2.Acute Hepatitis - Sarm

• Hepatitis is liver tissue inflammation

  • acute - resolves withing 6 months
  • chronic - beyond 6 months
• Hep A B and C are the most common

  • B, C and D are chronic
• acute viral hepatitis

  • diffuse liver inflammation
  • resolves spontaneously - 4 to 8 wk
• Acute viral hepatitis - symptoms

  • non-specific prodromal illness
  • dark urine and jaundice
  • diarrhea or constipation follow by abdominal discomfort
• acute viral hepatitis - PE

  • jaundice
  • tender or tender liver
  • splenomegaly
  • cervical lymphadenopathy
• AVH investigation

  • viral serologic testing - know specific viral cause
  • liver enzyme - confirm hepatitis
  • PT measurement - know severity of liver damage
• Fulminant hepatitis - acute massive liver necrosis leading to acute liver failure
• Fulminant hepatitis is due to viral hepatitis or drug injury such as acetaminophen
• Fulminant hepatitis - diagnosis

  • acutely ill with new onset jaundice
  • rapid changes in mental status or unexplained bleeding
• Acute viral hepatitis treatment?

  rest, fluids and nutrition's
• Antiviral drugs are not recommended in acute infection
• Hep A

  • common cause of acute viral hepatitis
  • spread of fecal oral route - poor sanitation
• Hep A - pts will excrete virus in fecal for about 2 to 3 weeks before onset of symptoms and 2 weeks more
• Hep A - diagnosis

  • serological testing
  • IgM anti-HAV present = active HAV infection
  • IgG anti-HAV
  • indicates previous exposure - not diagnostic
• Which hep viral does not cause chronic hepatitis?

  Hep A
• Hep A prevention - vaccine to ( take 2 weeks to be effective)

  • travelers
  • lab workers
  • pts with chronic liver disease
• Hep A prevention - immunoglobulin

  • protective for 3 months
  • should give to old and IC pts
• Hep E infection during pregnancy is associated with fulminant hepatitis
• Hep E diagnosis - IgM anti-HEV is present
• Hep B

  • transmitted parenterally
  • lead to chronic infection
  • leading to cirrhosis and hepatocellular carcinoma
• Hep B transmission

  • contaminated blood transfusion
  • vertical transmission - mother to baby
  • mucosal contact
• What is window period

  • HBs-Ag and Anti-HB is not detectable
  • pts is infectious
• Acute hep B - serology - positive for?

  HBsAg and IgM anti-HBc
• Hepatitis if severe check?

  anti-HDV levels
• Hep D

  • can replicate in Hep B virus
  • can have co-infection
  • infect chronic HBV carriers (super infection)
• Hep D serology - check anti HDV, if HBV is present
• treatment of Hep D?

  treat Hep B
• Hep C

  • develop into chronic states - progress to cirrhosis
• Hep C diagnosis

  • positive anti HCV - implies exposure
  • needs HCV RNA test - confirm active disease
• Anti HCV not protective against re-infection