EXPLAIN ABOUT DIFFRENT HEPATITIS TYPE AND DIAGNOSI AND ANTIGEN ANTIBODY LEVELS AT DIFRENT TIMES

1. By-SHIVANSH
8TH SEM GROUP 1
UNIVERSITY GEOMEDI
DIFFERENTIAL DIAGNOSIS OF VIRAL &
ALCOHOLIC HEPATITIS

2. INTRODUCTION
• Inflammatory Disease - Mostly asymptomatic.
• Acute and Chronic (6 MONTHS).
• Caused by- Hepatitis virus A,B,C,D,E
-Heavy alcohol use, genetic, autoimmune,some other infections.
• Vaccination – 3 Dose needed.
• Complication- Coinfection, Super infection, Fluminant hepatitis
Liver cirrhosis, Liver failure.

3. CLINICAL MANIFESTATION
• Poor appetite
• Nausea & Vomiting
• Fatigue & Tiredness
• Right upper Quadrent pain
• Portal hypertension
• Jaundice
• Diarrhea
• Encephalopathy & Coagulopathy

5. VIRAL HEPATITS
• A & E Spread via Fecal oral Root.
• B & C via sexual or blood
contamination.
• D Stands only with preexisting
B.
• Precore mutant virus- in Europe
& Russia.

6. Diagnosis for Viral Hepatitis
• Serological Study
• Antigen testing for HBsAg , HBcAg , HBeAg , HCV, HBxAg.
• PCR HBV/HCV DNA (>20000 IU/ml)
• LFT (Ratio of SGPT to SGOT >1 )
• Ultra sonography- echo texture and span of liver.
(Starry sky liver with increased span)

7. • HBsAg+
IGM anti HBc+
• HBsAg+
IgG anti HBc
• IgM anti HBc+
• Anti HBsAg+
• IgG anti HBcAg
Acute
Hapetitis B.
Cronic
Hepetitis B.
Gap period.
Vaccinated
Remote Inf.
Or Low level
carrier

9. Fulminant Hepatitis
• IgM anti HBcAg + IgM anti HDV Ag
• IgG anti HBcAg + IgM anti HDV Ag
• Features-
• Encephalopathy
• Coagulopathy
• MELD score for transplantion (>17)
(Bilirubin, PT, S. Creatinine)
COINFECTION
SUPERINFECTION/FULMINANT

10. Alcoholic Hepatitis
• 20 % cases of total , Male-160 gm/day , Female-20 gm/day .
• HCV, Genetics, Obesity.
• Macro vesicular fat deposition.
• Mallory hyaline bodies.
• Features-Right upper quadrant pain,nausea,vomiting,jaundice absent
-Portal hypertension, splenomegaly, Caput medusa.
• -

11. Diagnosis for alcoholic Hepatitis
• SGOT (MOST SPECIFIC) 2-7 TIMES ELEVATED
• SAP (S.alkaline phosphate)Increased
• Ultrasonography (echo texture,portal reversal flow)
• PT Elevated
• MADDREY’S/Discriminant score (>21 start treatment)
{4.6*(pt above normal limit)+s.bilirubin}
• Glasgow Alcoholic hepatitis score
(Age, wbc count, bilirubin, pt, BUN)

12. Treatment
• Hepatitis B – if HBeAg+, PCR DNA = >20000IU/ml +SGPT*2 times
- Tenofovir(300mg/day*48week) /Entecavir.
• Fulminant Hepatitis - Lactulose (NH3 binder) ,Rifaximine(bacteriostatic)
- enema ,IV L.O.L.A(Ormithine and aspartate for urea formation
-IV 10% glucose, Frozen plasma ( vitamin k not helpful)
• Alcoholic Hepatitis- PREDNISOLONE (3mg/day*4 week)
-Naltrexone(deaddiction)
-TNF A INHIBITOR