all about hepatitis

2. HEPATITIS
 Hepatitis refers to an inflammation of the
liver cells and damage to the liver. There
are different types and causes, but the
symptoms can be similar.

3. CAUSES

4. Symptoms
 Many people with hepatitis experience either mild or no symptoms.
When symptoms appear, they can do so from 15 to 180 days after
infection. This applies to all types of hepatitis.
 Acute hepatitis
 The initial phase of hepatitis is called the acute phase. The symptoms
are similar to mild flu, and may include:
 Jaundice hepatitis
 Jaundice is a symptom of hepatitis.
 diarrhea
 fatigue
 loss of appetite
 mild fever
 muscle or joint aches
 nausea
 slight abdominal pain
 vomiting
 weight loss
 jaundice

5. CLASSIFICATION
 1968 De Groot et al. In the journal Lancet published a classification
of chronic hepatitis, which was approved by the European
Association for the Study of the liver. The classification is based on
the isolation of morphological variants of chronic hepatitis. The
authors proposed to distinguish the following morphological variants
of chronic hepatitis.
 Chronic persistent hepatitis - characterized by severe infiltration of
lymphoid cells of portal fields (portal hepatitis). These infiltrates do
not penetrate the hepatic lobule, they do not cause damage to the
integrity of the border plate (the layer of hepatocytes separating the
portal field from the hepatic lobe). In hepatocytes, dystrophic
changes can occur. Possible proliferation of Kupffer cells, the
development of portal fibrosis.
 Chronic aggressive hepatitis (hereinafter, the term aggressive was
replaced by active hepatitis from deontological considerations).
 With this variant of chronic hepatitis, the inflammatory infiltrate
seizes the portal tracts and further, destroying the border plate,
invades the hepatic lobule, an inflammatory reaction from moderate
to severe is noted. Depending on this in the subsequent began to
allocate chronic hepatitis with moderate and pronounced activity.

7. Types
 hepatitis
 Hepatitis has several different types, but the
symptoms of each are similar. Hepatitis can
take acute and chronic forms.
 The three main types of hepatitis are known
as hepatitis A, B, and C. Each is caused by a
different virus. All three types can be acute,
lasting for 6 months or less, and types B and
C can be chronic, lasting for longer.

10. PCR AND ELISA
DIAGNOSTICS FOR
HEPATITIS
 the patient's sera positive for HBV DNA by PCR were checked for
anti-HDV antibodies using 3rd generation ELISA assay kit (Globe
Diagnostics, Italy) using the methodology described in the
manufacturer's protocol. In brief, incubator was set to 37 ± 1°C. All
the reagents were brought to room temperature before use
(approximately 1 hour), without removing the plate from the bag.
All components were shaken well. Then the plate was removed
from the package. A 1/20 dilution of serum samples in tubes apart
was prepared by adding 5 μL of sample to 95 μL of sample dilution
solution (1/20 dilution). 80 μL of sample dilution solution was
added into all wells except in those assigned to controls. 20 μL of
the 1/20 dilutions of serum samples, 100 μL of positive control,
100 μL of cutoff (cutoff in duplicate), and 100 μL of negative control
were added into the corresponding wells. Plate was covered with
a sealing sheet and incubated at 37 ± 1°C for 60 min

11.  . Then the antigen-conjugate complex was
prepared. The seal was removed and aspirate
liquid from all wells was washed five times with
0.3 mL of washing solution per well. Then
Immediately 100 μL of reconstituted antigen-
conjugate complex was added into each well,
covered with a sealing sheet, and incubated in
incubator 37 ± 1°C for 60 min. The seal was
removed and liquid from all wells was aspirated
and washed five times with 0.3 mL of washing
solution per well. Immediately after that 100 μL of
substrate solution was added into each well,
incubated at room temperature for 20 min, and
protected from light and then immediately 50 μL
of stopping solution was added into all wells, and
finally read with ELISA Plate Reader at 450 nm
within 1 hour of stopping.

