This power point presentation includes basic clinical principals in hepatitis and this is mainly describe about viral hepatitis.

1. Hepatitis
Harindu Udapitiya,
Temporary Lecturer,
Division Of Pharmacology

2. Overview….
1. What is hepatitis
2. Causes
3. Viral hepatitis
3.1. General viral Hepatology
• phases
• Symptoms
• Signs

3. 3.2. Specific viral Hepatology
Hepatitis A-E
- Incubation period
- Transmission
- Investigation
- Treatments

4. 1.What is Hepatitis?
• Inflammation of the liver
characterized by patchy or
diffuse necrosis.

5. 2.Causes

6. 1. Hepatitis virus
2. Alcohol
3. Drugs and toxines- paracetamol,
methyldopa,isoniazid
4. Autoimmune
5. Hereditary- Wilson’s disease, haemochromatosis
6. Other viruses-IMN, CMV
7. Some systemic diseases-IBD

7. 3.Viral hepatitis
• Hepatitis virus A-E
• Can be classified as,
1. Acute
2. Chronic-is defined as
any hepatitis
lasting for 6 months
or longer

8. 3.1. General Viral hepatology

9. Symptoms
• The clinical presentation of infectious hepatitis varies with the
individual, as well as with the specific causative virus.
• The classic presentation of acute infectious hepatitis involves 4
phases.

10. 1. Phase 1 (viral replication phase) – Patients are asymptomatic
during this phase; laboratory studies demonstrate serologic
and enzyme markers of hepatitis
2. Phase 2 (prodromal phase)-
– Anorexia
– Ausea
– Vomiting
– alterations in taste
– arthralgias,
– malaise, fatigue
– urticaria

11. 3. Phase 3 (icteric phase)-
• Yellowish discoloration of eyes
• Dark urine
• RHC pain
4. Phase 4 (convalescent phase) – Symptoms and icterus
resolve, and liver enzymes return to normal

12. Signs
• Physical findings in patients with hepatitis vary with
the type of hepatitis and the time of presentation.
• General Ex-
– Ill looking
– Febrile to touch
– Signs of dehydration
– Icterus
– Cervical lymphadenopathy
– urticarial rashes

13. CVS Ex
– Tachycardia
Abdominal
– RHC tenderness
– Tender hepatomegaly
– Splenomegaly

14. 3.2. Specific Viral hepatology

15. Source of
virus
feces blood/
blood-derived
body fluids
blood/
blood-derived
body fluids
blood/
blood-derived
body fluids
feces
Route of
transmission
fecal-oral percutaneous
permucosal
percutaneous
permucosal
percutaneous
permucosal
fecal-oral
Chronic
infection
no yes yes yes no
Prevention pre/post-exposure
immunization
pre/post-exposure
immunization
blood donor
screening;
risk behavior
modification
pre/post-exposure
immunization;
risk behavior
modification
ensure safe
drinking
water
Type of Hepatitis
A B C D E

16. Hepatitis A
 Incubation period: Average 30 days
Range 15-50 days
 Complications: Fulminant hepatitis
Cholestatic hepatitis
Relapsing hepatitis
Post hepatic syndrome
 Chronic sequelae: None

17. Laboratory Diagnosis
 Acute infection is diagnosed by the detection of
HAV-IgM in serum.
 Past Infection i.e. immunity is determined by the
detection of HAV-IgG.
 Cell culture – difficult and take up to 4 weeks, not
routinely performed
 Direct Detection – EM, RT-PCR of faeces. Can detect
illness earlier than serology but rarely performed

18. Treatment
No specific Tx.
-Bed rest
-Symptomatic Rx
Fever-Antipyretics
Vomiting-Antiemetics
Pruritus-colestyramine

19. Prevention
 Pre-exposure
travelers to intermediate and high HAV-endemic
regions
 Post-exposure (within 14 days)
• Routine
-household and other intimate contacts
• Selected situations
-institutions (e.g., day care centers)
-common source exposure (e.g., food prepared by
infected food handler)

20. Hepatitis B
 Incubation period: Average 60-90 days
Range 45-180 days
 Spectrum
– Chronic Persistent Hepatitis - asymptomatic
– Chronic Active Hepatitis - symptomatic exacerbations of
hepatitis
– Cirrhosis of Liver
– Hepatocellular Carcinoma

21. Laboratory Diagnosis
• 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-HBc IgG - past or chronic infection.
• HBeAg - indicates active replication of virus and
therefore infectiveness.
• Anti-Hbe - virus no longer replicating. However, the
patient can still be positive for HBsAg which is made by
integrated HBV.
• HBV-DNA - indicates active replication of virus, more
accurate than HBeAg especially in cases of escape
mutants. Used mainly for monitoring response to therapy

22. Treatment
• 1. Symptomatic
• 2. Antivirals
– Indications
• HBeAg +ve carriers with chronic active hepatitis
• Decompensated cirhosis
• Detection of HBV DNA by PCR
– Drugs
• alpha-interferon
• Lamivudine
• Adefovir
• Entecavir

23. Prevention
• Active immunization
– Recombinant HbsAg vaccine
– For individuals at risk and for neonates
• Passive immunization
– Hep B immunoglogulines
– Following acute post exposure and neonates who
born to hep B + mothers.
• Other measures
– - screening of blood donors, blood and body fluid
precautions.

24. Hepatitis C
Incubation period: Average 6-7
wks
Range 2-26 wks
Spectrum
Chronic hepatitis-80%
Cirrhosis-20-30%

25. Laboratory Diagnosis
1. HCV antibody - generally used to
diagnose hepatitis C infection. Not
useful in the acute phase.
2. HCV RNA-by PCR
3. HCV-antigen

26. Treatment
• Acute- No specific Tx, Supportive Mx
• Chronic-
– Interferon
– Ribavirin

27. Prevention
• Screening of blood, organ, tissue donors
• High-risk behavior modification
• Blood and body fluid precautions
• No vaccine available.

28. Hepatitis D
• A defective virus, may only co-infect with HBV or
superinfect person with hep B.

29. Hepatitis E
 Incubation period: Average 40 days
Range 15-60 days
 Spectrum
Fulminant hepatitis-1-2%
No chronic form

30. From past papers….
2014 Jan

31. Summery….
• Hepatitis causes
Viral hepatitis
 Symptoms &
Signs
 Transmission
 Diagnosis
 Treatment
 Prevention

32. Further reading….
• Autoimmune Hepatitis
• Wilson’s disease
• Haemochromatosis

33. References….
• Kumar & clerk 8th edition
• Medscape

34. Questions
…

35. Thank you….