HEPATITISS/L DR AAMIR HUSSAINASSTT PROFESSOR

OBJECTIVES AT THE END OF LECTURE,THE SECOND YEAR

MBBS STUDENT WILL BE ABLE TO UNDERSTAND THE DIFINITION OF HEPATITISCAUSES RESPONSIBLE FOR HEPATITISCLINICAL FEATURES OF ACUTE AND

CHRONIC HEPATITISCOMPLICATIONSPREVENTION &TREATMENT OF HEPATITIS

INTRODUCTION

HEPATOCYTE AND LIVER LOBULE

DEFINITION

INFLAMMATION OF LIVER DAMAGE TO HEPATOCYTESRAISED ALT

TYPES ACUTE

Temporary, self-limiting CHRONIC(>6 MONTHS)

Persistent, leads to Fibrosis, Cirrhosis or malignancy FULMINANT(WITHIN 8 WEEKS)

jaundice, encephalopathy and cerebral edema

PRESENTS AS JAUNDICE, YELLOW DISCOLORATION OF EYES AND SKIN

CAUSES OF ACUTE HEPATITIS VIRAL HEPATITIS

HAV,HBV,HCV,HDV,HEV,CMV,EBV,HSV,YFV NON-VIRAL INFECTION(LEPTOSPIROSIS etc) ALCOHOL TOXINS(amanita phalloides, carbon tetrachloride) DRUGS(paracetamol, isoniazid) ISCHEMIC HEPATITIS AUTOIMMUNE METABOLIC/HEREDITARY DISEASES PREGNANCY REYE’S SYNDROME

CAUSES OF CHRONIC HEPATITIS VIRAL HEPATITIS

HBV & HCV ALCOHOL DRUGS NON-ALCOHOLIC FATTY LIVER DISEASE AUTOIMMUNE

HEPATOCYTE INJURY BILE DUCT INJURY

PRIMARY BILIARY CIRRHOSIS PRIMARY SCLEROSISNG CHOLANGITIS

HAEMOCHROMATOSIS WILSON’S DISEASE ALPHA 1 ANTITRYPSIN DEFICIENCY CRYPTOGENIC/UNKNOWN

CLINICAL FEATURES LOW-GRADE FEVER LOSS OF APPETITE NAUSEA VOMITING MALAISE DIARRHOEA YELLOW DISCOLORATION DARK URINE TENDER HEPATOMEGALY

CLINICAL PRESENTATION OF CHRONIC LIVER DISEASE

JAUNDICE ASCITES HEMETEMESIS AND MELENA HEPATIC ENCEPHALOPATHY PALMAR ERYTHEMA,DUPYTRENS

CONTRACTURE OR FLAPPING TREMORS PORTAL HYPERTENSION & SPLENOMEGALY PLEURAL EFFUSION LEG EDEMA RENAL FAILURE

COMPLICATIONS CHRONIC FULMINANT(8 WKS)

HYPERACUTE(< 1 WK)ACUTE(<4 WKS)

HYPOGLYCAEMIA METABOLIC ACIDOSIS INFECTIONS/SEPSIS RENAL FAILURE

INVESTIGATIONSLIVER BIOCHEMICAL TESTS

ALTASTALKALINE PHOSPHATASEGAMMA GTBILIRUBINALBUMINPT & INR

INVESTIGATIONS HEPATITIS VIRAL PROFILE

ANTI HAV ANTI HEV HBs Ag and IgM ANTI HBc ANTI HCV ANTI HDV if HBs Ag positive

AUTOANTIBODIES ANA AMA ASMA ANTI LKM

INVESTIGATIONS IRON PROFILE

IRONFERRITINTIBCTRANSFERRIN SATURATION

CAERULOPLASMIN,SERUM AND URINARY COPPER

ALPHA 1 ANTITRYPSIN TOXICOLOGY SCREEN OF BLOOD AND URINE

ADDITIONAL INVESTIGATIONS RANDOM BLOOD ALCOHOL IMMUNOGLOBULINS HFE GENE TEST ALPHA 1 ANTITRYPSIN GENOTYPE ANTI TTG ANCA BIOPSY

