PATOFISIOLOGI HEPATITIS

COMPILED BY:

 Amelya putri sagita ( PO7134223015)

 Putri Maulida (PO7134223036)

 Putri Ramadhona (PO7134223033)

 Salman Alfarisi ( PO7134223038)

 Gita nada hartawan ( PO7134223005)

 Anindia khalisa (PO7134223013)

LECTURER

Fider Saputra T., S.Hum., M.Hum.

HEALTH POLYTECHNIC MINISTRY OF PALEMBANG

MEDICAL LABORATORY TECHNOLOGY

BACHELOR OF APPLIED MEDICAL LABORATORY TECHNOLOGY

SCHOOL YEAR 2023/2024

PREFACE

In the name of Allah, the Most Gracious, the Most Pious, We praise and thank God for His presence,
which has bestowed His grace, guidance and inayah on us so that we can finish the paper on
Hepatitisini. This paper we have compiled with the maximum and get help from various parties so as to
facilitate the making of this paper.

To that end we extend our gratitude to all those who have contributed in the making of this paper.
Apart from that, we are fully aware that there are still shortcomings in terms of both sentences and
grammar. Therefore with open arms we receive all the suggestions and criticism from our readers so
that we can improve this scientific paper.

Finally, we hope that this hepatitis paper can provide benefits and inpirasi to the reader.

CHAPTER 1

INTRODUCTION
A. BACKGROUND

Hepatitis is inflammation and liver injury due to hepatic reactions to various conditions, especially
viruses, drugs and alcohol. Hepatitis is a dominant systemic infection that attacks the liver. Viral hepatitis
is a term used for viral hepatic infections with necrosis and inflammation of liver cells that produce a
unique set of clinical, biochemical and cellular changes. Hepatitis is a process of inflammation of the liver
tissue. Hepatitis in lay language is often referred to as liver or jaundice.Though the definition of lever
itself is actually derived from the Dutch language which means the liver, not the liver disease. But many
of the assumptions that develop in society mean liver is a disease of liver inflammation. while the term
yellow pain can actually cause a hiccup, because not all jaundice is caused by inflammation of the liver,
but also because of inflammation in the gallbladder. (M. Sholikul Huda)

Hepatitis is a diffuse inflammatory process in tissues that can be caused by viral infections and by toxic
reactions to drugs and chemicals. (Sujono Hadi, 1999).

Viral hepatitis is a systemic infection by virus with necrosis and clinical, biochemical and cellular
characteristics. (Smeltzer, 2001). From some of the above understanding can be concluded that hepatitis
is an inflammatory disease in liver tissue caused by viral infections that cause cells liver cells are
damaged so that it can not function properly.

History

The breakthrough understanding of hepatitis came in 1963 when Dr Baruch Blumberg discovered an
antigen that detected the presence of hepatitis B (HBV) in blood samples.

At the t ime, Dr Blumberg was actually researching the genetics of disease susceptibility. He did not set
out to discover hepatitis, but his work led to a major breakthrough and increased understanding of the
disease.

In the 1950s, Dr Blumberg started to explore whether inherited traits could make different groups of
people more or less susceptible to the same disease. He and his team travelled around the world visiting
native populations in remote locations to collect blood samples for analysis. The intention was to look
for genetic differences to see whether these differences were associated with a particular disease.

Specifically, they studied hemophiliac patients who had received multiple blood transfusions and
therefore would be exposed to blood they had received from donors. The consequence of receiving
other people's blood is that the immune system produces 'antibodies' against the foreign blood serum
proteins, or 'antigens' from the donors.

Dr Blumberg and his team identified an unusual antigen from a blood sample of an Australian Aborigine,
which they called the Australia antigen. After further research, this turned out to be the antigen that
caused hepatitis B, which was officially recognised in 1967.
Just two years later in 1969, Dr Blumberg and his colleague, Dr Iriving Millman, invented the hepatitis B
vaccine. The US Food and Drug Administration named it the first 'anti-cancer' vaccine because the
prevention of chronic hepatitis infections results in the prevention

of primary liver cancer due to HBV (approximately 80% of people with chronic hepatitis B will develop
liver cancer). More than 500,000 people die each year from liver cancer.

