The document is a lecture presented by Mr. Dahir Abdiwali on hepatitis, detailing its types, modes of transmission, and the pathophysiology of various forms of the disease. It highlights the prevalence and serious health consequences associated with viral hepatitis, as well as preventive measures and treatments for hepatitis A, B, C, D, and E. By the end of the session, students are expected to understand the nature of hepatitis and be equipped to discuss its implications in healthcare.

1. Child Growth & development
Lecturer: Mr - Dahir Abdiwali
Lecture: HEPATITIS
Semester: FIVE
Faculty :Health sciences
Department: nursing

2. PRESENTATION
ON
“Hepatitis”

3. Specific objectives
At the end of this session, students will be able to:
• Introduce Hepatitis.
• State the facts related to Hepatitis
• Enumerate the classification of Hepatitis
• the types of viral hepatitis
• Describe the mode of transmission of Hepatitis.
• Explain the patho-physiology of Hepatitis

4. INTRODUCTION
 Liver is the largest organ of the human body.
 It weights 1.2-1.5 kg in the adult.
 It is the chemical factory of the body.
 It performs multiple functions which are essential
for life.
 It has enormous reserve capacity and marvelous
regenerating power

5. Liver Functions
Metabolic function
Synthetic function
Excretory function
Detoxifying function
Secretory function
Storage function
Miscellaneous Function

6. Introduction
• The word “hepatitis” comes from the ancient
Greek word “hepar” meaning liver and
English word “itis” meaning inflammation.
• Hepatitis is the widespread inflammation of
liver cells resulting from viral or bacterial
infection, drugs, alcohol or chemicals toxic to
the liver and some metabolic and vascular
disorders.

7. Facts related
to
Hepatitis

8. WORLD
• About 2.3 billion people of the world are infected
with one or more of the hepatitis viruses.
• Viral hepatitis results in around 1.4 million deaths
each year, HBV and HCV are responsible for about
90% of these fatalities, whilst the remaining 10% of
fatalities are caused by other hepatitis viruses.
• Globally, only 1.5 million clinical cases of HAV are
reported annually while the rate of infection is much
higher.

9. Cont…
• Approximately one-third of the World’s population
have been infected with HBV.
• Around 5% of this population are chronic carriers
and a quarter of these carriers develop serious liver
diseases such as chronic hepatitis, cirrhosis and
hepatic carcinoma.
• Every year, 7,80,000 HBV-related deaths are
documented around the globe.
-World Journal of Clinical Cases (2018)

10. Classification
• Viral Hepatitis
• Bacterial Hepatitis
• Toxic and drug-induced hepatitis
• Alcoholic hepatitis
• Autoimmune hepatitis

11. Cont…
• Viral hepatitis is the most common type of hepatitis
worldwide.
• Bacterial hepatitis: bacterial infection of the liver results
in pyogenic liver abscesses, acute hepatitis, .
• Toxic and drug-induced hepatitis
• Many chemical agents, including medications, industrial
toxins, and dietary supplements, can cause hepatitis.

12. Cont…
Alcoholic hepatitis
• Excessive alcohol consumption is a significant cause
of hepatitis and is the most common cause of
cirrhosis.
Autoimmune hepatitis
• It is a chronic disease caused by an abnormal immune
response against liver cells. Formerly called lupoid
hepatitis.

13. Types of viral hepatitis
• Hepatitis A
• Hepatitis B
• Hepatitis C
• Hepatitis D
• Hepatitis E

14. Stages of Hepatitis Infection
• The various clinical patterns and pathologic
consequences of different hepatotropic viruses
can be considered under the following
headings:
i) Carrier state
ii) Asymptomatic infection
iii) Acute hepatitis
iv) Chronic hepatitis
v) Fulminant hepatitis (Submassive to massive
necrosis)

15. Stages of liver disease

16. Hepatitis A (Infectious hepatitis)
Etiology:
Hepatitis A virus (HAV).
HAV is a RNA virus of Entero virus family.
Incubation period:
15-50 days (average 28 days)

18. Mode of transmission
• Feco-oral route (the ingestion of food or liquid
infected by the virus)
• Close personal contact
• Transmission possible with oral-anal contact
during sex

19. Pathophysiology
Hepatitis A virus invade the body
Multiplication occurs in intestinal epithelium
Reaches liver by intestinal epithelium
Replication within liver cells
Enters intestine with bile
Appears in feces

21. Diagnosis
History taking
Physical examination
Biochemical test: Bilirubin, protein and
alanine aminotransferase
Stool examination.

