Hepatitis Ppt Sept 2006


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Hepatitis Ppt Sept 2006

  1. 1. Hepatitis <ul><li>Inflammation of the liver </li></ul>
  2. 2. Causes of Hepatitis <ul><li>Reactions to chemical agents, drugs & toxins </li></ul><ul><li>Autoimmune diseases </li></ul><ul><li>Viruses </li></ul>
  3. 3. Acute Viral Hepatitis <ul><li>Hepatitis A, B, C, D, E </li></ul><ul><li>Hepatitis B is 9 th leading cause of death in the world </li></ul><ul><li>75% of those chronically infected with Hep B live in the Asia-pacific region </li></ul><ul><li>In NZ approx 1% of population has been exposed to the Hep C virus </li></ul><ul><li>Approx 40% of HIV infected pts have Hep C virus </li></ul>
  4. 4. Hepatitis A <ul><li>Usually transmitted through faecal-oral route </li></ul><ul><li>Can occur sporadically but frequently occurs in small outbreaks caused by faecal contamination of food or drinking water </li></ul><ul><li>Also spread by drinking contaminated milk & eating shellfish from infected waters </li></ul>
  5. 5. Hepatitis A (cont.) <ul><li>Present in the blood only briefly </li></ul><ul><li>Virus replicates in liver, excreted in bile & shed in the stool </li></ul><ul><li>Found in faeces 2 or more weeks before the onset of symptoms & up to 1 week after the onset of jaundice </li></ul>
  6. 6. Risk factors for Hep A <ul><li>People travelling overseas who have not previously been exposed to virus </li></ul><ul><li>Young children are asymptomatic therefore play important role in spread of disease </li></ul><ul><li>Institutions housing large numbers of people </li></ul><ul><li>Oral behaviour & lack of toilet training promote spread in daycare centres </li></ul>
  7. 7. Clinical Manifestations <ul><li>Abrupt onset </li></ul><ul><li>Fever </li></ul><ul><li>Malaise </li></ul><ul><li>Nausea </li></ul><ul><li>Anorexia </li></ul><ul><li>Abdominal discomfort </li></ul><ul><li>Dark urine </li></ul><ul><li>Jaundice </li></ul><ul><li>Children under 6yrs usually asymptomatic </li></ul><ul><li>Symptoms last approx 2 mths but can last longer </li></ul>
  8. 8. Hepatitis B <ul><li>More serious health problem than Hep A </li></ul><ul><li>Highest rate of disease occurs in 20 – 49 year age group </li></ul><ul><li>Incidence is decreasing because of Hep B vaccine </li></ul><ul><li>Can cause chronic hepatitis, cirrhosis of liver, liver necrosis & a carrier state </li></ul><ul><li>30% asympotomatic </li></ul>
  9. 9. Mode of Transmission <ul><li>Inoculation with infected blood or serum </li></ul><ul><li>Found in body secretions so can be transmitted by oral or sexual contact </li></ul><ul><li>Highly prevalent among injecting drug users, persons with multiple sexual partners & men who have sex with men </li></ul>
  10. 10. Hepatitis B <ul><li>Health care workers are at risk because of exposure to blood & needle stick injuries </li></ul><ul><li>Virus can be spread through blood/blood products transfusion </li></ul><ul><li>2 – 10% of adults infected with hep B become chronic carriers & may transmit the disease </li></ul><ul><li>Chronic carriers may have normal liver, low grade or severe liver disease & are at greater risk of liver cancer </li></ul>
  11. 11. Hepatitis C <ul><li>Most common cause of chronic hepatitis, cirrhosis and liver cancer </li></ul><ul><li>Many are unaware they are chronically affected because they are not clinically ill </li></ul><ul><li>Infected persons serve as source of infection to others & are at risk of chronic liver disease during 2 or more decades after infection </li></ul>
  12. 12. Hepatitis C <ul><li>Injecting drug use most important risk factor </li></ul><ul><li>Transmission of small amts of blood during tattooing, acupuncture & body piercing </li></ul><ul><li>Incidence of sexual & mother-to-child transmission is uncertain </li></ul><ul><li>Occupational exposure due to needle stick injuries </li></ul>
  13. 13. Hepatitis C <ul><li>Incubation period 15-150 days (average 50 days) </li></ul><ul><li>Clinical symptoms milder than other types of viral hepatitis </li></ul><ul><li>Can be asymptomatic </li></ul><ul><li>Non-specific – fatigue, malaise, anorexia, weight loss </li></ul><ul><li>Jaundice uncommon </li></ul>
  14. 14. Hepatitis C <ul><li>High rate of persistence </li></ul><ul><li>Able to induce chronic hepatitis and cirrhosis </li></ul><ul><li>Increases risk of liver failure </li></ul><ul><li>*No vaccine that protects against Hep C </li></ul>
  15. 15. Phases of Hepatitis <ul><li>Preicteric </li></ul><ul><li>Precedes jaundice, lasts 1-21 days </li></ul><ul><li>Period of maximum infectivity for hep A </li></ul><ul><li>Anorexia, nausea, vomiting </li></ul><ul><li>R) upper quadrant abdominal discomfort </li></ul><ul><li>Constipation or diarrhoea </li></ul><ul><li>Malaise, headache, low grade fever, arthralgias, skin rashes </li></ul>
  16. 16. Icteric Phase <ul><li>Lasts 2-4 weeks & characterised by jaundice </li></ul><ul><li>Jaundice </li></ul><ul><li>Pruritus (accumulation of bile salts under skin) </li></ul><ul><li>Dark urine (excess bilirubin excreted by kidneys) </li></ul><ul><li>Light or clay coloured stools (obstruction of bile ducts) </li></ul><ul><li>Fatigue, weight loss </li></ul>
  17. 17. Posticteric Phase <ul><li>Begins as jaundice is disappearing & lasts weeks to months (average 2-4mths) </li></ul><ul><li>Malaise, easy fatigability </li></ul><ul><li>Hepatomegaly </li></ul><ul><li>Relapses can occur </li></ul><ul><li>Disappearance of jaundice does not indicate total recovery </li></ul>
  18. 18. Chronic Hepatitis <ul><li>Inflammatory reaction of liver of more than 3 – 6 months duration </li></ul><ul><li>Chronic viral hepatitis ranks as chief reason for liver transplants in adults </li></ul><ul><li>Clinical features highly variable </li></ul><ul><li>Most common – fatigue, malaise, anorexia, bouts of jaundice </li></ul><ul><li>No simple & effective treatment </li></ul>
  19. 19. Jaundice <ul><li>Results from abnormally high accumulation of bilirubin in the blood </li></ul><ul><li>A yellowish discolouration to the skin & deep tissues </li></ul><ul><li>Becomes evident when serum bilirubin is above 40 µg/L (normal 5-20µg/L) </li></ul><ul><li>Often hard to detect in persons with dark skin </li></ul>
  20. 20. Jaundice <ul><li>Usually first detected in sclera of eye </li></ul>
  21. 21. Jaundice
  22. 22. Causes of Jaundice <ul><li>Excessive destruction of RBCs </li></ul><ul><li>Impaired uptake of bilirubin by liver </li></ul><ul><li>Decreased conjugation of bilirubin </li></ul><ul><li>Obstruction of bile flow in liver or bile ducts </li></ul>