Awareness session on Hepatitis B and Hepatitis C by Dr Debashis Nanda with the Rotaract club of Cuttack Golden Star.

1. HEPATITIS B
&
HEPATITIS C
-DR DEBASHIS NANDA
MEDICAL OFFICER, SUB-DIVISIONAL HOSPITAL, HINDOL

2. LIVER
• The liver is located in the upper right-hand portion of the abdominal cavity, beneath
the diaphragm, and on top of the stomach, right kidney, and intestines.
• Shaped like a cone, the liver is a dark reddish-brown organ that weighs about 3
pounds.
• The liver holds about 13% of the body's blood supply at any given moment.
Functions of the liver
The liver regulates most chemical levels in the blood and excretes a product called
bile. This helps carry away waste products from the liver. All the blood leaving the
stomach and intestines passes through the liver. The liver processes this blood and
breaks down, balances, and creates the nutrients and also metabolizes drugs into
forms that are easier to use for the rest of the body or that are nontoxic.

3. VIRAL HEPATITIS
• VIRAL HEPATITIS: IT IS THE INFLAMMATION OF LIVER DUE
TO A VIRUS.
• THERE ARE 5 DIFFERENT TYPES OF VIRUSES CAUSING 5
DIFFERENT TYPES OF VIRAL HEPATITIS.

4. CLINICAL FEATURES COMMON TO BOTH
HEPATITIS : B & C
• SYMPTOMS ARE VARIABLE AND INCLUDE YELLOWING OF THE EYES, ABDOMINAL PAIN
AND DARK URINE. SOME PEOPLE, PARTICULARLY CHILDREN, DON'T EXPERIENCE ANY
SYMPTOMS.
• IN CHRONIC CASES, LIVER FAILURE, CANCER OR SCARRING CAN OCCUR.
SOME CAN
HAVE NO
SYMPTOMS,
BUT PEOPLE
MAY
EXPERIENCE:
WHOLE BODY: FATIGUE OR MALAISE
SKIN: WEB OF SWOLLEN BLOOD VESSELS IN THE SKIN OR
YELLOW SKIN AND EYES
ALSO COMMON: FLUID IN THE ABDOMEN

5. HEPATITIS - B

6. HEPATITIS-B VIROLOGY

7. OVERALL: VERTICAL >> PER-CUTANEOUS
HEPATITIS – B : MECHANISM OF TRANSMISSION
VERTICAL (ENDEMIC
AREA)
• IF MOTHER IS ANTI-
HBe + , THEN THE
RISK OF
TRANSMISSION TO
THE BABY IS
APPROXIMATELY
10%.
PER-CUTANEOUS
(NON ENDEMIC AREA
)
• NEEDLE STICK
INJURY >> BLOOD
TRANSFUSION
OTHER MOT
• VARIABLE RISK IS
ASSOCIATED WITH
THE SEXUAL MOT.
• HUMAN BITE IS A
RARE MOT ( VIRUS
IS SECRETED INTO
THE SALIVA ).
DESPITE VIGOROUS SCREENING, ABOUT 1 CASE OF HEP-B TRANSMISSION IS SEEN FOR NEARLY 2
LAKHS UNITS OF BLOOD TRANSFUSED.
(AS SOME DONORS HAVE LOW LEVEL OF HBsAg TITRES , WHICH ISN’T DETECTED BY THE ROUTINE
SCREENING PROCESS)
FECO-ORAL & BREAST MILK AREN’T MOT FOR HEP-B(VIRUS IS DESTROYED IN THE GASTRIC PH)

8. HEPATITIS B: QUICK FACTS
• INCUBATION PERIOD = 60 DAYS
• MOST COMMON VIRAL CAUSE OF CHRONIC HEPATITIS : HEP-B
• MOST COMMON CAUSE OF HEPATO-CELLULAR CARCINOMA : HEPA-B
RISK AFTER
ACUTE
VERAL
HEPATITIS
FULMINANT HEPATITIS : 0.1 – 1%
CARRIER STATE : 0.1 – 30%
CHRONIC HEPATITIS : 1-10 %
C/F
SPECIFIC
TO HEP-B
SERUM SICKNESS LIKE ILLNESS ( TYPES-3 HS)
MGN
PAN

9. HEPATITIS-B : SEROLOGY Marker Significance
HBs Ag
Anti-HBs
VIRUS +
VIRUS -
HBe Ag
Increasing
infectivity of
Pt.
Anti-HBe
decreasing
infectivity of
Pt.
HBc Ag
Never +ve in
blood
Anti-HBc
Exposure to
virus

10. MARKERS OF
REPLICATION
HBV- DNA
(QUANTITATIVE
MARKER OF
REPLICAATION)
> 2000 IU/ML IS
SIGNIFICANT
HBeAg
(QUALITATIVE
MARKER OF
REPLICATION)
+VE = REPLICATION
ACTIVE
-VE = NO ACTIVE
REPLICATION
HBsAg ONLY
POST VACCINATION

