Hepatitis
: GENERAL COMPARESION
Acute
Less than 6 months
Dose Not cause complications except if
.there was comorbidities
No functional abnormality in LIVER
Sub clinical onset specially in
(epidemic) , missed diagnose(flue like
manifestations ) , Self limited ( no
hospitalization only if developed
dehydration or encephalopathy) , need
supportive treatment ( like antipyretic ,
antiemetic)
Come with : Nausea, vomiting,
anorexia, taste/smell disturbance,
,headaches
.fatigue, myalgia, low-grade fever
Jaundice after flu symp. By 1-2 weeks
Only some progress to icteric (clinical
jaundice) phase, lasting days
to weeks ,Pale stools and dark urine 1-
5 d prior to icteric phase
Hepatomegaly and RUQ pain
Splenomegaly and cervical
lymphadenopathy (10-20% of cases)
: POOR PROGNOSIS IF
Patient has Co- morbidity other due
chronic disease ( slide 7)
Viral : A , E , acute B
Liver enzymes here inc. By
‫ ضعف‬10-20
10-20x
Chronic
More than 6 months
Chronic viral disease is the principal cause of
chronic liver disease, cirrhosis and hepatocellular
.carcinoma worldwide
asymptomatic, or may
present as mild, slowly progressive hepatitis ,
vague symptoms develop after exposure 6-5
,.weeks
BUT : if patient come with ACUTE
manifestations ( symptoms of disease)
This is ( good prognosis ) why ? it's give a
clue that he has immunity fighting the
infection . so the disease my resolve , versus
of patient has no symptoms that's mean he
will reach to chronicty ( no immunity
fighting )
: Patients with chronic Hep
‫يتشخصوا بالصدفة‬
.Viral : C , B developed after Acute phase
And D , Autoimmune
Toxic: alcohol Drugs: alpha-methyl dopa,
methotrexate , INH
AST+ALT(more) Metabolic: Wilson’s disease,alpha-1
‫ولكن وظيفة الكبد غير متأثرة‬ antitrypsin deficiency and hemochromatosis
))bronze- diabetes
Cryptogenic: unknown cause

‫البسيط‬ ‫المزمن‬

HAV HEV HBV HDV HCV

RNA virus RNA virus DNA virus RNA virus RNA virus
.Feco-oral trans Feco-oral Blood + vertical Blood Blood
.Sexual trans requiring HBsAg ‫المرض اللي متعبنا اوي‬
Diagnosed by very similar to ‫األب بيتغدى مع عياله‬ for entry into ‫النه يتغير في الجينوم زي‬
elevated hepatitis A ‫عادي‬ hepatocyte, ‫اإلنفلونزاـ كده‬
transaminases, Usually transmitted therefore infects Rapid change in
positive by contaminated In many cases the only patients envelope proteins
anti-HAV IgM water infection is subclinical with hepatitis B; so difficult to
Fulminant hepatitis causes more develop a vaccine
epidemic ‫ألنه في‬ 1-2% rises to 20% If there is acute aggressive drugs users or ‫يجي مع‬
‫فأي احد يصاب اطفال‬ in pregnant women clinical episode the disease than ‫او اللي نقلوا دم‬
‫او بالغين‬ Prevention and virus is cleared in 99% hepatitis B virus
In children: control with good of patients alone Extrahepatic
characteristically .sanitation , hygiene ‫معاه اعراضـ مناعيةـ‬ manifestations
asymptomatic Immune Co-infection: arthritis,
In adults: fatigue, Vaccine has been : phenomenn acquire HDV and cryoglobulinaemia
nausea, developed Skin rashes, HBV at the same with or without
,arthralgia, fever never becomes polyarthritis , arteritis time has better glomerulonephritis
jaundice chronic and no and prognosis than and porphyria
‫نادراًـ‬ carrier Glomerulonephritis superinfection .cutanea tarda
Can cause ‫في نفس الوقت‬ There is higher
fulminant hepatic chronic ‫ويحصل منه‬ ‫أفضل‬ incidence of diabetes,
failure and following 1-10% acute( ‫من ورا بعض‬ and association with
subsequent death acute hepatitis, HDV infection lichen planus, sicca
(<1-5%) which may be on pre-existing syndrome (dry
.Can relapse subclinical )HBV infection mouth,eye) and non-
:‫اكثر مع‬ HDV can present hodgkin’s lymphoma
Vaccine has been neonatal or as fulminant
developed childhood hepatic failure : Main cause
but never infection than (FHF) and/or Cirrhosis and
becomes chronic when HBV is accelerate hepatocellur C
and no carrier acquired in adult progression to
life cirrhosis
Management:
low-dose
Vaccine has been interferon
developed
Vaccine of HBV
? How to diagnose

