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Similar to Hepatitis acute
Hepatitis acute
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- 2. Hepatitis • Any diseaseprocess characterized by a diffuse inflammatory infiltrate of liver tissue, with or without a degree of hepatocellular necrosis and local fibrosis. • Etiology Infectious, Chemical, Toxic and Autoimmune
- 3. Clinical Forms • Acuteviral hepatitis • Recent infection and inflammation of the liver • Chronic viral hepatitis • Persistent viral infection of liver tissue lasting more than 6 months
- 4. • Causes ofAcute Hepatitis • Viruses (A,B,C,E,EBV,CMV) • Alcohol • Toxins (Carbon tetrachloride) • Drugs (INH, PZA)
- 5. Acute Hepatitis • Prodromalillness (Flu like) • Vomiting • Aversion to alcohol and cigarettes • ABDOMINAL discomfort • Pale faeces and dark urine • Jaundice
- 6. Agents of ViralHepatitis • Enterically transmitted hepatitis • Hepatitis A and E. • Acute diseases with no chronic phase
- 7. • Blood-borne viralhepatitis – Hepatitis B, C and D, all chronic infections • Systemic agents not restricted to the liver – HSV, VZV, EBV, CMV, HIV.
- 8. Hepatitis A • SymptomaticIllness • Symptomatic in 80% of adults but not children (<3%) • Malaise, Vomiting and jaundice prominent • Transmission patterns • Person to person contact • Common source outbreaks especially seafood
- 9. HAV Pathogenesis • Ingestedorally, Resistant to stomach acid • Reaches the liver via the intestine • Replicates in hepatocyte cytoplasm • Secreted in the bile and excreted in faeces • Cell mediated immune clearance and cyto-pathology • Symptoms last 2-3 weeks
- 10. Laboratory Diagnosis ofHAV • Serological diagnosis • Preferred method is EIA for anti-HAV IgM • Acute antibody response with a rise in IgM • Simultaneous gradual rise in IgG
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- 13. Treatment • Supportive re-hydrationand nutrition • Avoid alcohol • Outcome • �Recovery in > 99%, clinical relapse in 4-20% • �Rarely need to hospitalize or transplant • �Fulminant hepatitis <0.35%
- 14. Hepatitis E • Epidemiology •�A major cause of sporadic and epidemic hepatitis • �Water-borne • �Only 5% of adult cases have jaundice
- 15. HEV Pathogenesis • �Entryacross intestinal mucosa (unknown) • �Secreted in faeces • 2 weeks before and 1 week after symptoms • �Detected in serum for two weeks after onset • �Affects liver Kupffer cells and hepatocytes • �Cholestasis is a feature in 50% of cases • �Injury appears immune mediated
- 16. Laboratory Diagnosis ofHEV • EIA based assays for IgM and IgG
- 17. HEV Prevention andTreatment • Treatment • Supportive therapy • No specific treatment • Prevention • �No vaccines available • �Recombinant protein in animal & human trials • �Immune serum globulin is ineffective
- 18. • Alcoholic Hepatitis •Can be acute or chronic • Risk of cirrhosis variable…genetics, sex (women • more susceptible,) presence of chronic hepatitis, • possibly nutritional factor • Presentation can range from an asymptomatic • person to a critically ill one
- 19. • Drug inducedLiver Disease • 3 subtypes • � Direct hepatotoxic group • � Idiosyncratic reactions • � Cholestatic reactions
- 20. • Direct hepatotoxicGroup • �Dose related severity • �Latent period after exposure • Examples…acetominophen, alcohol, carbon • tetrachloride, niacin, vitamin A
- 21. • Idiosyncratic Reactions •� Sporadic and rare • � Not dose related • � Occasionally fever and eosinophilia • suggesting an allergic type reaction
- 22. • Cholestatic Reactions •� Non-inflammatory (direct effect on bile • secretion)…examples estrogens, anabolic steroids, • azathioprine • � Inflammatory (portal areas with cholangitis) often • with allergic features…examples erythromycin, • ampicillin-clavulanic and semi-synthetic penicillins, • chlorpropamide
- 23. • Autoimmune Hepatitis • Generally affects young females (less often postmenopausal) • ANA and anti-smooth muscle antibodies each present • in 70% • Hypergammaglobulinemia • Extrahepatic manifestations are clues…amenorrhea, • thyroiditis, acne, Sjogrens, arthritis, Coomb-positive • hemolytic anemia, nephritis • Old name was Lupoid Hepatitis
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- 25. Parenteral -IV drug abusers, health workers are at increased risk. Sexual - sex workers and homosexuals are particular at risk. Perinatal(Vertical) - mother(HBeAg+) →infant. HBV:HBV: Modes of TransmissionModes of Transmission
- 26. Pathogenesis & Immunity •Virus enters hepatocytes via blood • Immune response (cytotoxic T cell) to viral antigens expressed on hepatocyte cell surface responsible for clinical syndrome • 5 % become chronic carriers (HBsAg> 6 months)
- 27. Clinical Features Incubation period:Average 60-90 days Insidious onset of symptoms : Tends to cause a more severe disease than Hepatitis A. Premature mortality from chronic liver disease: 15%-25%
- 29. Possible Outcomes ofHBV InfectionPossible Outcomes of HBV Infection Acute hepatitis B infection Chronic HBV infection 3-5% of adult- acquired infections 95% of infant- acquired infections Cirrhosis Chronic hepatitis 12-25% in 5 years Liver failureHepatocellular carcinoma Liver transplant 6-15% in 5 years 20-23% in 5 years DeathDeath
- 30. Prevention • Vaccination • -highly effective recombinant vaccines • Hepatitis B Immunoglobulin (HBIG) • -exposed within 48 hours of the incident/ neonates whose mothers are HBsAg and HBeAg positive. • Other measures • -screening of blood donors, blood and body fluid precautions.
- 33. Hepatitis B Vaccine •Infants: several options that depend on status of the mother – If mother HBsAg negative: birth, 1-2m,6-18m – If mother HBsAg positive: vaccine and Hep B immune globulin within 12 hours of birth, 1-2m, 6m • Adults * 0,1, 6 months • Vaccine recommended in – All those aged 0-18 – Those at high risk
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- 35. Pathology of HCV •Acute Hepatitis C: – Generally benign: • No jaundice (80%) • Usually asymptomatic – Can be severe, but liver failure rare Only real threat of acute Hepatitis C is its ability to reach chronic stages undetected and untreated.
- 36. Pathology of HCV •Chronic Hepatitis C: – 70% of patients become chronic – Possible results: • Cirrhosis • End-stage liver disease • Hepatocellular carcinoma
- 37. Transmission • Direct bloodor fluid exposure • Perinatal Transmission • Transmission: • Other things thought to be associated with HCV: – Tatoos – Acupuncture – Ear Piercing
- 39. • Indications ForTreatment – Increased ALT activity – Liver biopsy fibrosis – Detectible serum HCV RNA
- 40. • Vaccine: – Difficult: •High mutation rate
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