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Viral Hepatitis (Virus Hepatitis)
Viral Hepatitis (Virus Hepatitis)
Viral
Hepatitis
FAKULTAS KEDOKTERAN
UNIVERSITAS ISLAM SUMATERA
UTARA
2013
WHAT IS VIRAL
HEPATITIS ?
Etiology
Major
agents:
HAV
HBV
HGV
HCV
TTV
HDV
HFV
HEV
Minor agents:
EBV,CMV
HSV,VZV
Rubella,Measles
Coxsackie
B
Adenovirus
Transmission
HAV HBV HCV
HDV HE
V
Fecal-oral
Percutan.
Perinatal
Sexual
Epidemiology
HAV:fecal-oral
HEV:fecaloral
Rarely bloodborne
HBV:percutaneous contact
Mucous membrane
contact
Sexual contact
Perinatal:third trimester
Epidemiology
HCV:
Percutaneous transmission
Transfusion(0.1 %),needle
stick(1.8 %)
Mucousal transmission (rare)
Sexual transmission is
rare(monogamy) Perinatal
transmission is uncommon
Sexual transmission of
HCV
Multiple
sexual partner
HIV and STD
Anal sex
Open sore
Sex during menstruation
Pathology
Infiltration
of mononuclear
cells
Hepatic cells necrosis
Kupfer cells hyperplasia
Variable degrees of
cholestasis
In more severe cases;
Clinical Stages
Incubation
period
Prodromal (preicteric)
phase
Icteric phase
Convalescence
Variation in
staging
Asymptomatic
Anicteric
Fulminant
Chronic
Incubation
Period
HAV:15-45
days(30)
HBV: 30-180 days(60-90)
HCV: 15-160 days(50)
HDV: 30-180 days(60-90)
HEV: 14-60 days(40)
Preicteric Phase
Systemic & nonspecific
symptoms
Flu-like syndrome & dyspepsia
Fever, sore throat, cough,
headache
Fever, anorexia, malaise, nausea,
vomiting, abdominal pain
Icteric Phase
Clinical
jaundice
Dark urine : 1-5 days before
jaundice
Patient may feel better
Resolution of fever
Pruritus
Icterus
Icterus
Jaundice
Icteric Phase
Liver
is enlarged,tender
Cervical adenopathy(10-20%)
Splenomegaly(10-20%)
Fever is absent
Encephalopathy :Irritability,
lethargy, confusion
Convalescence
Resolution
of symptoms
Liver is enlarged
Pruritus
Complete recovery:
1-2 months A,E
3-4 months B,C (3/4)
Laboratory
Findings
CBC
:leukopenia,
lymphocytosis
Normal Hb; except
haemorrhage
Normal platelet; except DIC
ESR is normal
Serum
Ig
Serologic
Diagnosis
M anti-HAV
HBs Ag and Ig M anti-HBc
HCV Ab, HCV RNA PCR
anti-HDV
anti-HEV
Complications
Hepatitis
A : Relapsing
hepatitis
Cholestatic hepatitis
Chronicity : HBV,HCV,HDV
Fulminancy : HAV, HBV, HDV,
HEV
Diferential
Diagnosis
Viral
hepatitis by minor
agent
Gram negative Sepsis
Cholangitis, cholecystitis
Acute on chronic hepatitis
Drug-related hepatitis
Ischemic hepatitis
Management
Indication of admission:
Bilirubin>20 mg/dl
Hypoglycemia
Abnormal PT
Hypoalbuminemia
Poor
oral intake
Mental change,letargy
Low compliance
Other chronic disease
Management
Restriction
activity
Drug &Alcohol avoidance
Isolation is not necessary,
unless special cases
Symptomatic
Monitoring
Regular
physical
examination
Liver size, mental state,
icterus
Check of LFT, PT, Bilirubin
Serial check of HBsAg and
HCVAb
Prevention
Hand
washing, hygiene
Universal percaution
No sharing of personal
items (razor, toothbrush,
nail clipper)
Sexual barrier
Chronic Viral
Hepatitis
Definition:
chronic
necroinflammatory
injury
and
hepatocellular
1-Antitrypsin deficiency
Clinical appearance of
CH
mostly asymptomatic
~20%: mild fatique; rarely: mild
RUQ pain
Late symptoms of CH
Hepatitis C
Chronic hepatitis C
(CHC)
60-70%
Chronic hepatitis
20-30%
Liver cirrhosis
~5%
HCC
Immunodeficiency
Alcohol abuse
Iron overload
Hepatitis B
Epidemiology of HBV
Transmission of HBV
HBV is present in all body fluids and secretions!
Horizontal transmission:
by blood, blood products, surgery
injection-drug abuse, needle-stick injury
sexual activity,
occupational exposure
household contact
Acute hepatitis
10%
Persistent infection
Fulminant hepatitis
90%
Recovery and clearance
of HBV-DNA
2-3%
Chronic active hepatitis
1%
Liver cirrhosis
Carrier state
100-fold risk
HCC
Acute
Infection
Stabilisation
Chronic
Hepatitis
Chronic
Carrier
Compensated
Cirrhosis
Cirrhosis
Liver
Cancer
Progression Decompensated
Cirrhosis
(Death)
3050 Years
Adapted from Feitelson, Lab Invest 1994
Death
Healthy Liver
Cirrhosis
Liver Fibrosis
Liver Cancer
Diagnosis of CHC
Diagnosis of CHB
Virological:
HBV: serology, se HBV-DNA; antiHDV
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