HxAg : mean antigen of the virus e.g : ( HBAg , HCAg..etc )

Anti-HxAg : mean your Antibodies that fight the antigen e.g ( anti-HEV , Anti-HDV..etc )
IgM : means immunoglobulin's of RECENT infection
IgG : means of immunoglobulin's of OLD infection ( carrier ) or from VACCINES
ALT ,AST are enzymes found inside the liver cell , if they are high in serum
that indicate hepatocellular damage , so they are liver biomarkers
ALT is the more specific for hepatocellular damage than AST because
AST is also high in hymolysis , cardiac infarction
Quality : detect virus genotype
Quantity : detect virus Load

: First step to do in Hepatitis B

15 ‫ساليد‬
‫علشان هو منه نوعين مزمن وبسيط‬
-HbsAg = it means the person has a hepatitis B infection = ) surface Antigen (

ve+ ‫بدون ما أعرف هو مزمن او بسيط المهم خالص لو‬

Hepatitis B ‫معناه عنده‬

-If +ve – NEXT STEP : do other serological AB and Ag to know if this patient Immune or carrier or Active

Also I can do PCR because it’s a DNA virus :D

‫ ويقلي انه‬HbeAg : (envelope antigen) is a hepatitis B viral protein. It is an indicator of active viral replication
,.‫الشخص معدي أكثر‬
HBV DNA : I do it to give me a clue about management and drug therapy
- Anti-HBs = ) Antibodies (

ve+ ‫ افرح لو شفتو‬Tells me the person have immunity

Anti-HBc (core antigen ) I will see it in LIVER BIOPSY-

- In neonate with hep B they are more liable to chronicty L

‫ كل ماكان أكثر عرضة للكرونك‬.. ‫كل ماكان السن صغير‬
With mother have an active infection , GIVE : VACCINE + Immunoglobulin
)‫(طوالي بعد الوالدة‬
Also HEALTH care worker who had prick with infected needle : GIVE : VACCINE + Immunoglobulin

Hepatitis B chronic patient may present with : mild virus symptoms – cirrhosis- Autoimmune
‫ حرب باردة ويتشخصوا بالصدفة‬, phenomenon because they are in
: Biopsy asses the severity of the disease and chronicty
Mild : inflammatory cells
Moderate : inflammatory cells + fibrotic tissues
Severe : fibrotic cells only (Here will be normal hepatic enzymes level cuz there is no a life cells to
distract )

Every patient with chronic hepatitis should have screening for Hepatocellular
carcinoma every 6 months ultrasound to see focal change or serum high
.fetoprotein marker

If Hepato cellular carcinoma happen : (NO) cure or response to chemotherapy only surgical
.removed

:See

Treatment of each one and management she did not mention something outside the slides
Also Autoimmune Chronic Active Hepatitis ( cirrhosis in young age) & Drug Induced
Liver( acetaminophen antidote is N-acetylcysteine) Disease & Alcoholic Liver Disease (non-
alcoholic fatty liver with : Obase +DM2+ metabolic S.)