LIVER SMALL BOWEL LARGE BOWEL

ADDITIONAL INVESTIGATIONSCOMPLETE HEPATITIS B PROFILE

HBs Ag & ANTI HBs AgANTI HBc IgM & TOTALHBe Ag & ANTI HBe AgHBV DNA BY PCR

HCV RNA BY PCRHDV DNA BY PCR

IMMUNISATION ANTI HBs Ag

PAST INFECTION/CONVALESCENCE ANTI HBc TOTAL & ANTI HBs Ag

INCUBATION/ACUTE HBsAg & ANTI HBc IgM

INFECTIVITY HBe Ag & HBV

SEROCONVERSION ANTI HBe Ag or ANTI HBs Ag

HEPATITIS B INTERPRETATION OF SEROLOGY

IMAGING ULTRASONOGRAPHY DOPPLER US OF HEPATIC VEINS CT SCAN MRI MRCP ERCP PTC EUS SLIT-LAMP EYE EXAMINATION

CLINICAL AND EPIDEMIOLOGICAL FEATURES OF VIRAL HEPATITIS

FEATURE HAV HBV HCV HDV HEV

INCUBATIONDAYS IN MEAN

30 75 50 75 40

ONSET ACUTE INSIDIOUS OR ACUTE

INSIDIOUS INSIDIOUS OR ACUTE

ACUTE

AGE PREFERENCE

CHILDREN YOUNG ADULTS

ADULTS YOUNG ADULTS

YOUNG ADULTS

TRANSMISSION FAECAL-ORAL PERCUTANEOUSPERINATALSEXUAL

PERCUTANEOUS

PERCUTANEOUSPERINATALSEXUAL

FAECAL-ORAL

CARRIER STATE NONE UPTO 30% 3% VARIABLE NONE

SEVERITY MILD OCC SEVERE MODERATE OCC SEVERE MILD

FULMINANT 0.1% 0.1-1% 0.1% 5-20% 1-2%

CANCER NONE YES YES VARIABLE NONE

PROGNOSIS EXCELLENT WORSE WITH AGE

MODERATE ACUTE GOODCHRONIC POOR

GOOD

PREVENTION

VACCINES ARE AVAILABLE FOR HEPATITIS AHEPATITIS BHEPATITIS E

TREATMENT OF ACUTE VIRAL HEPATITIS

REST OR MOBILITY AS TOLERATEDHIGH-CALORIE DIETGLUCOSE JUICE IV FLUID FOR VOMITINGCHOLESTYRAMINE FOR PRURITUSAVOID DRUGSNO ROLE FOR STEROIDS

TREATMENT OF CHRONIC HEPATITIS B

PEGYLATED INTERFERONLAMIVUDINE ADEFOVIRENTECAVIRTENOFOVIRTELBIVUDINE

TREATMENT OF CHRONIC HEPATITIS C

PEGYLATED INTERFERONRIBAVIRINSOFOSBUVIRDACLATASVIRLEDIPASVIRSIMEPRAVIR

TREATMENT OF AUTOIMMUNE HEPATITIS

PREDNISOLONEAZATHIOPRINE

TREATMENT OF ALCOHOLIC LIVER DISEASE

ABSTINENCEHIGHLY NUTRICIOUS DIETMULTIVITAMINSPREDNISOLONEPENTOXIFYLINE

TREATMENT OF NONALCOHOLIC FATTY LIVER DISEASE

LIFESTYLE CHANGESVITAMIN EPIOGLITAZONE OR GLUCOPHAGESTATINS

TREATMENT OF HAEMOCHROMATOSISAVOID IRON OR IRON CONTAINING

FOODWEEKLY

PHLOBOTOMIES/VENESECTIONDEFEROXAMINEDEFERASIROXDEFERIPRONE

TREATMENT OF WILSON’S DISEASEAVOID COPPER CONTAINING FOODPENICILLAMINEPYRIDOXINETRIENTINEZINCAMMONIUM TETRATHIOMOLYBDATE

THANKS