The hepatitis B vaccine has been administered to millions of people, particularly in Asia and Africa, thus
saving many, many lives. In the early 1970s, the cause of infectious hepatitis was found and named the
Hepatitis A virus (HAV). In 1989 hepatitis C virus (HCV) was isolated. Unfortunately, there is no vaccine
for hepatitis C, but in 80% of cases, carriers who complete a treatment course can be cured. In 1990
hepatitis E virus (HEV) and in 1995, Hepatitis G virus (HGV), were identified. In 1976, Dr Baruch Blumberg
was awarded the Noble Prize for Medicine in recognition of his discovery of the hepatitis B virus. He died
on 5 April 2011at the age of 85 years.

B. FORMULATION OF THE PROBLEM

1. Definition Hepatitis ?
2. Various types of Hepatitis?
3. How to causes of Hepatitis?
4. Symptoms of Hepatitis?
5. Hepatitis Diagnosis?
C.OBJECTIVE

1. To find out what is Hepatitis

2. To find know how many types of Hepatitis
3. To find out how causes of Hepatitis
4. To know the symptoms of hepatitis
5. To know how to diagnose Hepatitis

CHAPTER II

DISCUSSION

A.DEFINITION OF HEPATITIS

Hepatitis is a medical condition characterized by inflammation of the liver. It can be caused by various
factors, including viral infections, excessive alcohol consumption, exposure to toxic substances, certain
medications, or autoimmune reactions. Hepatitis can occur acutely, where liver inflammation lasts
briefly and usually resolves on its own, or chronically, where inflammation persists long-term and can
cause permanent liver damage.
Viral infection is a common cause of hepatitis. There are several types of hepatitis viruses, such as
hepatitis A, B, C, D, and E, each with different modes of transmission, symptoms, and complications. For
example, hepatitis A and E are typically transmitted through consumption of contaminated food or
water, while hepatitis B, C, and D are more commonly transmitted through contact with infected blood
or body fluids.

Symptoms of hepatitis can vary from mild to severe. Common symptoms include nausea, vomiting,
fever, weakness, loss of appetite, abdominal pain, changes in skin and eye color to yellow (jaundice),
weight loss, dark urine, and pale-colored stools. In some cases, especially with chronic hepatitis, an
individual may experience no symptoms at all.

Diagnosing hepatitis typically involves a physical examination, blood tests to detect the presence of the
virus or liver damage, and additional tests such as liver ultrasound or liver biopsy. Treatment for
hepatitis depends on the type and severity of the disease. For acute hepatitis, treatment is generally
supportive and includes rest, maintaining adequate nutrition, and avoiding alcohol. For chronic
hepatitis, antiviral therapy or other treatments may be necessary to control inflammation and prevent
further liver damage.

In addition to medical treatment, preventive measures are also important in managing hepatitis. These
include vaccination for hepatitis A and B, avoiding contact with infected blood or body fluids, regular
handwashing, maintaining food and water hygiene, using condoms during sexual intercourse, and
avoiding intravenous drug use.

In severe cases, complications of hepatitis may include liver cirrhosis, liver failure, liver cancer, or even
death. Therefore, it is important to seek medical attention promptly if experiencing symptoms of
hepatitis or have increased risk factors. With proper diagnosis and treatment, as well as good prevention
practices, many cases of hepatitis can be treated and complications prevented.

