Pathophysiology and clinical Aspect in Ayurveda as well as modern

1. PATHOPHYSIOLOGY AND CLINICAL ASPECT
DR MOHAMMAD AAMIR
MD SCHOLAR
DEPARTMENT OF KAYACHIKITSA

2.  INTRODUCTION
 PREVALENCE
 SEROLOGY & INTERPRETATION
 CLINICAL FEATURES
 IMMUNISATION
 WHAT ABOUT AYURVEDA

3. INTRODUCTION
Liver is the largest organ of body weighing
1.2-1.5 kg
Inflammation to this organs can be due to various reasons
,termed as hepatitis
Drug induced
Infection
Alcohol etc
The structural anomalies — hepatitis,cirrhosis ,cyst ,tumour
and malignancy
Functional anomalies –RBC breakdown , Reduction of
serum, albumin,platelets,clotting factors

4.  Hepatitis A
 Hepatitis B
 Hepatitis C
 Hepatitis D
 Hepatitis E
Viral Hepatitis

5. Hepatitis B
 It is defined as a liver
disease that results
from infection with the
Hepatitis B virus
(HBV)and is spread
through contact with
infected body fluids or
blood products

6.  Hepatitis B virus is the only DNA virus and
that too double stranded .
 HAV,HCV,HEV,HDV all are RNA virus and
single stranded .
 Double stranded and too DNA = more
complex= more complex serology

7. Incubation period of HBV
is 30-180 days
HBV is present in all
physiologic and
pathologic body fluids
,excepts in stools.

8. PREVALENCE
&
EPIDEMIOLOGY
Worldwide , 500 million
people are estimated to be
infected with Hepatitis B or C
These viruses kill 1.5 million
people per year .
1 in every 3 people has been
exposed to either or both
viruses .
Most infected people do not
know about it due to dormant
symptoms.

9.  PERCUTAEOUS
 INTRAVENOUS ROUTE –IV DRUG
ABUSE,BLOOD TRANSFUSION
 SEXUAL –UNPROTECTED SEXUAL
INTERCOURSE
 MOTHER TO CHILD DURING PARTURITION
(vertical )
 SALIVA

10. The Hepatitis B Virus has three antigens
Surface Antigen (HBsAg)
Core Antigen (HBcAg)
Envelope Antigen (HBeAg)

11. Antigens
 HBsAg is a surface antigen…greater
the quantity of HBsAg more likely to
develop symptoms
 HBeAg :- The e antigen is marker of
viral replication.so more HBeAg is in
blood,more the virus is partying in
body.It is marker of strong infectiblity
and transmission.
 HBcAg :- found inside the hepatitis
virus .It does not Circulate in blood .So
blood test is not useful

12. Antibodies
Produced as a part of immune
response.
B cells produce antibodies against
antigens.
Types of antibodies
Surface Antibodies
E antibodies
Core Antibodies

13. Hepatitis B surface Antibody
Immune response to theHep B surface antigen
Antigen is also given as a part of Vaccine.
+ve Hep B Antibody = Vaccinated
+ve Hep B Antibody =in response to an infection.
Use other viral marker to distinguish
Previous vaccine. Due to an infection

14. Patient is less infectious
Good Immune response to the virus
Patients is in acute phase of infection
Virus is replicating very quickly
Hep B e antigen level ——- infectivity
Hep B e antigen = - ve
Hep B e antibody = +ve
Remember
HBeAg

15. Hep B core antigens Middle . Blood
Hep B core Antibodies
Acute. Chronic. Past infections
IgM (Acute infection)
IgG (Helps to protect against future infections )

17. Who is at risk of infection?
 Hepatitis B can affect any age group:
 Sex partners of infected individuals.
 Men who have sex with men (MSM).
 Household contacts of infected people.
 Healthcare providers.
 People living with HIV infection.

