Professional Documents
Culture Documents
Hepatitis, introduction(1)
Generic
liver
Caused by a number of viruses, other
infectious agents, and toxins
Viral Hepatitis
There
HBV 6-30%
HCV 0-7%
HIV 0.3
Symptoms
Can
Because
Most
May
Complete
Laboratory test
A
Hepatitis A
Labs
ALT > AST usually >1000 IU/dl
Bilirubin >10 mg/dl is common
IgM anti-HAV-gold standard for diagnosis
Hepatitis A (Contd)
Treatment
Prevention
handwashing, good
sanitation
Postexposure propylaxis
GI 9
Hepatitis B
GI 10
Routes of Transmission
Percutaneous :
Contaminated needle stick (injecting drug use and
occupational exposure/nosocomial) more
common from patient to health care provider
Hemodialysis, Human bite, Transplant or
transfusion, Sharing razors
Permucosal
Sexual intercourse (50% of cases in U.S)
Perinatal-infant born (infection at or after birth)
90% if mother HBeAg positive (30% if negative)
C/S doesnt prevent & breastfeeding doesnt
increase risk
Contact with infected household objects (toothbrush
or razor)
Individual at Risk
Clinical Course
Incubation period averages 60-90 (range
45-180 days)
Onset is often insidious
HBV causes clinical illness in 30-50 % of
all individuals age five and older, but
less than 10 % of those aged under five
years
Symptoms may include anorexia,
fatigue, nausea, vomiting, abdominal
pains, muscle or joint aches, mild fever,
dark urine, skin rases, and jaundice
Diagnostic panels
Prevention/Prophylaxis
Education
Hepatitis C
HEPATITIS C VIRUS
Single, positivestranded Flaviviridae
RNA virus
Individual at Risk
Injecting drug users
Persons occupationally
exposed to blood
Hemodialysis patients
Tranfusion and
transplant recipients
(prior to 1992)
Hepatitis C transmission
Exposure to infected blood before 1992 (Screening
started in 1992)
Heterosexual monogamous relationships (Risk low 00.5%/year
Perinatal
2% when EIA positive, 7% when HCV RNA positive
NO data on preventive by C/S
Breastfeeding doesnt appear to transmit
Routes of Transmission
Percutaneous
Permucosal
Sexual intercourse
Perinatal-infant born to an HBV infected mother
Contact with infected household objects (i.e
toothbrush or razor that may have blood on it)
Hepatitis C Treatment
Highest
Genotype
Prognosis
GI 28
HEP D & E
HDV
HEV
Large
More
Hepatic injury
Patterns of Hepatic Injury
Inflammation = hepatitis
Degeneration (ballooning ) : swelling and edema of
hepatocytes
Necrosis - coagulative necrosis (ischemia), less common
( liver has dual blood supply)
Apoptosis = councilman body ( apoptotic bodies in the
liver caused by viral hepatitis)
Regeneration : possible in all but not in fulminate diseases
Fibrosis : seen in cirrhosis
Hepatic failure : fulminate damage (80 to 90% of liver is
damaged)
Jaundice
Unconjugated Hyperbilirubinemia
Bilirubin overproduction hemolytic anemias, resorption of
major hemorrhages, ineffective Erythropoiesis in the bone marrow
Cholestasis - Types
Intrahepatic
Hepatocellular
dysfunction or
intrahepatic bile duct
disease
Congenital
Transplantation is only
the treatment
if uncorrected- becomes
cirrhotic
Extrahepatic
resulting from
obstruction
Acquired
amenable
to surgical
correction
if uncorrected- becomes
cirrhotic
Liver Cirrhosis
Liver
Hepatocellular failure, or
Portal Hypertension syndrome
Three
characteristics
Clinical features
Jaundice,
hypoalbuminemia, hyperammonemia
Fetor hepaticus
Hyperestrogenemia : palmar erythema, spider
angiomas of the skin (one or two are normal
esp. in pregnancy), hypogonadism,
gynecomastia
Complications
Coagulopathy ( hepatic synthesis of clotting factors)
Multi- organ failure, hepatic encephalopathy ( excess
ammonia)
Hepatorenal syndrome
Inflammation
(Hepatitis)
Fibrosis
(Cirrhosis)
Palmar erythema
Spider
angiomas
The Complications of
Liver Cirrhosis
Hematemesis-melena
Ascites per magna
Peritonitis bacterial spontanea
Hepatorenal syndrome
Hepatic encephalopathy
Hepatoma
Ascites
In
Ascites (Contd)
Hepatic Encephalopathy
Hepatorenal Syndrome
Hepatoma
Gallbladder Disease
Acute
Cholecystitis
Gallbladder Disease
(Contd)
Choledocholithiasis
Cholangitis