an approach to evaluation and management of infection of liver causing jaundice

1. Acute viral hepatitis
A, B, C, D, E

2. Acute hepatitis- causes
 Viral- AVH
 Hepatitis A-E
 Immunosuppressed- CMV, EBV, HSV
 Other infection- Leptospirosis, Brucellosis
 Alcohol
 Drugs- H,R,Z, paracetamol etc.
 Ischemic
 Pregnancy
 SLE
 Wilson’s disease

3. Common features of AVH
 Variable incubation period, followed by
 Fever, malaise, myalgia, RUQ pain,
nausea/vomiting, loss of appetite
 Jaundice, seen in ~1/3rd
,
follows resolution of fever
 More symptomatic in young
 ALT/SGPT- markedly elevated
 FHF rare- ~1%- encephalopathy
 Clinical resolution over 2-6 weeks

4. Hepatitis A
 RNA virus of picornavirus family
 Transmission- feco-oral
 Sporadic or epidemic
 Incubation period- ~30 days
 More severe in adults
 FHF rare, no chronic state
 Rx- supportive
 Vaccine - inactivated HAV- 2 doses in 1 year

5. Hepatitis E
 RNA virus of herpeviridae family
 Transmission- water-borne
 Epidemics in developing world
 Incubation period- 3-8 weeks- avg. 5 wks.
 Severe in pregnant women
 Mostly self-limited, no chronicity
 Rx- supportive

6. Hepatitis B
 dsDNA virus, 8 genotypes- A-H
 Transmission- sexual, infected blood, vertical
 Incubation period- average 3 months
 FHF- rare, mortality ~60%
 Chronicity- 1-10%, more in infants ~90%
 Rx-
 Supportive
 HBIG- attenuates severity- 0.06 ml/kg
 Lamivudine/Entecavir in severe disease
 Vaccine- 3 doses- 0,1,6

7. HBV markers
 HBsAg- 1st
evidence of infection, persistence
indicates chronicity
 Anti-HBs- recovery, immunity
 HBcAg- not detected in blood
 IgMIgG anti-HBc over the course of
disease
 HBeAg- viral replication & infectivity
 Anti-HBe- decreased infectivity
 HBV-DNA- viral replication & infectivity

8. Hepatitis D
Only with HBV infection
Acute infection- no different
Chronic infection- more severe

9. Hepatitis C
 RNA virus of flavivirus family, 6 genotypes
 Transmission- sexual, infected blood, vertical
 Incubation period- 6-7 weeks
 Acute infection- usually asymptomatic
 Chronicity- >70%
 Dx- anti-HCV or HCV-RNA
 Rx- acute-supportive

10. Hepatitis C
 RNA virus of flavivirus family, 6 genotypes
 Transmission- sexual, infected blood, vertical
 Incubation period- 6-7 weeks
 Acute infection- usually asymptomatic
 Chronicity- >70%
 Dx- anti-HCV or HCV-RNA
 Rx- acute-supportive