IMMUNE MEDIATEDLIVER DISEASES AND VIRAL HEPATITISSpeakers :• Ammara Farouqi• Anam Hassan
IMMUNE-MEDIATED DISEASESImmune-mediated diseases are conditions which result fromabnormal activity of the bodys immune system.Autoimmune diseases are a subset of immune-mediated diseases.Autoimmune liver diseases (AILDs) Autoimmune liver diseases(AILDs) are common leading causes for liver cirrhosis and terminalstage of liver disease.Primary biliary cirrhosis, primary sclerosing cholangitis andautoimmune hepatitis are the three major immune-mediatedliver diseases.
AUTOIMMUNE HEPATITISCharacterized by continuing hepatocellular inflammation andnecrosis, tending to progress to cirrhosis.The disease often is associated with other autoimmune diseases.It is associated with other autoimmune diseases.
TYPES OF AUTOIMMUNE HEPATITIS:1. TYPE 1 : most common occur at any age but most often starts in young adulthood associated with other autoimmune disorders like type 1 diabetes, proliferative glomerulonephritis, thyroiditis and ulcerative colitis.2. TYPE 2 : less common typically affecting girls aged 2 to 14
SYMPTOMS OF AUTOIMMUNE HEPATITIS:1. Fatigue2. an enlarged liver3. jaundice4. itching5. skin rashes6. joint pain7. abdominal discomfort8. spider angiomas, or abnormal blood vessels, on the skin9. nausea10. vomiting11. loss of appetite12. dark urine13. pale or gray-colored stools
PREDNISOLONE. Prednisolone is a synthetic adrenal corticosteroid Corticosteroids have potent anti-inflammatory properties, and are used in inflammatory conditions such as arthritis, asthma, bronchitis, certain skin rashes, hepatitis and allergic or inflammatory conditions of the nose and eyes.1. weight gain2. anxiety and confusion3. thinning of the bones, a condition called osteoporosis4. thinning of the hair and skin5. diabetes6. high blood pressure7. cataracts8. glaucoma
AZATHIOPRINEAzathioprine is an Immunosuppressant.Prodrug (a precursor of a drug) which is converted in the body toits active form called mercaptopurine (Purinethol).It suppresses the proliferation of T and B lymphocytes and defendthe body against both infectious diseases & foreign materials.Azathioprine is found in breast milk.SIDE EFFECTS:1. Lowering of the white blood cell count2. cause nausea, vomiting, and loss of appetite3. cause liver toxicity4. fatigue, hair loss, joint pains, and diarrhea
CONTRAINDICATION:1. Not given to Hypersensitive patients2. Not given to pregnant women
PRIMARY BILIARY CIRRHOSISIrritation and swelling (inflammation) of the bile ducts ofthe liver leading to cirrhosis.Characterized by positive antimitochondrial antibodyIts cause is still unknown.Commonly affects middle-aged womenIt is associated with autoimmune disorders such asHypothyroidism and Sicca syndrome (dry eyes ormouth)
SYMPTOMS:1. Abdominal pain2. Enlarged liver3. Fatigue4. Fatty deposits under the skin5. Fatty stools6. Itching7. Jaundice8. Soft yellow spots on the eyelid
DIAGNOSIS:1. Elevated immunoglobulin M level in the blood2. Liver biopsy3. Anti-mitochondrial antibodies (results are positive in about 95% of cases)4. ultrasound imaging of the liver,TREATMENT:1. Medicines2. Vitamin Replacement Therapy3. Liver transplant4. AMA Test
CHOLESTRAMINE OR COLISTEPOLIt reduces Cholestrol level.It cures itching which is in some cases is a result ofof accumulation of bile acids in the skin.It ease the elimination of bile acids from the bodyand skin.SIDE EFFECTS:1. constipation2. bloating3. stomach pain4. gas5. upset stomach6. vomiting7. diarrhea8. loss of appetite9. heartburn10. indigestion
CONTRAINDICATION: •Hypersensitivity can cause complete biliary obstruction. •Renal impairment •Constipation
URSODEOXYCHOLICACID:It is one of the secondary bile acids, whichare metabolic byproducts of intestinalbacteria.Ursodiol dissolve gallstones in patientswho avoid surgery.Also prevent formation of gallstone bydecreasing the production of cholesterol.SIDE EFFECTS: 1. diarrhea 2. constipation 3. indigestion 4. dizziness 5. vomiting 6. sore throat 7. Cough with runny nose 8. muscle and joint pain 9. hair loss
CONTRAINDICATIONS:acute inflammation of the gall bladderimpaired contract ability of the gall bladderhypersensitivity to bile acidspregnant or breastfeedingchronic liver disease, peptic ulcers or in those withinflammatory diseases of the small intestine and colon.
