Hepatitis a & c

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This is a medically oriented presentation on Hepatitis C and Hepatitis A.

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  • Hepatitis a & c

    1. 1. Hepatitis A & C Created by Glenne Fletcher
    2. 2. BASIC FACTS• Hepatitis means inflammation of the liver• Refers to a family of viral infections which effect the liver. There are 6 types: Hepatitis A, B, C, D, E and G. The most common are types A, B and C.• Chronic Hepatitis can progress into cirrhosis of the liver, liver cancer (hepatocellular carcinoma/ HCC) , liver failure or death.• Hepatitis is the leading cause for liver transplant in the U.S. Center for Disease Control. (2008). CDC Fact Sheet Hepatitis . Retrieved on 3/14/10 from http://www.cdcnpin.org/scripts/hepatitis/index.asp
    3. 3. Functions of the liver• produces bile • stores iron (processes hgb• produces proteins for blood plasma • converts NH4 to urea• produces cholesterol • filters out poisons to help carry fats through the body • regulates blood clotting• converts glucose into glycogen • produces immune factors• regulates blood levels of amino acids • removes bacteria from blood University of Virginia Health System. ( 2007) . Liver, Biliary and Pancreatic Disorders: Hepatitis C. Retrieved on March 14, 2010 from www.hss.viriginia.edu/uvahealth/adult_liver/hepc.cfm
    4. 4. Why you want toprevent Hepatitis!
    5. 5. Why you want toprevent Hepatitis!
    6. 6. Hepatitis C• Identified as Hepatitis C in 1992 (had been non A /non B prior to that)• Is estimated to be present in 180 million people world wide• 4.1 million people in the US would test positive for HCV• 80% of those are HCV RNA positive WHO. (2003). Hepatitis C Fact Sheet. Retrieved on March 10,2010 from www.who.int/csr/disease/hepatitis/whodscsrlyo2003/en/index/html
    7. 7. • 2/3 of infected persons are unaware that they have the virus• Many are asymptomatic until advanced stages of liver disease are present• 15-45 % of infected people will spontaneously clear the virus• 55-85 % of infected people will become chronically infected• Chances of developing chronic hepatitis increase with age WHO. (2003). Hepatitis C Fact Sheet. Retrieved on March 10,2010 from www.who.int/csr/disease/hepatitis/whodscsrlyo2003/en/index/html
    8. 8. Symptoms• Not uncommon for the infected person to experience no symptoms• Symptoms may be flu-like, including fever, fatigue, muscle aches and joint pain, poor appetite, tenderness over the liver and nausea. Mayofoundation for Medical Education and Research ( MFMER). (2009). Hepatitis C Basics Retrieved March 13,2010 from www.mayoclinic.com/health/hepatitisc
    9. 9. Transmission:Blood Borne Pathogen Mayofoundation for Medical Education and Research ( MFMER). (2009). Hepatitis C Basics Retrieved March 13,2010 from www.mayoclinic.com/health/hepatitisc
    10. 10. Risk Factors• Any RECENT or REMOTE use of IV drugs• Persons with HIV, Hemophiliacs, dialysis patients, or recipients of blood transfusions/clotting factors prior to 1992• Children born to mothers who have the virus• Sexual partner of an infected person• Health Care Workers (HCW) exposed to needle sticks Mayofoundation for Medical Education and Research ( MFMER). (2009). Hepatitis C Basics Retrieved March 13,2010 from www.mayoclinic.com/health/hepatitisc
    11. 11. Testing for Hepatitis C• Blood tests determine if antibodies are present = immune response to antigen• Measure viral load (quantitative and qualitative) = HCV RNA• Determine the genotype of the virus(1-6 and 50 subtypes) = determines treatment• Can be false positive or false negative National Institute of Health. (2009).Hepatitis c. Retrieved on March 26,2010 from www.digestve.niddk.nih.gov/ddisease/pubs/chronichepc
    12. 12. Serologic tests• Liver function tests measure liver’s response to the virus (AST, ALT= liver enzymes)• HCV RNA is measured after 6 months of treatment to determine if TX effective/ cured: acute/chronic hepatitis National Institute of Health. (2009).Hepatitis c. Retrieved on March 26,2010 from www.digestve.niddk.nih.gov/ddisease/pubs/chronichepc