B. Various types of Hepatitis

A. HEPATITIS A
Hepatitis A is an inflammation of the liver caused by the hepatitis A virus (HAV). The virus
is primarily spread when an uninfected (and unvaccinated) person ingests food or water that is
contaminated with the faeces of an infected person. The disease is closely associated with unsafe
water or food, inadequate sanitation, poor personal hygiene and oral-anal sex.
Unlike hepatitis B and C, hepatitis A does not cause chronic liver disease but it can cause
debilitating symptoms and rarely fulminant hepatitis (acute liver failure), which is often fatal. WHO
estimates that in 2016, 7134 persons died from hepatitis A worldwide (accounting for 0.5% of the
mortality due to viral hepatitis).
Hepatitis A occurs sporadically and in epidemics worldwide, with a tendency for cyclic
recurrences. Epidemics related to contaminated food or water can erupt explosively, such as the
epidemic in Shanghai in 1988 that affected about 300 000 people (1). They can also be prolonged,
affecting communities for months through person-to-person transmission. Hepatitis A viruses persist
in the environment and can withstand food production processes routinely used to inactivate or control
bacterial pathogens.
The incubation period of hepatitis A is usually 14–28 days.
 Symptoms of hepatitis A range from mild to severe and can include fever, malaise, loss of appetite,
diarrhoea, nausea, abdominal discomfort, dark-coloured urine and jaundice (a yellowing of the eyes
and skin). Not everyone who is infected will have all the symptoms.
Adults have signs and symptoms of illness more often than children. The severity of disease and fatal
outcomes are higher in older age groups. Infected children under 6 years of age do not usually
experience noticeable symptoms, and only 10% develop jaundice. Hepatitis A sometimes relapses,
meaning the person who just recovered falls sick again with another acute episode. This is normally
followed by recovery.
There is no specific treatment for hepatitis A. Recovery from symptoms following infection
may be slow and can take several weeks or months. It is important to avoid unnecessary medications
that can adversely affect the liver, e.g. acetaminophen, paracetamol.
Hospitalization is unnecessary in the absence of acute liver failure. Therapy is aimed at
maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost
from vomiting and diarrhoea.
B. HEPATITIS B
Hepatitis B is an infection of the liver caused by the hepatitis B virus. The infection can be
acute (short and severe) or chronic (long term). Hepatitis B can cause a chronic infection and puts
people at high risk of death from cirrhosis and liver cancer. It can spread through contact with infected
body fluids like blood, saliva, vaginal fluids and semen. It can also be passed from a mother to her
baby.
Hepatitis B can be prevented with a safe and effective vaccine. The vaccine is usually given
soon after birth with boosters a few weeks later. It offers nearly 100% protection against the virus.
Hepatitis B is a major global health problem. The burden of infection is highest in the WHO Western
Pacific Region and the WHO African Region, where 97 million and 65 million people, respectively,
are chronically infected. Sixty-one million people are infected in the WHO South-East Asia Region,
15 million in the WHO Eastern Mediterranean Region, 11 million in the WHO in the WHO European
Region and 5 million in the WHO Region of the Americas.
In highly endemic areas, hepatitis B is most commonly spread from mother to child at birth
(perinatal transmission) or through horizontal transmission (exposure to infected blood), especially
from an infected child to an uninfected child during the first 5 years of life. The development of
chronic infection is common in infants infected from their mothers or before the age of 5 years.
Hepatitis B is also spread by needlestick injury, tattooing, piercing and exposure to infected
blood and body fluids, such as saliva and menstrual, vaginal and seminal fluids. Transmission of the
virus may also occur through the reuse of contaminated needles and syringes or sharp objects either in
health care settings, in the community or among persons who inject drugs. Sexual transmission is
more prevalent in unvaccinated persons with multiple sexual partners.
Hepatitis B infection acquired in adulthood leads to chronic hepatitis in less than 5% of cases,
whereas infection in infancy and early childhood leads to chronic hepatitis in about 95% of cases. This
is the basis for strengthening and prioritizing infant and childhood vaccination.
The hepatitis B virus can survive outside the body for at least 7 days. During this time, the
virus can still cause infection if it enters the body of a person who is not protected by the vaccine. The
incubation period of the hepatitis B virus ranges from 30 to 180 days. The virus may be detected
within 30 to 60 days after infection and can persist and develop into chronic hepatitis B, especially
when transmitted in infancy or childhood.
Symptoms
Most people do not experience any symptoms when newly infected.
 Some people have acute illness with symptoms that last several weeks:
yellowing of the skin and eyes (jaundice)
dark urine
feeling very tired
nausea
vomiting
pain in the abdomen.
When severe, acute hepatitis can lead to liver failure, which can lead to death.
Although most people will recover from acute illness, some people with chronic hepatitis B will
develop progressive liver disease and complications like cirrhosis and hepatocellular carcinoma (liver
cancer). These diseases can be fatal.
HBV-HIV coinfection
About 1% of persons living with HBV infection (2.7 million people) are also infected with
HIV. Conversely, the global prevalence of HBV infection in HIV-infected persons is 7.4%. Since
2015, WHO has recommended treatment for everyone diagnosed with HIV infection, regardless of the
stage of disease. Tenofovir, which is included in the treatment combinations recommended as first-
line therapy for HIV infection, is also active against HBV.
C. HEPATITIS C
Hepatitis C is a viral infection that affects the liver. It can cause both acute (short term) and
chronic (long term) illness. It can be life-threatening.Hepatitis C is spread through contact with
infected blood. This can happen through sharing needles or syringes, or from unsafe medical
procedures such as blood transfusions with unscreened blood products.
Symptoms can include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine
and yellowing of the skin or eyes (jaundice). There is no vaccine for hepatitis C, but it can be treated
with antiviral medications.
Early detection and treatment can prevent serious liver damage and improve long-term
health.Acute HCV infections are usually asymptomatic and most do not lead to a life-threatening
disease. Around 30% (15–45%) of infected persons spontaneously clear the virus within 6 months of
infection without any treatment.
The remaining 70% (55–85%) of persons will develop chronic HCV infection. Of those with
chronic HCV infection, the risk of cirrhosis ranges from 15% to 30% within 20 years.
Hepatitis C virus infection occurs in all WHO regions. The highest burden of disease is in the Eastern
Mediterranean Region with 12 million people chronically infected. In the South-East Asia Region (9
million), European Region (9 million) and the Western Pacific Region (7 million) people are
chronically infected. Eight million people are chronically infected in the African Region and 5 million
the Region of the Americas.
The hepatitis C virus is a bloodborne virus. It is most commonly transmitted through:
the reuse or inadequate sterilization of medical equipment, especially syringes and needles in
healthcare settings the transfusion of unscreened blood and blood products; and
injecting drug use through the sharing of injection equipment.
HCV can be passed from an infected mother to her baby and via sexual practices that lead to
exposure to blood (for example, people with multiple sexual partners and among men who have sex
with men); however, these modes of transmission are less common.
Hepatitis C is not spread through breast milk, food, water or casual contact such as hugging, kissing
and sharing food or drinks with an infected person.
 Most people do not have symptoms in the first weeks after infection. It can take between two
weeks and six months to have symptoms.
When symptoms do appear, they may include:
fever
feeling very tired
loss of appetite
nausea and vomiting
abdominal page
dark urine
pale faeces
joint pain
jaundice (yellowing of the skin or eyes).

