HEPATITIS A

What is Viral Hepatitis?

Hepatitis is inflammation of the liver and when we say Viral Hepatitis it means inflammation
of the liver caused by viral infections or viruses. These viruses are categorized by letters A
through E so we have Hepatitis A, Hepatitis B, C, D, and E. The diseases caused by these
viruses can either be acute or chronic and are contagious. This is what a healthy liver looks
like and a liver with inflammation.

Hepatitis A is an acute infection only which means the Hepatitis A virus can be cleared by
our body only and the liver will heal within six months with no lasting damage. It doesn’t lead
to chronic disease.
Hepatitis A is caused by infection with hepatitis A virus (HAV), a non-enveloped RNA virus
that is classified as a picornavirus. HAV was first identified by immune electron microscopy in
1973 and initially replicated in mammalian cell culture in 1979. Humans are the only natural
host.

It spreads through fecal-oral transmission. HAV is found in the stool and blood of infected
persons. It spreads when someone ingest the viru even in amounts too small to see through
person-to-person contact by sexual contact, caring for someone who is ill and using drugs
with others, and eating contaminated food and water.

Testing for hepatitis A virus (HAV) serology may be indicated for the work-up of patients with
suspected acute viral hepatitis to determine immune status (following recovery from natural
infection or as a result of immunization)
Immunoglobulin M (IgM) antibody to hepatitis A virus (anti-HAV) positive, OR Nucleic acid
amplification test (NAAT; such as polymerase chain reaction [PCR] or genotyping) for
hepatitis A virus RNA positive are the confirmatory laboratory evidence for diagnosis of
Hepatitis A.

Symptoms of hepatitis A can last up to 2 months and include fatigue, nausea, stomach pain,
and jaundice. Most people with hepatitis A do not have long-lasting illness. The best way to
prevent hepatitis A is to get vaccinated.

The overall case-fatality of Hepatitis A estimates range from 0.3% to 0.6% for all ages and
up to 1.8% among adults age 50 years or older.

People typically recover from hepatitis A without complications. In rare cases, hepatitis A
may lead to liver failure. Liver failure due to hepatitis A is more common in adults older than
age 50 and in people who have another liver disease.

How can Hepatitis A be prevented?

• Always wash your hands after using the bathroom.
• Always wash your hands after cleaning the toilet.
• Always wash your hands after changing diapers
• Always wash your hands after handling soiled towels or linens.
• Always wash your hands before fixing food or eating
• If exposed to hepatitis A, ask your doctor about immune globulin.
• If travelling to areas where hepatitis A is common:
-get immune globulin or vaccination before travel
-drink bottled beverages; and
-do not eat uncooked fruits or vegetables, unless you peel them yourself.
Use condom when having sexual intercourse

Hepatitis A is a liver infection caused by the hepatitis A virus (HAV). It is found in the stool
and blood of people who are infected. Hepatitis A is very contagious. It is spread when
someone unknowingly ingests the virus through the mouth — even in microscopic amounts
— through eating contaminated food or drink.
After ingestion of infected food or drink that starts from the mouth it will uptake from the
gastrointestinal tract. Gastrointestinal tract includes the following: The mouth that chews
infected food. Next, the pharynx or throat is a ring-like muscular tube that acts as the
passageway for air, food and liquid.
Third, the Esophagus that contracts as it moves infected food into the stomach, and stomach
that is a J-shaped organ that digests the food. Next, the small intestine. It has three parts:
the duodenum, jejunum, and ileum. It helps to further digest food coming from the stomach.
It absorbs nutrients and water from food so they can be used by the body. These are the
organs that food and liquids travel through when they are swallowed, digested, absorbed,
and leave the body as feces. As we all know, anything that is eaten or consumed, whether
it's food, alcohol, medicine or toxins, gets filtered by the liver. Liver has two main
responsibilities in the process of digestion, to make and secrete bile and to process and
purify the blood containing newly absorbed nutrients that are coming from the small
intestine. With this reason, Hepatitis A virus will reach the liver and it will replicate
predominantly in hepatocytes. This will result in cellular immune responses to the virus
leading to destruction of infected hepatocytes as it will cause the inflammation of the liver
because the tissues of the body become injured or infected.

Now we are going to move on to our pathophysiology. On this page we have the flowchart or
diagram of hepatitis A.
Into the next slide we have the non-modifiable factors which contains the age where it
affects all age if they are unvaccinated and to adults ranging from 19 to 59 years old, gender
which affects both women and men and hereditary where evidence suggests that a
predisposition to autoimmune hepatitis may run in families. Next is the modifiable factors, the
first modifiable factors is poor sanitation or when people don’t always wash their hands and
have proper hygiene, then living with a infected person, having sex with an infected person
and travelling to areas where there are many cases of hepatitis A without being immunized.