22. Treatment
• During acute stage, provide adequate bed rest
and nutritious diet to the patient.
• Anorexia can be managed by giving small,
frequent meals and supplemented IV fluids
with glucose
• Most people recover completely
• No medicine or treatment to make it go away.

23. • Prevention
• Good personal hygiene
• Environmental sanitation
• Administration of immunoglobulin : Give this Hepatitis
A vaccine within two weeks of exposure. Passive
immunity is produced after 6-8 weeks.
Immunoglobulin suppress over the symptoms of this
disease.
• Pre-exposure prophylaxis for people age 2 and older
who are traveling to or working in developing countries
should strongly consider the Hepatitis A vaccine.

24. Hepatitis B
• Hepatitis B, also known as Serum hepatitis.
• It is a serious disease that infect the liver and
can cause life long infection, cirrhosis, liver
scarring , liver cancer, liver failure and death.
• Etiology: Hepatitis B virus (HBV).
HBV is a double shelled DNA virus of
enterovirus family.

25. Cont..
• Incubation period: 48-180 days (average 120
days)
• HBV virus is found in the blood and in lesser
amounts in body fluids like saliva, semen,
vaginal secretions etc. of an infected person.

26. • Mode of transmission:
• Hepatitis B is mainly transmitted by,
• Unprotected sex with an infected person
• Sharing needles with an infected person
• Tattooing and piercing with tools that were not sterilized
• Sharing personal items such as razors or toothbrushes with
an infected person
• Mothers can inoculate the baby during the birth process
• Accidental needle pricks
• Blood transfusion
• Hemodialysis

27. Pathophysiology
Invasion of virus into the body
Multiplication inside the liver cells
Hepatocellular injury
Inflammatory cells infiltrate into the portal tracts
Kupffer cell hyperplasia
Cholestasis
Regeneration

28. Clinical manifestations

29. Diagnosis
 History taking
 Physical examination
• Serological tests: Enzyme Linked Immunosorbant
Assay (ELISA)
• Biochemical test

30. Treatment
• The aim of the treatment is to stop viral
replication, reduce liver damage, and improve
the quality of life. Eradication of the virus is
rare.
• Following measures can be implemented,
 Physical rest
 Psychological rest
Adequate nutrition-

31. Drug therapy:
• Alpha-interferone IV TDS to decrease
inflammation
• Antiviral drugs:
-Lamivudine (Epivir HBV) and
-Adefovir dipivoxil (Hepsera) orally
• Immunomodulating drugs:
-Oral ribavirin ( Virazol )
• Antiemetics to control vomiting

33. Hepatitis C
• Also known as non A, non B Hepatitis
previously.
• Etiology: Hepatitis C virus (HCV). HCV is a
RNA virus of enterovirus family.
• Incubation period: 14-180 days
• Mode of transmission: Same as Hepatitis B

35. Pathophysiology
• HCV is a virus that is carried in the blood
stream to the liver.
• It can then affect and damage the liver.
• This virus can also affect other parts of the
body such as digestive, nervous and immune
system.

36. Diagnosis
• History taking
• Physical examination
• Detection of antibody:
- Enzyme Linked Immunosorbant Assay
(ELISA)
• Anti-HCV antibody in acute infection
• Does not provide immunity to virus

37. Cont…
• Polymerase chain reaction (PCR) to detect
the virus.
• Liver function tests
• Ultrasound scan
• Liver biopsy

38. Treatment
• The main aim of treatment is to clear the HCV
virus from the body and prevent severe
damage leading to cirrhosis.
• The treatment consists of combination of two
different medicines
- PEGylated interferon (peginterferone)
- Ribavirin , fights virus
• Liver transplant- for advanced cirrhosis
• Avoid alcohol and follow good diet

39. Prevention
• Avoid sharing any injecting equipment
• Practice safe sex
• Avoid sharing personal items that may be
contaminated with blood, eg. Razor
• Donor screening for blood and tissue products
• No vaccine exists for HCV.