12.  Detection of HCV RNA by Nested PCR Viral RNA
was taken to reverse-transcribe the 5′ NCR of HCV
using Moloney murine leukemia virus reverse
transcriptase (M-MLV RTase, Fermentas) in a total
reaction volume of 20 μL. The reaction mixture
contained 4 μL MMLV (5x) buffer, 1 μL M-MLV reverse
transcriptase (RT) enzyme, 1 μL dNTPs (10 mM),
0.5 μL Rnase inhibiter (Fermentas), 1.5 μL RNase
free water, 1 μL specific antisense primer P2 5′-
ACTCGCAAGCACCTATCAGGCAGTAC-3′
(Macrogen, Korea), and 10 μL template (viral RNA).
cDNA was synthesized using ABI Veriti 96-well
thermocycler. Cycle conditions for cDNA were as
follows: 42°C for 55 minutes followed by 70°C for 10
minutes. The cDNA produced was stored at 4°C for
short-term storage or −20°C for prolonged storage.
cDNA product was used for qualitative analysis of
HCV infection. The first round PCR was

13.  performed using sense P1 5′-
CCCTGTGAGGAACACTGTCTTCACGC-3′
and antisense P2 5′-
ACTCGCAAGCACCTATCAGGCAGTAC-3′
primers (Macrogen, Korea) followed by
second round PCR (nested PCR), using the
first round product with inner sense P3 5′-
GAAAGCGTCTAGCATGGCG-3′ and
antisense P4 5′-CACAAGGCCTTTCCGACC-
3′ primers (Macrogen, Korea). PCRs were
carried out using Taq polymerase
(Fermentas) for 35 cycles. The PCR product
was visualized by 1.2% agarose gel and
stored at −20°C until further use.

14. Main syndromes
 Budd–Chiari syndrome is a very rare
condition, affecting one in a million adults.
The condition is caused by occlusion of the
hepatic veins that drain the liver. It presents
with the classical triad of abdominal pain,
ascites, and liver enlargement. The
formation of a blood clot within the hepatic
veins can lead to Budd–Chiari syndrome.
The syndrome can be fulminant, acute,
chronic, or asymptomatic.

15. HEPATORENAL SYNDROME
 Hepatorenal syndrome (often abbreviated HRS) is a life-threatening
medical condition that consists of rapid deterioration in kidney
function in individuals with cirrhosis or fulminant liver failure. HRS is
usually fatal unless a liver transplant is performed, although various
treatments, such as dialysis, can prevent advancement of the
condition.
 HRS can affect individuals with cirrhosis, severe alcoholic hepatitis,
or liver failure, and usually occurs when liver function deteriorates
rapidly because of a sudden insult such as an infection, bleeding in
the gastrointestinal tract, or overuse of diuretic medications. HRS is
a relatively common complication of cirrhosis, occurring in 18% of
people within one year of their diagnosis, and in 39% within five
years of their diagnosis. Deteriorating liver function is believed to
cause changes in the circulation that supplies the intestines,
altering blood flow and blood vessel tone in the kidneys. The kidney
failure of HRS is a consequence of these changes in blood flow,
rather than direct damage to the kidney. The diagnosis of
hepatorenal syndrome is based on laboratory tests of individuals
susceptible to the condition. Two forms of hepatorenal syndrome
have been defined: Type 1 HRS entails a rapidly progressive
decline in kidney function, while type 2 HRS is associated with
ascites (fluid accumulation in the abdomen) that does not improve
with standard diuretic medications.

16. Diagnosis
 Blood tests
 Nucleic acid tests
 Liver biopsy
 Elastography
 Surrogate markers

18. Treatment
Bed rest, abstaining from alcohol,
and taking medication to help
relieve symptoms. Most people
who have hepatitis A and E get
well on their own after a few
weeks.
Hepatitis B is treated with drugs,
such as lamivudine and adefovir
dipivoxil. Hepatitis C is treated
with a combination of
peginterferon and ribovarin.
Liver transplant of hepatitis B or
C, or D-caused liver failure.

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