Now let’s move on to the next slide, the first step is that Hepatitis A can be spread from
close, personal contact with an infected person, such as through certain types of sexual
contact (like oral-anal sex), caring for someone who is ill, or using drugs with others.
Then the virus will enter the liver, and into the liver cells or the hepatocytes, then the virus
will attach to a certain receptors and once the virus enters the hepatocytes it will undergo
into several steps which includes the uncoating of the RNA, and translation of the RNA into
proteins, then the RNA is replicated, then the VIRION which are the duplicates of the virus
are produced,
Then on this slide the virus is matured and will be released into other hepatocytes and affect
the environment, after that it will trigger our immune system and will release antibodies like
IgM and IgG and the Cytotoxic T cells, but then our own immune system will attack the
hepatocytes where the virus is and it will lead to inflammation and damage the hepatocytes,
then it will cause destruction to our hepatocytes or liver cells. Here we have two possible
cases, its either when the virus is eliminated by the antibodies it can actually destroy all the
virus and the patient will be able to recover
But it can also lead to the signs and symptoms, we have 2 stages here and the first stage is
called prodrome phase where they will feel fatigue or feeling unwell, fever and anorexia. The
second stage is called icteric phase where we can see here the more specific signs and
symptoms, icteric means jaundice and it is the yellowing of the eyes and skin, Hepatitis
damages the liver, making it less able to move bilirubin into the bile ducts. Jaundice happens
when there's too much bilirubin, a yellow-orange substance, in your blood. It's found in your
red blood cells. When those cells die, the liver filters it from the bloodstream. But if
something's wrong and your liver can't keep up, bilirubin builds up and can cause your skin
to look yellow. Then we have dark urine and pale stool.
Then after all the signs and symptoms it will lead to HEPATITIS A, and it can also lead to
complications, People typically recover from hepatitis A without complications. In rare cases,
hepatitis A may lead to liver failure. Due to its rapid development, acute liver failure is often
fatal if not treated as soon as possible. Without treatment, both acute and chronic liver failure
may eventually result in death. However, with timely medical attention, it's often possible to
make a full recovery.

HEPATITIS B
Let us now move on to Hepatitis B.

Hepatitis B can be an acute or chronic infection.Acute Hepatitis B infection lasts less than 6
months. Chronic Hepatitis B infection lasts 6 months or longer. It lingers because your
immune system can't fight off the infection. This may last a lifetime, resulting in cirrhosis and
liver cancer. Acute Hepatitis B can lead to chronic Hepatitis B. The risk for a person to
develop chronic infection depends on the age of the person when they become infected. The
younger the infected person, the more likely they are to develop chronic infection, about 90%
of infants with hepatitis B go on to develop chronic infection, whereas only 2%–6% of people
who get hepatitis B as adults become chronically infected.

It is a partially double-stranded DNA virus that belongs to the Hepadnaviridae family.

It spreads through blood and other bodily fluids including semen and vaginal fluids. Hepatitis
B is spread when blood, semen, or other body fluids from a person infected with the virus
enters the body of someone who is not infected. This can happen through sexual contact;
sharing needles, syringes, or other drug-injection equipment; or from mother to baby at birth,
due to the blood exchange that happens between mother and baby.

Not all people newly infected with HBV have symptoms, but for those that do, symptoms can
include fatigue, poor appetite, stomach pain, nausea, and jaundice. For many people,
hepatitis B is a short-term illness. For others, it can become a long-term, chronic infection
that can lead to serious, even life-threatening health issues.
There is a vaccine available for hepatitis B. A vaccine can prevent hepatitis B, but there's no
cure if you have the condition.

Hepatitis B is a “silent epidemic” because most people do not have symptoms when they are
newly infected or chronically infected. Thus, they can unknowingly spread the virus to others
and continue the silent spread of hepatitis B. For people who are chronically infected but
don’t have any symptoms, their liver is still being silently damaged.

Hepatitis B is not transmitted casually by sneezing or coughing, shaking hands, hugging or

sharing or preparing a meal. In fact, hepatitis B is not contracted during most of life’s daily
activities. You don’t need to separate cups, utensils, or dishes. You can eat a meal with or
prepared by someone with hepatitis B. Hugging, or even kissing won’t cause infection unless
there are bleeding gums or open sores during the exchange.

Tests that can help diagnose hepatitis B or its complications are:

Blood tests or Serological Tests. Blood tests can detect signs of the hepatitis B virus in your
body and tell your doctor whether it's acute or chronic. A simple blood test can also
determine if you're immune to the condition.
Liver ultrasound. A special ultrasound called transient elastography can show the amount of
liver damage.
Liver biopsy. Your doctor might remove a small sample of your liver for testing (liver biopsy)
to check for liver damage. During this test, your doctor inserts a thin needle through your
skin and into your liver and removes a tissue sample for laboratory analysis.

Hepatitis B affects approximately 296 million people, including over 6 million children under
the age of 5. Hepatitis B contributes to an estimated 820,000 deaths every year. 25% of
chronic hepatitis B infections progress to liver cancer.

Having a chronic HBV infection can lead to serious complications, such as:

Scarring of the liver (cirrhosis). The inflammation associated with a hepatitis B infection can
lead to extensive liver scarring (cirrhosis), which may impair the liver's ability to function.
Liver cancer. People with chronic hepatitis B infection have an increased risk of liver cancer.
Liver failure. Acute liver failure is a condition in which the vital functions of the liver shut
down. When that occurs, a liver transplant is necessary to sustain life.
Other conditions. People with chronic hepatitis B may develop kidney disease or
inflammation of blood vessels.