    13. 13. Viral Replication of Hepatitis C• Pathogen enters the body• Attaches to liver cells• RNA replicates and the virus spreads• As the immune system responds to the virus, it sends out fighter (T) cells which attack the virus but also attack surrounding liver tissue. This can lead to cirrhosis. http://www.youtube.com/watch?v=y6osMO5xnag&feature=related
    14. 14. Treatment• Maintain healthy lifestyle; avoid stress• Avoid all alcohol and any drug which is processed through the liver• Get vaccinated for Hepatitis A & B• Liver transplant if indicated American Liver Foundation. (2009). Hepatitis Information : Facts at a Glance Retrieved March 14, 2010 from www.liverfoundation .org
    15. 15. Antiviral Treatment• Pegylated Interferon (IM 1 x week/long half life)• Ribaviron (oral 2 x day)• Treatment determined by genotype and HCV RNA load after 6 months National Institute of Health. (2009).Hepatitis c. Retrieved on March 26,2010 from www.digestve.niddk.nih.gov/ddisease/pubs/chronichepc
    16. 16. Success of Treatment• Dependent on HCV RNA: lower baseline viral load responds better than higher baseline viral load• Genotype: types 2 & 3 respond better than type 1• Race: still under investigation• Comorbidity National Institute of Health. (2009).Hepatitis c. Retrieved on March 26,2010 from www.digestve.niddk.nih.gov/ddisease/pubs/chronichepc
    17. 17. Prevention• Do not share needles or any other drug paraphernalia (includes cookers, straws and rinse water)• Use only sterile equipment for tattoos and piercing• Never share personal items ie. toothbrushes, razors, nail clippers• Practice safe sex• HCW’s should practice standard precautions American Liver Foundation. (2009). Hepatitis Information : Facts at a Glance Retrieved March 14, 2010 from www.liverfoundation .org picture retrieved from ilbs.delhigovt.nic.in/image/picture/jpg
    18. 18. Hepatitis APicture retrieved on 3/26/2010 from www.doctoroncall.wordpress.com
    19. 19. Hepatitis A Basic Facts• Hepatitis A is a viral infection of the liver• Estimates project that 1/3 of all Americans will get Hepatitis A in their lifetime• Once you recover from Hep A you can not get it again• Is self limiting and rarely causes death American Liver Foundation. (2006). Hepatitis A :What you Need to Know Retrieved March 14th, 2010 from www.liverfoundation.org.
    20. 20. Hepatitis A World Wide WorldHAV ENDEMICITYREGIONS BY EPIDEMIOLOGICAL PATTERN • Estimates of 1.4 million infected persons world wide • Highest prevalence in countries with low socioeconomic standards and poor sanitation WHO. (2003). Hepatitis A Fact Sheet. Retrieved on March 10,2010 from www.who.int/csr/disease/hepatitis/whodscsrlyo2003/en/index/html picture retrieved from www.travmed.com/health_guide/images/hepA.jpg
    21. 21. HAV in USA • In 2007: 2,929 acute symptomatic cases reported • Based on adjustments due to asymptomatic infections and underreporting, estimates of 25,000 cases of HAV in USACDC.GOV.(2009). Hepatitis A FAQ for the health professional. Retrieved on March 22,2010 from www.cdc.gov/hepatitis/HAV/HAVfaq.htm#general
    22. 22. Clinical Diagnosis • onset of symptoms • elevated serum aminotransferase levels (ALT)= abnormal LFT’s • + serologic test IgM antibody to Hep ACDC.GOV.(2009). Hepatitis a faq for the health professional. Retrieved on March 22,2010 from www.cdc.gov/hepatitis/HAV/HAVfaq.htm#general
    23. 23. Symptoms• May occur two to seven weeks after exposure to the virus (average 28 days)• Symptoms are usually mild and flu-like however may be abrupt onset• Jaundice may occur temporarily• All symptoms usually resolve within six months• Most people recover < 2 monthsCDC.GOV.(2009). Hepatitis A FAQ for the health professional. Retrieved on March 22,2010 from www.cdc.gov/hepatitis/HAV/HAVfaq.htm#general
    24. 24. Transmission• HAV is transmitted by eating food or drinking water that has been contaminated with human waste• It may be transmitted person to person via anal/oral sex• Day care workers can spread it when diapering a baby• This is known as fecal-oral route of contamination• Transmission may occur 2-6 weeks before symptoms are present WHO. (2003). Hepatitis C Fact Sheet. Retrieved on March 10,2010 from www.who.int/csr/disease/hepatitis/whodscsrlyo2003/en/index/html picture retrieved from www.medscape.com
