VIRAL HEPATITIS

Bayar Baloch
2019/052
Group F
Objectives

● Define Viral Hepatitis

● Causes of Viral Hepatitis
● Classify Different Types of Viral Hepatitis (Acute vs Chronic)
● Differentiate between types of Acute Viral Hepatitis (A & E)
● Differentiate between types of Chronic Viral Hepatitis (B, C, & D)
 VIRAL HEPATITIS

Viral hepatitis is a systemic disease with

primary inflammation of the liver cause by
different viruses.
CAUSES OF VIRAL HEPATITIS
 TYPES OF VIRAL HEPATITIS

Viral Hepatitis

Acute Viral Hepatitis Chronic Viral Hepatitis

Hepatitis A & E Hepatitis B, C & D

 01
ACUTE HEPATITIS
(Hepatitis A & E)
 HEPATITIS A
Organism: The hepatitis A virus (HAV) belongs to the picornavirus
group of enteroviruses.

Incubation Period: 2- 4 weeks

Mode of Transmission: faecal-oral route

Population at Risk:
Children
Low-socio economic area (poor sanitation and over crowding)
Prisoners
 HEPATITIS A

Infectivity Period: Infected individuals,

who may be asymptomatic, excrete the virus in faeces for
about 2–3 weeks before the onset of symptoms and then
for a further 2 weeks or so.

Investigations:

Serology:
Active Infection: Anti-HAV IgM
Recovery/Vaccination: Anti-HAV IgG (protective antibody)
 HEPATITIS A
Silent/Subclinical: Asymptomatic

Classic Presentation: Occurs in 3 phases:

Prodromal phase:
● Headache
● Myalgia
● Arthralgia
● nausea and anorexia

Icteric phase:
● Jaundice
● Dark urine
● Pale stool
● Abdominal pain

Recovery phase
 HEPATITIS A
Treatment:
Self-limiting infection
Supportive treatment

Prevention:

Active Immunity:
Vaccine (2 doses),can be given in children >1 year of age, booster after 6-12 months.
Passive Immunity:
Immunoglobulin (post-exposure prophylaxis)

Proper sanitation
 HEPATITIS E
Organism: Hepatitis E is caused by an RNA virus.

Incubation Period: 3-8 weeks

Mode of Transmission: faecal-oral route

Clinical Features:
• Mild fever
• reduced appetite, nausea and vomiting lasting for a few days
• abdominal pain
• itching jaundice
• dark urine and pale stools
• Painful hepatomegaly
 HEPATITIS E
Investigations:

Serology:
Active Infection: Anti-HEV IgM

Hepatitis E differs from hepatitis A in that infection during pregnancy is

associated with the development of acute liver failure, which has a
high mortality.

Treatment:
Self-limiting infection
Supportive treatment
 02
CHRONIC HEPATITIS
(Hepatitis B, C, & D)
 HEPATITIS B
Organism: The hepatitis B virus (HBV) is a DNA virus that
belongs to the Hepadna group.

Incubation Period: 4- 20 weeks

Mode of Transmission:
 HEPATITIS B
Clinical Features:

Acute Infection:
• Fever
• jaundice .
• Painful hepatomegaly.
• Elevated serum transaminases (ALT>>AST).
• Followed by recovery.
• Can progress to fulminant hepatitis in <1% cases
 HEPATITIS B
Clinical Features:

Chronic Infection:
Usually asymptomatic.
90% of the infected babies and infants will develop a
chronic hepatitis B infection.

Complications:
Hepatocellular carcinoma
Cirrhosis

Hepatitis is one of the most common causes of

chronic liver disease and hepatocellular carcinoma
world-wide.
 HEPATITIS B
Investigations
 HEPATITIS B
Treatment:
The goals of treatment are HBeAg seroconversion, reduction in HBV-DNA and
normalisation of the LFTs.

Acute Infection:
Treatment is supportive with monitoring for acute liver failure, which occurs in less than
1% of cases.
Full recovery occurs in 90–95% of adults following acute HBV infection.
The remaining 5–10% develop a chronic infection which usually continues for life,
 HEPATITIS B
Chronic Infection:

Medical Treatment:
Nucleoside-nucleotide antiviral agents Entecavir or Lamivudine (1st line agents
Pegylated interferon Alpha (PEG INF-alpha)

Surgical Treatment:
Liver transplant

Prevention:
• Active: Recombinant vaccine (at birth, 1-month, after 6 months).
• Passive: Immune globulins.
• Use of sterilized needles
• Proper screening of blood before transfusion.
• Avoid unprotected sexual contact.
 HEPATITIS D
Organism: The hepatitis D virus (HDV) is an RNA-defective virus.

Incubation Period: 6-9 weeks

Mode of Transmission: Parenteral

Infection with HDV arises in following setting:

● Co-infection by HDV & HBV
● Super-infection of chronic HBV carriers by HDV

Management:
Effective management of hepatitis B effectively prevents
hepatitis D.
 HEPATITIS C
Organism: This is caused by an RNA flavivirus.

Incubation Period: 2 - 26 weeks

Mode of Transmission: Parenteral

 HEPATITIS C
Clinical Features:

Acute Infection:
80% is subclinical, only 10-20% is symptomatic any may cause:
• Fatigue
• Muscle pain
• Joint pain
Jaundice and complications of portal hypertension typically occur
only when the disease progresses to cirrhosis.

Chronic Infection:
Chronic hepatitis occurs in 80% of patients
Cirrhosis occurs in 20% of chronic infection within 20 years.
Hepatocellular carcinoma develops in 2-5% of patients with
cirrhosis.
 HEPATITIS C
Investigations:

Serology:
 HEPATITIS C
Treatment:
The aim of treatment is to eradicate infection.

Treatment of choice: The treatment of choice is pegylated α-interferon given

weekly subcutaneously, together with oral ribavirin.

Liver transplantation should be considered when complications of cirrhosis

occur, such as diuretic-resistant ascites.

Cure is defined as loss of virus from serum 6 months after completing therapy.

Prevention:
There is no active or passive protection against HCV.
References

• https://www.who.int/health-topics/hepatitis
• https://www.cdc.gov/hepatitis/abc/index.htm
• https://www.hopkinsmedicine.org/health/conditions-and-diseases/hepatitis
• Robbins Basic Pathology (10th Edition), Chapter 16 Liver and Gallbladder,
General Features of Liver Disease
Thank You