Hepatitis B is a vaccine-preventable disease. More than 1 billion doses of the hepatitis B

vaccine have been given worldwide, and it is considered to be a very safe and effective
vaccine to protect infants, children and adults from hepatitis B.

In addition to vaccination, there are other simple ways to help stop the spread of hepatitis B:
Wash your hands thoroughly with soap and water after any potential exposure to blood
Use condoms with sexual partners
Avoid direct contact with blood and bodily fluids
Clean up blood spills with a fresh diluted bleach solution (mix 1 part bleach with 9 parts
water)
Cover all cuts carefully
Avoid sharing sharp items such as razors, nail clippers, toothbrushes, and earrings or body
rings
Discard sanitary napkins and tampons into plastic bags
Avoid illegal street drugs (injecting, inhaling, snorting, or popping pills)
Make sure new, sterile needles are used for ear or body piercing, tattoos, and acupuncture

Hepatitis B can be spread when blood, semen, or other body fluids from a person infected
with the virus enters the body of someone who is not infected. However, Hepatitis B is rarely
spread through saliva.

The 3 ways to transmit hepa B includes unprotected sexual contact; sharing needles,
syringes, or other drug-injection equipment; or from mother to baby at birth.

Let’s discuss first the most common route of transmission of hepatitis B, the mother-to-child
during birth. This can happen during a vaginal delivery or a c-section. This transmission
occurs because of blood exchange between the mother and the baby. Oxygen and nutrients
from the mother's blood are transferred across the placenta to the fetus. Placenta is known
to filter oxygen, glucose and other nutrients to the baby through the umbilical cord. And this
enriched blood will flow through the umbilical vein and it moves through a shunt called the
ductus venosus that allows some of the blood to go towards the liver. And this will start the
infection of Hepa B Virus.

Second, sharing needles, Hepa b can be acquired through needlestick injury, tattooing, and
other shared drug-injection equipment. Needlestick injuries are wounds caused by needles
that accidentally puncture the skin. The hepa B virus goes directly into the cutaneous
circulation which is involved in the blood supply of the skin. Through this circulation, it carries
the hepa b virus directed into the bloodstream. Then, the HBV carries through the liver as it
is responsible for receiving and filtering all of the blood supply in the body. The liver
processes blood, breaking down the nutrients and chemicals your blood carries.

And lastly, through sexual contact. However, there are just certain types such as oral and
anal sex. Oral sex means using your mouth, lips or tongue to stimulate your partner's
genitals or anus. Through this contact, the body fluid which is the semen can be ingested
from the mouth down to other gastrointestinal tract such as throat, esophagus, stomach and
small intestine. All fluids that we intake are all filtered by the liver which is the target organ of
the Hepa B Virus

Now let’s move on to the pathophysiology of hepatitis B and we have here the flowchart of
hepatitis B.
Into the next slide we have the non-modifiable factors which are almost the same as
hepatitis A where it affects all age if they are unvaccinated and to adults ranging from 19 to
59 years old, gender which affects both women and men and hereditary where evidence
suggests that a predisposition to autoimmune hepatitis may run in families. Next is the
modifiable factors, the first modifiable factors is having unprotected sex with someone whos
infected, sharing needles during IV drug use and working on a health center where it
exposes us to human blood.

Now let’s move on to the next slide, the first step is that Hepatitis B is transmitted through
sexual contact, blood and birth, then it has almost the same process as hepatitis A
The virus will enter the liver and into the liver cells, then it will attach to an unknown receptor
of the liver cell, and will undergo a process called endocytosis. It is the process of capturing
a substance or particle from outside the cell by engulfing it with the cell membrane. The
membrane folds over the substance and it becomes completely enclosed by the membrane.
Then it will be transformed into covalently closed circular DNA, and it will replicate then it will
undergo the virion assembly of the hepatitis B virus and it will mature and will be released to
other hepatocytes or spread.
After the release of the virus, it will activate our immune response which will lead to secretion
of our antibodies like IgM and IgG antibodies and the cytotoxic T cells, then our immune
system will actually attack our own liver cells or the hepatocytes that are infected by the virus
which will lead to inflammation and damage the hepatocytes and will destroy our
hepatocytes.
Then it will lead to the signs and symptoms, we have here 3 phases, the first stage is called
prodromal phase where it will lead to early signs and symptoms such as fatigue, fever and
headache and into the second stage we have the icteric phase, it is also the same to our first
pathophysiology of hepatitis A where it includes jaundice or the yellowing of the eye and
skin, dark uring and hepatomegaly or the enlargement of the liver. And we also have the
convalescent phase or the recovery phase where the symptoms will become mild and the
patient can recover.

After the signs and symptoms, it will lead to Hepatitis B virus, and it can lead to possible
complications such as liver cancer and cirrhosis Cirrhosis is scarring (fibrosis) of the liver
caused by long-term liver damage. The scar tissue prevents the liver working properly.