D. HEPATITIS D
Hepatitis D is an inflammation of the liver caused by the hepatitis D virus (HDV), which
requires HBV for its replication. Hepatitis D infection cannot occur in the absence of hepatitis B virus.
HDV-HBV co-infection is considered the most severe form of chronic viral hepatitis due to more
rapid progression towards hepatocellular carcinoma and liver-related death. Vaccination against
hepatitis B is the only method to prevent HDV infection.
The routes of HDV transmission, like HBV, occur through broken skin (via injection,
tattooing etc.) or through contact with infected blood or blood products. Transmission from mother to
child is possible but rare. Vaccination against HBV prevents HDV coinfection and hence expansion of
childhood HBV immunization programmes has resulted in a decline in hepatitis D incidence
worldwide.
Chronic HBV carriers are at risk of infection with HDV. People who are not immune to HBV
(either by natural disease or immunization with the hepatitis B vaccine) are at risk of infection with
HBV, which puts them at risk of HDV infection.Those who are more likely to have HBV and HDV
co-infection include indigenous people, people who inject drugs and people with hepatitis C virus or
HIV infection. The risk of co-infection also appears to be potentially higher in recipients of
haemodialysis, men who have sex with men and commercial sex workers.
In acute hepatitis, simultaneous infection with HBV and HDV can lead to a mild-to-severe
hepatitis with signs and symptoms of indistinguishable from those of other types of acute viral
hepatitis infections. These features typically appear 3–7 weeks after initial infection and include fever,
fatigue, loss of appetite, nausea, vomiting, dark urine, pale-coloured stools, jaundice (yellow eyes) and
even fulminant hepatitis. However, recovery is usually complete, development of fulminant hepatitis
is infrequent, and chronic hepatitis D is rare (less than 5% of acute hepatitis).
In a superinfection, HDV can infect a person already chronically infected with HBV. The
superinfection of HDV on chronic hepatitis B accelerates progression to a more severe disease in all
ages and in 70‒90% of persons. HDV superinfection accelerates progression to cirrhosis almost a
decade earlier than HBV mono-infected persons. Patients with HDV induced cirrhosis are at an
increased risk of hepatocellular carcinoma (HCC); however, the mechanism in which HDV causes
more severe hepatitis and a faster progression of fibrosis than HBV alone remains unclear.
E. HEPATITIS E
Hepatitis E is inflammation of the liver caused by the hepatitis E virus (HEV). The virus has
at least 4 different types: genotypes 1, 2, 3 and 4. Genotypes 1 and 2 have been found only in humans.
 Genotypes 3 and 4 circulate in several animals including pigs, wild boars and deer without causing
any disease, and occasionally infect humans.
The virus is shed in the stools of infected persons and enters the human body through the
intestine. It is transmitted mainly through contaminated drinking water. The infection is usually self-
limiting and resolves within 2–6 weeks. Occasionally a serious disease known as fulminant hepatitis
(acute liver failure) develops, which can be fatal.
The incubation period following exposure to HEV ranges from 2 to 10 weeks, with an
average of 5 to 6 weeks. The infected persons excrete the virus beginning from a few days before to 3-
4 weeks after onset of the disease.In areas with high disease endemicity, symptomatic infection is
most common in young adults aged 15–40 years. In these areas, although infection does occur in
children, it often goes undiagnosed because they typically have no symptoms or only a mild illness
without jaundice.
Typical signs and symptoms of hepatitis include:
- an initial phase of mild fever, reduced appetite (anorexia), nausea and vomiting lasting for a few
days;
- abdominal pain, itching , skin rash, or joint pain;
- jaundice (yellow colour of the skin), dark urine and pale stools; and
- a slightly enlarged, tender liver (hepatomegaly).
These symptoms are often indistinguishable from those experienced during other liver illnesses
and typically last 1–6 weeks. In rare cases, acute hepatitis E can be severe and result in fulminant
hepatitis (acute liver failure). These patients are at risk of death. Pregnant women with hepatitis E,
particularly those in the second or third trimester, are at increased risk of acute liver failure, fetal loss
and mortality. Up to 20–25% of pregnant women can die if they get hepatitis E in third trimester.
Cases of chronic hepatitis E infection have been reported in immunosuppressed people,
particularly organ transplant recipients on immunosuppressive drugs, with genotype 3 or 4 HEV
infection. These remain uncommon

