Acute viral hepatitis

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GIT Lecture
Dr. Encarnacion

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Acute viral hepatitis

  1. 1. Acute Viral Hepatitis Elmer R. Encarnacion,MD
  2. 2. Types of Hepatitis CDC fact sheets, available at www.cdc.gov A B C D E G Source of virus Feces Blood, body fluids Blood, body fluids Blood, body fluids Feces Blood Route of Transmission Fecal-Oral Childbirth, needles, sex, transfusion Needles, transfusion (sex, childbirth) Needles, sex, transfusion (requires HBV co-infection) Fecal-Oral Transfusion (requires HBV, HCV, or HIV co-infection) Chronic Infection No Yes Yes Yes No No (whether it’s pathogenic to humans remains unclear) Prevention Vaccine Immuno-globulin Vaccine Immuno-globulin Blood donor screening, risk management, education HBV Vaccine Ensure safe drinking water Blood donor screening
  3. 3. Hepatitis A Virus <ul><li>RNA virus </li></ul><ul><li>Incubation period: 4 weeks </li></ul><ul><li>Replication limited to the liver </li></ul><ul><li>Virus present in liver, bile, stools, and blood </li></ul><ul><li>Infectivity diminishes once jaundice appears </li></ul><ul><li>Inactivation by boiling; formaldehyde, chlorine </li></ul><ul><li>Prevention by vaccination </li></ul><ul><li>Serologic marker: Anti HAV IgM </li></ul>
  4. 5. Hepatitis B <ul><li>DNA virus </li></ul><ul><li>Hepadnaviruses (hepatotropic) </li></ul><ul><li>Incubation period: 60 days </li></ul><ul><li>HBsAg+ precedes ALT elevation, symptoms </li></ul><ul><li>Extrahepatic sites: lymph nodes, bone marrow, lymphocytes, spleen, pancreas </li></ul>
  5. 7. <ul><li>Transmission of HBV varies by geographic area: </li></ul><ul><li>Mother to infant, child-to-child </li></ul><ul><ul><li>China, Southeast Asia, Middle East and parts of Africa and South America </li></ul></ul><ul><li>Parenteral Route (Intravenous or Intramuscular) </li></ul><ul><li>Intimate contact </li></ul><ul><ul><li>North America, Australia, Western Europe, temperate South America </li></ul></ul>
  6. 8. High-risk Individuals <ul><li>Infants born to HBV+ mothers </li></ul><ul><li>Adoptive families of children born in endemic areas </li></ul><ul><li>Recipients of blood products, including transfusions </li></ul><ul><li>Hemodialysis patients </li></ul><ul><li>Healthcare workers </li></ul><ul><li>Sexual partners of HBV carriers </li></ul><ul><li>People with sexually transmitted diseases </li></ul><ul><li>Intravenous drug users </li></ul><ul><li>People with multiple sexual partners </li></ul>
  7. 11. Acute vs Chronic Hepatitis B Acute Chronic Definition disease in which HBsAg persists for less than 6 months Persistence of HBsAg for more than 6 months Phases Incubation Prodromal Icteric Immune Tolerance Clearance Non-replicative Characteristics 1. Usually subclinical in children 2. 30%-50% of adult patients develop clinical manifestations 3. May become fulminant 1. Can be HBeAg (+) or (-) 2. Viral load is associated with disease activity 3. May progress to fibrosis, cirrhosis, or HCC
  8. 12. Signs and Symptoms Acute Chronic May be asymptomatic Usually asymptomatic Flu-like symptoms Malaise/Fatigue Skin Rash Extra-hepatic symptoms Jaundice Signs/symptoms of liver failure Light-colored stools Hepatocellular carcinoma Dark-colored urine
  9. 14. Pathogenesis of HBV Infection Averett DR and Mason WS. Viral Hep. Rev. 1995; 1 :129–42 Clinical hepatitis HBV-infected hepatocytes Inflammation and cell death HBV production Hepatocyte regeneration Uninfected hepatocytes Infection Immune response Re-infection Alcohol, co-infection etc.
  10. 15. Pathogenesis of Chronic HBV Infection Viral replication Transplant or Death Immune response Tissue damage Scarring HCC Cirrhosis Evidence of disease Adapted from Dr Z Goodman, Armed Forces Institute of Pathology, Washington, DC Host and environmental factors (e.g. alcohol, co-infection)
  11. 16. Prevention of HBV Infection <ul><li>Screening of blood/organ/tissue donors </li></ul><ul><li>Hepatitis B vaccine </li></ul><ul><ul><li>Available since 1981 </li></ul></ul><ul><ul><li>Vaccination programmes adopted in >150 countries worldwide </li></ul></ul><ul><ul><li>Inactivated or recombinant HBsAg </li></ul></ul><ul><ul><li>Routine vaccination of infants and previously unvaccinated children (by age 11) </li></ul></ul><ul><ul><li>Catch-up vaccination of high-risk groups of all ages </li></ul></ul><ul><ul><li>Screening pregnant women and rapid vaccination of infants born to infected women (HBIg and vaccine) </li></ul></ul><ul><ul><ul><li>Infants born to infected mothers must be vaccinated within the first 12 hours of life </li></ul></ul></ul>WHO-CSR, HBV Report 2002, available at www.who.int/emc-documents (12/10/2003)
  12. 17. Prevention of HBV Infection <ul><li>Screening of blood/organ/tissue donors </li></ul><ul><li>Hepatitis B vaccine </li></ul><ul><ul><li>Available since 1981 </li></ul></ul><ul><ul><li>Vaccination programmes adopted in >150 countries worldwide </li></ul></ul><ul><ul><li>Inactivated or recombinant HBsAg </li></ul></ul><ul><ul><li>Routine vaccination of infants and previously unvaccinated children (by age 11) </li></ul></ul><ul><ul><li>Catch-up vaccination of high-risk groups of all ages </li></ul></ul><ul><ul><li>Screening pregnant women and rapid vaccination of infants born to infected women (HBIg and vaccine) </li></ul></ul><ul><ul><ul><li>Infants born to infected mothers must be vaccinated within the first 12 hours of life </li></ul></ul></ul>WHO-CSR, HBV Report 2002, available at www.who.int/emc-documents (12/10/2003)
  13. 18. Treatment Algorithm

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