11. HEPATITIS-B : MANAGEMENT
ACUTE HEP-B
SUPPORTIVE
CARE
REPEAT
SEROLOGY AFTER
6 MONTHS
CHRONIC HEP-B :
HBsAg + ANTI
HBc
NON- CIRRHOTIC
HBV DNA
> 2000 IU/ML
LIVER BIOPSY
MOD-SEVERE
HEPATITIS
START
ANTIVIRALS
NORMAL- MILD
HEPATITIS
OBSERVE
< 2000 IU/ML
OBSERVE
CIRRHOTIC
MELD SCORE
< 18
START ANTI-
VIRALS
>18
LIVER
TRANSPLANT
MELD SCORE
MODEL for END STAGE LIVER
DISEASE
PARAMETERS
• SERUM CREATININE
• SERUM BILIRUBIN
• INR
ANTI-VIRAL D/O/C : TENOFOVIR ( IN NORMAL GFR )
ENTECAVIR ( IF GFR <60 ML/MIN )
DURATION OF TREATMENT : 1YR (APPROX.)
TARGET OF TREATMENT : HBV DNA : <2000 IU/ML

12. HEPATITIS - C

13. HEPATITIS-C : VIROLOGY

14. HEPATITIS-C : MODE OF TRANSMISSION
HEPATITIS–C
MOT
PER-CUTANEOUS
( ENDEMIC/ NON-
ENDEMIC )
NSI ( 6% )
BT ( 1 IN 18L
TRANSFUSIONS )
OTHER
VERTICAL ( 5% )
SEXUAL ( 5% )
RARE MOT HUMAN BITE
FECO-ORAL AND BREAST FEEDING AREN’T MOT FOR HEP-C

15. HEPATITIS-C : QUICK FACTS
• INCUBATION PERIOD : 50 DAYS
• MOST COMMON VIRAL CAUSE OF LIVER CIRRHOSIS : HEPATITIS-C
• MOST COMMON ACUTE VIRAL HEPATITIS LEADING TO CHRONIC HEPATITIS :
HEPATITIS-C
• MOST COMMON INDICATION OF LIVER TRANSPLANTATION : HEP-C
RISK AFTER
ACUTE
VERAL
HEPATITIS
FULMINANT HEPATITIS : 0.1%
CARRIER STATE : 2.5%
CHRONIC HEPATITIS : 85%
C/F
SPECIFIC
TO HEP-C
INSULIN RESISTANCE (T2DM)
CRYOGLOBULINEMIA
PORPHYRIA CUTANEA TARDA , LICHEN PLANUS
B-CELL NHL , THYROID CA , RENAL CELL CA

16. HEPATITIS-C : SEROLOGY
MAIN POSSIBILITY : HEPATITIS C PROGRESSING TO A CHRONIC INFECTION ( VIRUS > 6 MONTHS )
SCREENING INVESTIGATION FOR HEPATITIS-C : ANT-HCV ------ +VE ----> HCV RNA ( CONFIRMATORY TEST )

17. HEPATITIS-C : MANAGEMENT
ACUTE HEP-C
SUPPORTING
TREATMENT
ANTI-VIRALS
( IFN-ALPHA FOR
12-24 WEEKS )
CHRONIC HEP-C
NON-CIRRHOSIS
GIVE ANTI-
VIRALS TO
ALLPATIENTS .
REPEAT
SEROLOGY AFTER
6 MONTHS
CIRRHOSIS
MELD SCORE
< 18
ANTI-VIRALS
> 18
TRANSPLANT
ANTI-VIRALS : SOFOSBUVIR ( DOC ) , VELPATASVIR
DURATION OF TREATMENT : 12 WEEKS
TARRGET OF TREATMENT : HCV-RNA
UNDETECTABLE IN BLOOD

18. HOW TO PREVENT ?
• TAKE VACCINES AND GET YOUR CHILDREN VACCINATED.
• HEP-B VACCINE : ZERO DOSE AT BIRTH (PREFERRABLY < 24 hrs OF
LIFE), THEN 3 MORE DOSAGES WITH PENTA V VACCINE AT 6, 10 & 14
WEEKS.
• HEP-C VACCINE : No vaccine is currently available, but several
vaccines are currently under development.
• SCREENING OF VIRAL GENOMES
• SCREENING OF IG M & IG G ANTIBODIES
• AVOID MULTIPLE SEXUAL EXPOSURE
• AVOID UNNECESSARY BLOOD
TRANSFUSIONS
• MAINTAIN PROPER BLOOD HYGIENE

19. THANK YOU
• DR DEBASHIS NANDA
• drdebashisnanda@gmail.com
• Fb @drdebashisnanda
• Insta @drdebashisnanda
• Twitter @drdebashisnanda
• Koo @drdebashisnanda
• Yt @debashisnanda
• http://drdebashisnanda.weeblysite.com