PRIMARYSCLEROSINGCHOLANGITISchronic and progressivedisease of the bile ducts.infection in the bile ducts thatleads to cirrhosis and liverfailure.It can occur alone as well as inassociation with Crohnsdisease (Inflammatory BowelDisease).
SYMPTOMS:1. Fatigue2. Itching3. Yellowing of the skin and eyes (jaundice4. Enlarged liver5. Enlarged spleen6. Loss of appetite and weight loss7. Repeat episodes of cholangitis.8. Abnormally elevated blood levels of liver enzymes9. Abdominal pain
DIAGNOSIS: 1. Blood Tests 2. Radiological Tests 3. Liver Biopsy 4. Colonoscopy TREATMENT:1. Medications such as Cholestyramine, Ursodeoxycholic acid, Fat- soluble vitamins (D, E, A, K) and that quiet the immune sys. (prednisone, azathioprine, cyclosporine, methotrexate)2. Liver transplant
What Is Hepatitis ?Hepatitis (plural hepatitides ) is a medical condition defined by theinflammation of liver and characterized by the presence ofinflammatory cells in the tissues of organ .
Causes Of Hepatitis:•Drugs•Alcohols•Chemicals•Auto-immune disease•Viruses•Blood transfusions
Symptoms :. For those who do develop symptoms of viral hepatitis, themost common are flu- like symptoms including:• loss of appetite• nausea• vomiting• Fever• weakness• tiredness• aching in the abdomenLess common symptoms include:• dark urine• light-colored stools• fever• jaundice (a yellow appearance to the skin and white portion ofthe eyes)
Types Of Viral HepatitisThere are several viral hepatitis caused by specificviruses, they have been named as :• Hepatitis A virus (HAV)• Hepatitis B virus (HBV)• Hepatitis C virus (HCV)• Hepatitis D virus (HDV)• Hepatitis E• Hepatitis F• Hepatitis G (not confirmed yet).
Hepatitis A (HAV)At one time, hepatitis A wasreferred to as "infectioushepatitis" because it could bespread from person to person likeother viral infections. Infectionwith hepatitis A virus can bespread through the ingestion offood or water, especially whereunsanitary conditions allow wateror food to become contaminatedby human waste containinghepatitis
Hepatitis B (HBV)Type B hepatitis was at one timereferred to as "serum hepatitis," becauseit was thought that the only wayhepatitis B virus (HBV) could spread wasthrough blood or serumAbout 6-10% of patients with hepatitis Bdevelop chronic HBV infection (infectionlasting at least six months and oftenyears to decades) and can infect othersas long as they remain infected. Patientswith chronic hepatitis B infection alsoare at risk of developing cirrhosis, liverfailure and liver cancer.
