Acute Viral Hepatitis

Under Kind Guidance of Dr. (Prof.) G.G. Mansharamani Prep. By Dr. Rahul Arora

Liver

Liver (Gen. Information)

Largest organ of body-1-1.5 Kg, 1.52.5% 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, stellate celss, endothelial cells, blood vessels. Organized in lobules with portal areas at the periphery and central veins in centre

Liver Diseases
Classified as
Hepatocellular
(Viral hep, Alcoholic Hepatitis)

Cholestatic
(Obstructive)- Gall stone diseases, malig obstruction, Billiary cirrhosis)

Mixed

Clinical Manifestations
Fatigue- most characterisitic and most common symptom. Typically arises after activity or exercise Nausea, vomitings Right upper quadrant discomfort Itching can be there in later stages

Clinical Manifestations
Jaundice- hall mark of Liver disease Usually reported darkening of urine by the patients. Color of stool golden yellow Jaundice clinically detectable at bilirubin level of 2.5 mg/dl and above.

Clinical history
Food habits Sexual activeness Drug history Blood transfusions Alcohol intake

Physical Examination
Icterus Hepatomegaly with tenderness Palmar erythema Itching marks Fetor hepaticus (Later stages) Ascites, edema, hepatic failure (in fulminant hepatitis)

Jaundice

Caput medusae

Ascites with inverted umbilicus

Gynaecomastia

Spider Naevus/Angioma

Blood Investigations done

Liver function tests
Fractions- conjugated (30%) and unconjugated Uconjugated (increased in hemolysis and genetic disorders) Urine bilirubin (conjugated bilirubin) Blood ammonia levels

Investigations done
Serum enzymes Aminotransferases represent hepatocellular injury AST (Aspartate aminotrasferase), usually present in liver cardiac muscle, skeltal muscle, kidneys, brain, pancreas, lungs, leucocytes ALT (Alanine transferase), manly in liver

Investigations done
In acute Hepatitis, ALT higher than AST ratio >2:1 In alcoholic hepatitis ratio >3:1 Alkaline phosphotase, Glutamyl transpeptidase, 5 nuclitidase raised in cholestatic jaundice

Ultrasonography Urine bile salts and pigments Coagulation profile

Types of Viral Hepatitis Hepatitis A - enteric Hepatitis B - parenteral Hepatitis C - parenteral Delta hepatitis-parenteral Hepatitis E - enteric

Types of Viral Hepatitis

Generally causes are 5 types Of Hepatitis A,B,C,D,E. Other transfusion transmitted viruses identified- Hep.-G virus and TT virus All viruses RNA viruses except Hep. B- DNA virus

Viral Hepatitis A
RNA virus Most common cause of Hepatitis worldwide 30% of viral hepatitis caused by HAV in US Faeco-oral route of transmission Large outbreaks due to contamination of food and water.

Viral Hepatitis A
Incubation period- 1to 4 weeks. Diagnosis by anti HAV antibodies. May be silent (subclinical) Starts by mild fever, fatigue and few loose stools All cases resolve in 4-6 weeks No chronic hepatitis or cirrhosis seen Treatment- supportive

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%

Diagnosis of HBV
History- Blood transmission Viral markers
Acute IgM anti-HBc, HBeAg. HBsAg, HBV DNA Chronic- IgG antiHBc, HBeAg, anti HBe, HBsag, HBV DNA

Complications of Chronic HBV Infection Cirrhosis Decompensated liver disease Hepatocellular carcinoma Death

Treatment of HBV
Interferons Lamivudine Adefovir Entecavir Telbivudine Liver transplantation

Hepatitis C Virus
200 million carriers worldwide Incidence In US has decreased to 18000 cases per year $ million infected in US with HCV and 10,000 die each year of HCV related chr. Liver diseases HCV- frequent cause of hepatocellular carcinoma

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 resolution and 85% go into chronic HCV.HCC devlops in 1-2% of patients

Hepatitis C
Diagnosis by Anti HCV ab, HCV RNA Treatment
Interferons Ribavarin Liver transplantation

Hepatitis D
Small RNA virus Presents as coinfection with Hep. D Diagnosis by HDV RNA or HDV antigen Chronicity same as hepatitis B Mode of transmision- paraentral Treatment Interferons

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.

Thanks