    25. 25. Transmission Facts• Virus can live outside body for months depending on environmental conditions• Is killed by heating foods to 185 degrees F for 1 minute• Can be spread in cooked food if contaminated after cooking• US water supply tx with chlorine which kills HAV CDC.GOV.(2009). Hepatitis a faq for the health professional. Retrieved on March 22,2010 from www.cdc.gov/hepatitis/HAV/HAVfaq.htm#general
    26. 26. Who gets Hep A ? picture retrieved on 3/26/2010 from www.whoint/csr/disease/hepatitis/whodscsredc2007/en/index.4html
    27. 27. Tests• Blood test determines antibody presence• There is rarely a need to determine viral load in Hepatitis A patients• Liver biopsy is not indicated unless there are unusual complications CDC.GOV.(2009). Hepatitis a faq for the health professional. Retrieved on March 22,2010 from www.cdc.gov/hepatitis/HAV/HAVfaq.htm#general
    28. 28. Complications• Most people recover completely within six months of developing symptoms and do not develop chronic hepatitis• Approximately 100 people die in the US annually from complications due to Hep A• Complications are more likely in the elderly and in persons who already have liver disease. American Liver Foundation. (2006). Hepatitis A:What you need to know. Retrieved march 14, 2010 from www.liverfoundation.org
    29. 29. Treatment• Healthy lifestyle• No alcohol or drugs, unless approved by healthcare practitioner• There are no medications for Hep A• IG (immune globulin) may be given to an exposed person if done in the first 2 week window American Liver Foundation. (2006). Hepatitis A:What you need to know. Retrieved march 14, 2010 from www.liverfoundation.org
    30. 30. Vaccination• Vaccination with Hep A vaccine (two doses six months apart) for the following:• All children over age one• International travelers• Patients with known liver disease• People who have had liver transplant• IV drug users• MSWM American Liver Foundation. (2006). Hepatitis a:What you need to know. Retrieved march 14, 2010 from www.liverfoundation.org
    31. 31. Type of Vaccines• Single antigen: contains Hep A antigen only = Havrix and Vaqta• Combined Antigen: contains Hep A and Hep B antigens = Twinrix• Vaccination lasts up to 25 years CDC.GOV.(2009). Hepatitis a faq for the health professional. Retrieved on March 22,2010 from www.cdc.gov/hepatitis/HAV/HAVfaq.htm#general
    32. 32. Prevention• Avoid raw or undercooked food which may have been contaminated (especially shellfish)• Wash hands after any contact with feces and before food preparation• Use condoms, gloves and dams for any sexual act that may expose you to fecal material• All employees in institutions (day care, prisons, nursing homes) must use standard precautions• Vaccinate appropriately Center for Disease Control. (2009). Hepatitis A fact sheet.. Retrieved on March 14th, 2010 from cdcpin.org/scripts/hepatitis/index_asp
    33. 33. ReferencesAmerican Liver Foundation. (2006). Hepatitis a: what you need to know. Retrieved on March 14, 2010 fromwww.liverfoundation.org.American Liver Foundation. (2009). Hepatitis c information: facts at a glance. Retrieved on March 14, 2010from www.liverfoundation.org.Center for Disease Control. (2009). Hepatitis a fact sheet. Retrieved on March 14th, 2010 fromcdcpin.org/scripts/hepatitis/index_aspCenter for Disease Control. (2009). Hepatitis c information for health professionals. Retrieved on March,14, 2010 from www.cdc.gov/hepatitis/HCV/HCVfaq.htm#section2 Mayo Foundation for Medical Health and Research. (2009). Hepatitis c. Retrieved on March 14 , 2010from www.mayoclinic.com/health/hepatitis cNational Institute of Health.(2009). Hepatitis c facts.Retrieved on March 22, 2010 fromwww.digestive.niddk.nih.gov/ddiseases/pubs/chronichepcUniversity of Virginia Health System. (2009). Hepatitis overview. Retrieved on March 14, 2010 fromwww.healthsystem.virginia.edu/UVAhealth/adult_liver/liver.cfmWorld Health Organization. (2003). Hepatitis c fact sheet. Retrieved on March 10,2001 fromwww.who.int/csr/disease/hepatitis/whodscsrlyo2003/en/index/html

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