18.  HBsAg –A reliable marker of infection and appears first before
the symptoms;disappears over 3-6 months
 Anti HBs –appears after disappearance of HBsAg and persists
lifelong .
 HBcAg –not found in blood .
 Anti HBc –usually the first antibody to appear and persists
lifelong ; initially it is of Ig M type and later IgG type.

19.  HBeAg –detected transiently,early in the course ;it’s persistence
is correlated with continued viral replication ,infectivity and
progression to chronicity.
 Anti HBe –detected later during the course .
 HBV DNA –A marker of active replication and appears along with
HBsAg.
 Mildly elevated but may be as high as 1000 units .ALT tends to
be more raised than AST .
 Once Cirrhosis develops ,AST level exceeds ALT.

20. Serum Bilirubin-It may be normal or raised up
to 10mg/dl
Serum proteins ——- Hypoalbuminemia in
severe cases and hyperglobuminemia.
Prothrombin time ——-prolonged

22. HBsAg Anti -HBs Anti-HBc HBeAg Anti-HBe Interpretati
on
+ve (Acute) - IgM + - Acute
hepatitis B
+ve (>6
months )
- IgG + - Chronic
hepatitis B +
acute viral
replication
+ve (>6
months)
- IgG - + Chronic
hepatitis B +
low viral
replication
- + IgG - + or - Hepatitis B
recovery
phase
(immunity)
- + - - - Vaccination
COMMON SEROLOGICAL PATTERN
IN HBV INFECTIONS

24. HBsAg POSITIVE
Anti HBc POSITIVE
IgM anti HBc POSITIVE
Anti HBs NEGATIVE
Yes , Active infection
Yes , Previous or
ongoing infection
Acute ongoing
infection
No immunity

25. HBsAg POSITIVE
Anti HBc POSITIVE
IgM anti HBc. NEGATIVE
Anti HBs NEGATIVE
Yes , Active infection
Yes , Previous or
ongoing infection
No Acute infection
No immunity

26. HBsAg NEGATIVE
Anti HBc NEGATIVE
Anti HBs POSITIVE
No , Active infection
No , Previous or
ongoing infection
Yes,immunity

27. HBsAg POSITIVE
Anti HBc POSITIVE
IgM anti HBc. POSITIVE
Anti HBs NEGATIVE
Yes , Active infection
Yes , Previous or
ongoing infection
Acute ongoing
infection
No immunity

28. HBsAg NEGATIVE
Anti HBc POSITIVE
Anti HBs NEGATIVE
Four possibilities
1.Resolved infections
2.False +ve anti HBc
thus susceptible
3.Low level Ch. Infection
4.ResolvingAcute infection

29. Susceptible
HBsAg NEGATIVE
Anti HBc NEGATIVE
Anti HBs NEGATIVE

30. Prognosis
Acute ——————good
Chronic ————poor
Severity
Occasionally severe

31. Immunisation schedule for Hepatitis B virus
Vaccine Dose 1 Dose 2 Dose 3 Dose 4
3 dose
Series
Brand names
Enteric,
Recombivax HB
Stand alone
Hep B vaccine
At BIRTH
(<24 hours )
Stand alone
Hep B vaccine/
Pentavalent
1 month after
dose 1
Pentavalent
6 month after
dose 1
4 dose
Series
Brand names
Vaxelis,
pediarix
Stand alone
Hep B vaccine
At BIRTH
(<24 hours )
Pentavalent 1
AT 6 weeks
Pentavalent 2
At 14 weeks
Pentavalent 3
At 6 month

32. Contraindications
Case of Anaphylaxis
Hypersensitivity following a previous dose of vaccine
INJECTION SITE
Three injections are given
in deltoid muscle at 0,1,6
months .Dose is 10ug for
children under 10 years
and 20ug in children above
10 years

34. Three criteria are used namely
Serum levels of HBV DNA (Serum HBV DNA
above 2000 IU/ml )
Serum levels of ALT (greater than two times the
normal)
Histological grade and stage .(Moderate to
severe)

