Presentation on viral hepatitis

1. ASAD ASLAM KHALDI

2. Objectives
● Define Viral Hepatitis
● Causes of Viral Hepatitis
● Classify Different Types of Viral Hepatitis (Acute vs Chronic)
● Differentiate between types of Acute Viral Hepatitis (A & E)
● Differentiate between types of Chronic Viral Hepatitis (B, C, & D)

3. VIRAL HEPATITIS
Viral hepatitis is a systemic disease with
primary inflammation of the liver cause
by different viruses.

4. CAUSES OF VIRAL HEPATITIS

5. TYPES OF VIRAL HEPATITIS
Viral Hepatitis
Chronic Viral Hepatitis
Acute Viral Hepatitis
Hepatitis A & E Hepatitis B, C & D

7. 01
ACUTE HEPATITIS
(Hepatitis A & E)

8. Organism: The hepatitis A virus (HAV) belongs to the
picornavirus group of enteroviruses.
Incubation Period: 2- 4 weeks
Mode of Transmission: faecal-oral route
Population at Risk:
Children
Low-socio economic area (poor sanitation and over crowding)
Prisoners
HEPATITIS A

9. Infectivity Period: Infected individuals,
who may be asymptomatic, excrete the virus in faeces for
about 2–3 weeks before the onset of symptoms and then
for a further 2 weeks or so.
Investigations:
Serology:
Active Infection: Anti-HAV IgM
Recovery/Vaccination: Anti-HAV IgG (protective antibody)
HEPATITIS A

11. Silent/Subclinical: Asymptomatic
Classic Presentation: Occurs in 3 phases:
Prodromal phase:
● Headache
● Myalgia
● Arthralgia
● nausea and anorexia
Icteric phase:
● Jaundice
● Dark urine
● Pale stool
● Abdominal pain
Recovery phase
HEPATITIS A

13. Treatment:
Self-limiting infection
Supportive treatment
Prevention:
Active Immunity:
Vaccine (2 doses),can be given in children >1 year of age, booster after 6-12
months.
Passive Immunity:
Immunoglobulin (post-exposure prophylaxis)
Proper sanitation
HEPATITIS A

14. HEPATITIS E
Organism: Hepatitis E is caused by an RNA virus.
Incubation Period: 3-8 weeks
Mode of Transmission: faecal-oral route
Clinical Features:
• Mild fever
• reduced appetite, nausea and vomiting lasting for a few days
• abdominal pain
• itching jaundice
• dark urine and pale stools
• Painful hepatomegaly

15. HEPATITIS E
Investigations:
Serology:
Active Infection: Anti-HEV IgM
Hepatitis E differs from hepatitis A in that infection during pregnancy is
associated with the development of acute liver failure, which has a high
mortality.
Treatment:
Self-limiting infection
Supportive treatment

17. 02
CHRONIC HEPATITIS
(Hepatitis B, C, & D)

18. HEPATITIS B
Organism: The hepatitis B virus (HBV) is a DNA virus that
belongs to the Hepadna group.
Incubation Period: 4- 20 weeks
Mode of Transmission:

19. HEPATITIS B
Clinical Features:
Acute Infection:
• Fever
• jaundice .
• Painful hepatomegaly.
• Elevated serum transaminases (ALT>>AST).
• Followed by recovery.
• Can progress to fulminant hepatitis in <1% cases

20. HEPATITIS B
Clinical Features:
Chronic Infection:
Usually asymptomatic.
90% of the infected babies and infants will develop a
chronic hepatitis B infection.
Complications:
Hepatocellular carcinoma
Cirrhosis
Hepatitis is one of the most common causes of
chronic liver disease and hepatocellular carcinoma
world-wide.

21. HEPATITIS B
Investigations

22. HEPATITIS B
Treatment:
The goals of treatment are HBeAg seroconversion, reduction in HBV-DNA and
normalisation of the LFTs.
Acute Infection:
Treatment is supportive with monitoring for acute liver failure, which occurs in less than
1% of cases.
Full recovery occurs in 90–95% of adults following acute HBV infection.
The remaining 5–10% develop a chronic infection which usually continues for life,

23. HEPATITIS B
Chronic Infection:
Medical Treatment:
Nucleoside-nucleotide antiviral agents Entecavir or Lamivudine (1st line agents
Pegylated interferon Alpha (PEG INF-alpha)
Surgical Treatment:
Liver transplant
Prevention:
• Active: Recombinant vaccine (at birth, 1-month, after 6 months).
• Passive: Immune globulins.
• Use of sterilized needles
• Proper screening of blood before transfusion.
• Avoid unprotected sexual contact.

24. HEPATITIS D
Organism: The hepatitis D virus (HDV) is an RNA-defective
virus.
Incubation Period: 6-9 weeks
Mode of Transmission: Parenteral
Infection with HDV arises in following setting:
● Co-infection by HDV & HBV
● Super-infection of chronic HBV carriers by HDV
Management:
Effective management of hepatitis B effectively prevents
hepatitis D.

25. HEPATITIS C
Organism: This is caused by an RNA flavivirus.
Incubation Period: 2 - 26 weeks
Mode of Transmission: Parenteral

26. HEPATITIS C
Clinical Features:
Acute Infection:
80% is subclinical, only 10-20% is symptomatic any may cause:
• Fatigue
• Muscle pain
• Joint pain
Jaundice and complications of portal hypertension typically occur
only when the disease progresses to cirrhosis.
Chronic Infection:
Chronic hepatitis occurs in 80% of patients
Cirrhosis occurs in 20% of chronic infection within 20 years.
Hepatocellular carcinoma develops in 2-5% of patients with
cirrhosis.

27. HEPATITIS C
Investigations:
Serology:

29. HEPATITIS C
Treatment:
The aim of treatment is to eradicate infection.
Treatment of choice: The treatment of choice is pegylated α-interferon given
weekly subcutaneously, together with oral ribavirin.
Liver transplantation should be considered when complications of cirrhosis
occur, such as diuretic-resistant ascites.
Cure is defined as loss of virus from serum 6 months after completing therapy.
Prevention:
There is no active or passive protection against HCV.

31. References
• https://www.who.int/health-topics/hepatitis
• https://www.cdc.gov/hepatitis/abc/index.htm
• https://www.hopkinsmedicine.org/health/conditions-and-diseases/hepatitis
• Robbins Basic Pathology (10th Edition), Chapter 16 Liver and Gallbladder,
General Features of Liver Disease

32. Thank You