differ by:
-mode of transmission
-liver damage they cause
-how they affect health
Most common cause of liver disease worldwide.
Mild attacks are asymptomatic.
May be acute or chronic.
Can occur at any age.
acute viral hepatitis:
- <6mths
-observed with all types
chronic viral hepatitis:
-viremia and hepatic inflammation >6mths following infection
-hep B,C and D
-may lead to cirrhosis and end stage liver disease
hepatitis
A
only host virus -
humans
no reported cases of
chronic hepatitis
major cause of acute
hepatitis
most attacks are
mild
mode of transmission:
faecal-oral route
risk factors
international travels
to endemic areas
sexual
contact
shell fish with the
virus
IV drug users +
non-sterile needles
workers involved
with primate animals
food service
handlers
patients with
clotting
factors
disorders
healthcare
workers
household contact
with infected person
diagnosis
antibodies to hepatitis
A virus in the serum
IgM - usually present about
3 weeks post exposure;
undetected within 6mths
IgG - present at the same time as IgM;
indicates protection and lifelong
immunity against infection
treatment
no drug
treatment; only
supportive
prevention
good personal hygiene
& proper sanitary waste
disposal
immunoglobulin
hepatitis A
vaccine
hepatitis
B
blood borne
infection
highest conc of virus -
blood & serous fluids
incubation
period
3-6mths
may be acute or
chronic
mode of
transmission
blood or body fluids through
peri-natal, sexual or IV drug use
blood
transfusions
from infected
donors
sexual
intercourse
risk factors
about 1/3 reported
cases will have no
identifiable risk factors
men having sex
with other men
many heterosexual
partners
use of non-sterile
needles
recipients of blood
products
household contact with
hepatitis B with open wounds
healthcare providers
with contact with
contaminated needles
dialysis
patients
diagnosis
surface antigen
(HBsAg)
envelope antigen
(HBeAg)
antibodies to the core
antigen (HBcAg)
virological marker: HBV
DNA
prevention
avoid contaminated blood products
or refrain from high risk behaviour
healthcare workers in contact
with contaminated needles
having multiple
sexual partners
perinatal
transmission
unprofessional
body piercing
diagnosis
test for anti-hepatitis C
virus in serum
prevenion
avoid contaminated blood products
or refrain from high risk behaviour
individuals at high risk should be
testes since its asymptomatic
treatment
peginteferon plus
ribavirin
ribavirin
caracteristics
blood borne with greater
infectivity than HIV
mode of transmission:
blood and body fluids
often
asymptomatic
about 85% develop
chronic disease
leading indication for
liver transplant
worldwide
fulminant
hepatitis
liver
transplant
acute - no drug
treatment only
supportive
signs and symptoms
hepatitis D
Hepatitis D virus (HDV) is a virus that requires hepatitis B virus (HBV) for its replication. HDV infection occurs
only simultaneously or as super-infection with HBV. The virus is transmitted through contact with the blood
or other body fluids of an infected person. Vertical transmission from mother to child is rare.
At least 5% of people with chronic HBV infection are co-infected with HDV, resulting in a total of 15 – 20
million persons infected with HDV worldwide. However, this is a broad global estimation since many
countries do not report the prevalence of HDV. Worldwide, the overall number of HDV infection has
decreased since 1980s. This trend is mainly due to a successful global HBV vaccination programme.
HDV-HBV co-infection is considered the most severe form of chronic viral hepatitis due to more rapid
progression towards liver-related death and hepatocellular carcinoma. Currently, treatment success rates
are generally low. Hepatitis D infection can be prevented by hepatitis B immunization.
hepatitis E
Hepatitis E is a liver disease caused by infection with a virus known as hepatitis E virus (HEV). Every
year, there are an estimated 20 million HEV infections worldwide, leading to an estimated 3.3 million
symptomatic cases of hepatitis E
tansmission
ingestion of undercooked meat or meat products derived
from infected animals; transfusion of infected blood
products; and vertical transmission from a pregnant
woman to her fetus.
Prevention
maintaining quality standards for public water supplies;
establishing proper disposal systems for human feces.
vaccines
bilirubin metabolism
jaundice
Haemolytic jaundice
Possible causes: sickle cell anemia or G6PD deficiency
In haemolytic anaemia
Presentation/Investigation ↑UCB ↑ Normal or Increased CB Urine and blood urobilinogen will be increased
Hepatocellular Jaundice
Reduced bilirubin conjugation as a result to the damaged
hepatocytes such as in liver cirrhosis and hepatitis.
↑UCB ↑Urobilinogen in urine and blood ??? Dark urine
(Urobilinogen) Pale stool ↑ AST and ALTCB
Obstructive jaundice
Obstruction in bile secretion that might be because of tumour or gallstone.
GI pain and nausea, pale stools
Because of extra hepatic cholestasis, CB increases in the blood
. Dark urine (CB) Urobilinogen is absent