around 50% but 50% of responders will relapse upon withdrawal of treatment. Ribavirin - there is less experience with ribavirin than interferon. However, recent studies suggest that a combination of interferon and ribavirin is more effective than interferon alone.

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Screening of blood, organ, tissue donors Proper sterilization of equipments Sanitation Prevention of Hepatitis C

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