35. Aim of treatment of chronic Hepatitis B
 Seroconversion of HBeAg when present to anti Hbe
.when HBeAg disappears,remission is usually attained
for several years .
 Reduction of HBV DNA to 400 IU / L or less .
 Achieve normal levels of serum ALT.
 Histological improvement in inflammation and fibrosis
in the liver biopsy.
 Patient usually remain HBsAg positive ,but loss of
serum HBsAg indicates a good response

36. Drugs used for Chronic Hepatitis B Virus
Entecavir– very effective and quickly reduces HBV DNA by 48
weeks .
Dose :- 0.5 -1 mg daily
Tenofovir – very effective and has similar potency to entecavir .it
is used for HIV patients with HBV infections.
Dose :- tenofovir disoproxil fumarate 300mg daily
Pegylated alpha 2a interferon ———response occurs in 25-
40%cases.
Dose :- 180 ug once a week subcutaneous

37. Liver transplant:– if liver is severely damaged.
Treatment to prevent hepatitis B
infection after exposure
Call doctor immediately
An injection of immunoglobulin
given within 12 hours of
exposure may be helpful.
Hepatitis a Vaccine for long term
prophylaxis.

39. What

41. Yakrit vikaras are discussed under Udara rog prakraran.
Charak Samhita———- plihodar treatment
Sushruta Samhita ———- yakruit as yakritdalyudar ,but no specific
treatment except siravedhan on the right hand side.
Detailed description of yakrit vikaras ———— Bhavaprakash
Sign & symptoms of yakrit vridhi (Hepatomegaly)
Mand Jawar (mild fever )
Mand Agni (low digestive power)
Ksheen Bala (weakness)
Ati pandu (extreme anemic)

42. Since yakrit vikaras are mentioned under Udar roga,,so
line of treatment is also used.
दोषातिमात्रोपचयाि् स्रोिोमार्गतिरोधिाि्|
सम्भवत्युदरं िस्मातित्यमेव तवरेचयेि्||६१|
तपत्तोदरे िु बतििं पूवगमेव तवरेचयेि्|
दुबगिं त्विुवास्यादौ शोधयेि् क्षीरबस्तििा||६८
सवगमेवोदरं प्रायो दोषसङ्घािजं मिम्||९५||
िस्मास्तरिदोषशमिीं तियां सवगत्र कारयेि्|
दोषैः क
ु क्षौ ति सम्पूर्णे वतिमगन्दत्वमृच्छति||९६||
िस्माद्भोज्याति भोज्याति दीपिाति िघूति च|

43. Name of yakrit vikara Name of Ayurvedic text
Yakrit vridhi Bhavapraksh
Yakritadallyudar Ashtang Samgraha
Yakritgat dosha Charak Samhita
Yakritodara Charak Samhita
Yakrit vidradhi Sushruta Samhita

44. प्लीिोतिष्टा: तिया: सवाग: यक
ृ िरोर्े समाचरेि।
कायाांच दतक्षर्णे बािौ ित्र शोतर्णमोक्षर्णम।।
 समुद्र क
े सीप की भस्म को युस्तिपूर्णग दुग्ध क
े साथ सेवि
 अक
ग क
े पत्तोंको सैंधव िवर्ण क
े साथ पुट पाक करक
े दिी क
े साथ सेवि
 शंख िाभी भस्म + जंबीरी िींबू क
े रस
 शरपुंखा की जड़ का कल्क + िि
 यक
ृ ि व प्लीिा की शांति क
े तिए सेमि क
े फ
ू ि को उबाि कर राि भर
रििे दे,,तफर प्रािैः राई क
े चूर्णग क
े साथ खािा चातिए ।

45. युिं प्लीिोदरी जािं सव्योषं िूदकोदरी|
प्रयोर्ार्णां च सवेषामिु क्षीरं प्रयोजयेि्||१९३||
दोषािुबन्धरक्षाथां बिस्थयागथगमेव च|

47. DR MOHAMMAD AAMIR
MD SCHOLAR
DEPARTMENT OF KAYACHIKITSA
Guided by Dr Sujit Kumar