Hepatitis C (HCV)Type C hepatitis was previously referred toas "non-A, non-B hepatitis,Patients with chronic hepatitis C infectionare at risk for developing cirrhosis, liverfailure, and liver cancer.The hepatitis C virus (HCV) usually isspread by shared needles among drugabusers, bloodtransfusion, hemodialysis, and needlesticks. Approximately 90% of transfusion-associated hepatitis is caused by hepatitisC
Types D, E, F, and GHepatitisThere also are viral hepatitis types D, E, F (notconfirmed yet), and G. The most important ofthese at present is the hepatitis D virus(HDV), also known as the delta virus or agent. Itis a small virus that requires concomitantinfection with hepatitis B to survive. HDVcannot survive on its own because it requires aprotein that the hepatitis B virus makes (theenvelope protein, also called surface antigen)to enable it to infect liver cells.
Who Is At Risk For ViralHepatitis?People who are most at risk for developing viralhepatitis are:• Workers in the health care professions• People with multiple sexual partners• Intravenous drug users• Hemophiliacs• Blood transfusion• By piercing body (tattooing).
Tests Used to Diagnose Viral Hepatitis • Liver enzyme tests • Test for antibodies • liver biopsy A number of conditions have the same symptoms as viral hepatitis.• Mononucleosis• Reaction to medicines, such as birth control pills, certain antibiotics, oracetaminophen (Tylenol®)•Autoimmune hepatitis•Infections caused by certain viruses, such as herpes simplex virus,cytomegalovirus, or coxsackievirus• Congestive heart failure• Wilsons disease• Liver cancer
How is viral hepatitis treated? Treatment of acute viral hepatitis and chronic viral hepatitis are different. Acute Hepatitis: In patients with acute viral hepatitis, the initial treatment consists of relieving the symptoms of nausea, vomiting, and abdominal pain. Careful attention should be given to medications which can have adverse effects in patients with abnormal liver function. Only those medications that are considered necessary should be administered since the impaired liver is not able to eliminate drugs normally, and drugs may accumulate in the blood and reach toxic levels. In addition, sedatives and "tranquilizers" are avoided because they may accentuate the effects of liver failure on the brain and cause lethargy and coma. It occasionally is necessary to provide intravenous fluids to prevent dehydration caused by vomiting.
Medications for chronic hepatitis C infection include: Chronic Hepatitis: Treatment of chronic infection with hepatitis B and hepatitis C usually involves medication or combinations of medications to eradicate the virus. Medications for chronic hepatitis C infection include: • Injectable interferon • Oral ribavirin Medications for chronic hepatitis B infection include: • Injectable interferon • Oral lamivudine (epivir) • Oral adefovir (hepsera) • Oral entecavir (baraclude)
RIBAVIRIN :Ribavirin (brand names:, Rebetol, Ribasphere, Vilonaand Virazole) is an anti-viral drug indicated for severe ,hepatitis C infection . Ribavirin is a prodrug.Mechanism:ribavirin is known to enhance host T-cell-mediated immunity against viral infectionthrough helping to switch the host T-cellphenotype from type 2 to type 1.ContraindicationsWomen who are pregnant or menwhose female partners arepregnant; hypersensitivity toribavirin or any component of theproduct.
Medications for chronic infection with hepatitis B and hepatitis C are notalways effective. Prolonged treatment (6 months to years) often isnecessaryFulminant hepatitis. Treatment of acute fulminant hepatitis should be done incenters that can perform liver transplantation since acute fulminant hepatitis has ahigh mortality without liver transplantation.
How Is Viral Hepatitis Prevented?Prevention of hepatitis involves measures to avoidexposure to the viruses, using immunoglobulin inthe event of exposure, and vaccines.Hepatitis A. Two hepatitis A vaccines areavailable, Havrix andVaqta. Both contain inactive(killed) hepatitis A virus.For active vaccination, a harmless hepatitis Bantigen is given to stimulate the bodys immunesystem to produce protective antibodies againstthe surface antigen of Hepatitis B. Vaccines thatare currently available are made (synthesized)using recombinant DNA technology(joining DNAsegmentsThere is currently no vaccine for Hepatitis C.