C. Causes of Hepatitis
There are various things that can cause hepatitis, ranging from viral infections, alcohol
addiction, use of certain drugs, autoimmune diseases, and liver worm infections.The
following is an explanation of each cause of hepatitis:
1. Hepatitis A
Hepatitis A is caused by infection with the hepatitis A virus (HAV). Transmission of this
type of hepatitis can occur through food or drink contaminated with the hepatitis A
virus.
2. Hepatitis B
This type of hepatitis is caused by infection with the hepatitis B virus (HBV). Hepatitis B
can be transmitted through unprotected sexual intercourse and blood transfusions. In
rare cases, pregnant women infected with the hepatitis B virus can transmit this virus to
their fetus.
3. Hepatitis C
Hepatitis C is caused by infection with the hepatitis C virus (HCV). Hepatitis C can be
transmitted through unprotected sexual intercourse or the use of non-sterile injection
needles.
Just like hepatitis B, this virus can be transmitted from a mother infected with hepatitis
C to her fetus.
4. Hepatitis D
Hepatitis D is inflammation of the liver due to infection with the hepatitis D virus (HDV).
This type of hepatitis is rare, but can cause serious health problems.
A person can be infected with hepatitis D if they have a history of hepatitis B.
Transmission of this virus can be through the use of non-sterile syringes or blood
transfusions.
5. Hepatitis E
Hepatitis E is caused by infection with the hepatitis E virus (HEV). Hepatitis E is
transmitted through water or food contaminated with this virus. Therefore, hepatitis E is
easily transmitted in environments with poor sanitation.
6. Hepatitis due to alcohol addiction
Consuming excessive alcoholic drinks can cause inflammation of the liver and cause
permanent damage to liver cells. This certainly interferes with liver function. If left
untreated, this condition can progress to liver failure and cirrhosis.

7. Hepatitis due to certain drugs

This type of hepatitis, which is also called toxic hepatitis, occurs due to consuming
excess doses of certain drugs. The liver can become inflamed or damaged because it
works too hard to break down these drugs.
8. Hepatitis due to autoimmune disease
In hepatitis caused by autoimmune disease, the body's immune system mistakenly
attacks liver cells, causing inflammation and liver damage.
9. Hepatitis due to liver flukes
Liver inflammation can also occur due to infection with liver flukes, namely
opisthorchiidae and fasciolidae. One of the opisthorchiidae liver fluke species that most
often causes infections is Clonorchis.
A person can get this type of hepatitis if they eat food that is undercooked and
contaminated with liver worm larvae.
10. Acute hepatitis of unknown cause
Apart from those mentioned above, there is also a type called mysterious acute
hepatitis. The cause of this hepatitis is unknown, but there are suspicions that this
disease is related to Adenovirus and SARS-CoV-2.

D. DIAGNOSIS

History: R/ symptoms appear

•Physical examination

•Supporting Px:
Liver function tests: AST/SGOT and ALT/SGPT
Hepatitis virus antibody test: HAV, HBV, HCV viruses
Tests for viral proteins and genetic material
Abdominal ultrasound
Liver biopsy