40. Hepatitis D
• Also known as delta virus. Unlike the other
forms, hepatitis D cannot be contracted on its
own. It can be contracted only if a person is
already infected with hepatitis B.
• Etiology: Hepatitis D virus (HDV). HDV is a
RNA virus of enterovirus family.
• Mode of transmission:
Blood or body fluids as with HBV.
• Incubation period: 14-56 days

41. Clinical manifestations
• The symptoms of hepatitis B and hepatitis D
are similar. The common symptoms include:
- Jaundice, joint pain, abdominal pain, vomiting,
loss of appetite, dark urine, fatigue
• Hepatitis D can also cause the symptoms of
hepatitis B to worsen or appear in those who
have been infected but have not yet developed
symptoms.

42. Diagnosis
• History taking
• Physical examination
• Detection of antibody:
- Enzyme Linked Immunosorbant Assay (ELISA)
• Anti-HDV antibody in acute infection
• Does not provide immunity to virus
• Polymerase chain reaction (PCR) to detect the
virus.
• Liver function tests

43. Treatment
• Currently there are no known treatments for
acute or chronic hepatitis D.
• Chronic HDV is treated with alpha interferone
in practice.
• Antiviral medications do not seem to be very
effective in treating hepatitis D.

44. Prevention
• Preventing HBV also prevents HDV.
• It is recommended that all persons be vaccinated
for Hep. B.
• Standard precautions for all the patients in the
health care setting.
• Avoid contact with infected blood, contaminated
needles and an infected person’s personal items.
• No vaccine exists for HDV.

45. Hepatitis E
• Etiology: Hepatitis E virus (HEV).
HEV is a RNA virus of enterovirus family.
• Incubation period:15-60 days
• It is usually a self-limiting, and resolves within
4-6 weeks.
• HEV is more severe in pregnant women,
especially in the third trimester.

47. Mode of transmission
• Feco-oral route due to fecal contamination of
drinking water.
• Eating contaminated raw shellfish
• Ingestion of products derived from infected
animals.

48. Clinical manifestations
• Symptoms are similar to Hepatitis A infection,
which includes,
- Jaundice, anorexia, hepatomegaly, abdominal
pain and tenderness, nausea and vomiting and
fever.

49. Diagnosis
• History taking
• Physical examination
• Detection of antibody:
- Enzyme Linked Immunosorbant Assay (ELISA)
• Anti-HEV antibody in acute infection
• Once infected with HEV, the person is immune to
virus
• Reverse transcriptase polymerase chain
reaction (RT-PCR) to detect the virus.
• Liver function tests

50. Treatment
• Treatment with immunoglobulin immediately
after exposure within two weeks of exposure.
• Usually self-limiting, no treatment required.
• Hospitalization is required in case of
fulminant hepatitis and for infected pregnant
women.
• Avoid alcohol
• Symptomatic treatment of flu-like illness

51. • Prevention
• Hepatitis E vaccine is usually available for
people 2 years or older.
• Maintaining safe water supply
• Establishing proper disposal systems to
eliminate sanitary waste.

52. Any queries ???

53. Post Test
1) Answer the following questions.
1. the types of viral hepatitis ?
2. Describe the mode of transmission of Hepatitis ?
3. Define Hepatitis ?
4. What did you understand about the lesson ?
5. In your opinion ,what advice would you give
To a person with hepatitis since you are a
medical student ?

54. Summary

55. Reference
• Retrieved from
https://www.cdc.gov/mmwr/volumes/67/rr/rr6701a1.htm
on 19 june, 2021
• Retrieved from
https://www.who.int/occupational_health/activities/5pepgui
d.pdf on 19 june, 2021
• Retrieved from
https://emedicine.medscape.com/article/775507-
treatment#d15 on 19 june, 2021