Hepatitis    Ppt   Sept 2006
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Hepatitis Ppt Sept 2006

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Hepatitis    Ppt   Sept 2006 Hepatitis Ppt Sept 2006 Presentation Transcript

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