Acute Viral Hepatitis

Under Kind Guidance of

Dr. (Prof.) G.G. Mansharamani
Prep. By Dr. Rahul Arora

Liver

Liver (Gen. Information)

Largest organ of body-1-1.5 Kg, 1.52.5% of body mass
Recieves dual blood supply-20%
From Hepatic artery (O2 rich) and
80% (nutrient rich) from portal vein
Majority of Cells- Hepatocytes,
remaining-Kupferr cells, stellate
celss, endothelial cells, blood
vessels.
Organized in lobules with portal
areas at the periphery and central
veins in centre

Liver Diseases
Classified as
Hepatocellular
(Viral hep, Alcoholic Hepatitis)

Cholestatic
(Obstructive)- Gall stone diseases, malig
obstruction, Billiary cirrhosis)

Mixed

Clinical Manifestations
Fatigue- most characterisitic
and most common symptom.
Typically arises after activity or
exercise
Nausea, vomitings
Right upper quadrant discomfort
Itching can be there in later
stages

Clinical Manifestations
Jaundice- hall mark of Liver
disease
Usually reported darkening of
urine by the patients.
Color of stool golden yellow
Jaundice clinically detectable
at bilirubin level of 2.5 mg/dl
and above.

Clinical history

Food habits
Sexual activeness
Drug history
Blood transfusions
Alcohol intake

Physical Examination

Icterus
Hepatomegaly with tenderness
Palmar erythema
Itching marks
Fetor hepaticus (Later stages)
Ascites, edema, hepatic failure
(in fulminant hepatitis)

Jaundice

Caput medusae

Ascites with inverted

umbilicus

Gynaecomastia

Spider Naevus/Angioma

Blood Investigations done

Liver function tests
Fractions- conjugated (30%) and
unconjugated
Uconjugated (increased in
hemolysis and genetic disorders)
Urine bilirubin (conjugated
bilirubin)
Blood ammonia levels

Investigations done
Serum enzymes
Aminotransferases represent
hepatocellular injury
AST (Aspartate aminotrasferase),
usually present in liver cardiac
muscle, skeltal muscle, kidneys,
brain, pancreas, lungs, leucocytes
ALT (Alanine transferase), manly in
liver

Investigations done
In acute Hepatitis, ALT higher than
AST ratio >2:1
In alcoholic hepatitis ratio >3:1
Alkaline phosphotase, Glutamyl
transpeptidase, 5 nuclitidase
raised in cholestatic jaundice

Ultrasonography
Urine bile salts and pigments
Coagulation profile

Types of Viral Hepatitis

Hepatitis A - enteric
Hepatitis B - parenteral
Hepatitis C - parenteral
Delta hepatitis-parenteral
Hepatitis E - enteric

Types of Viral Hepatitis

Generally causes are 5 types Of
Hepatitis A,B,C,D,E.
Other transfusion transmitted
viruses identified- Hep.-G virus
and TT virus
All viruses RNA viruses except
Hep. B- DNA virus

Viral Hepatitis A
RNA virus
Most common cause of Hepatitis
worldwide
30% of viral hepatitis caused by
HAV in US
Faeco-oral route of transmission
Large outbreaks due to
contamination of food and water.

Viral Hepatitis A
Incubation period- 1to 4 weeks.
Diagnosis by anti HAV antibodies.
May be silent (subclinical) Starts by
mild fever, fatigue and few loose
stools
All cases resolve in 4-6 weeks
No chronic hepatitis or cirrhosis
seen
Treatment- supportive

Viral Hepatitis B
DNA virus
Incubation period- 30-180 days.
Blood Transmission Blood tansfusion,
syringes, drug abusers;Vertical, Sexual,
Body secretions
About 300-350 million chronic carriers
worldwide. 75% of all cases occur in Asia.
An estimated 40 million carriers are in
India, Incidence -3-4%

Diagnosis of HBV
History- Blood transmission
Viral markers
Acute IgM anti-HBc, HBeAg.
HBsAg, HBV DNA
Chronic- IgG antiHBc, HBeAg, anti
HBe, HBsag, HBV DNA

Complications of Chronic HBV

Infection
Cirrhosis
Decompensated liver disease
Hepatocellular carcinoma
Death

Treatment of HBV

Interferons
Lamivudine
Adefovir
Entecavir
Telbivudine
Liver transplantation

Hepatitis C Virus
200 million carriers worldwide
Incidence In US has decreased
to 18000 cases per year
$ million infected in US with
HCV and 10,000 die each year
of HCV related chr. Liver
diseases
HCV- frequent cause of
hepatocellular carcinoma

Hepatitis C Virus
Mode of transmission
paraenteraly , vertical and sexual
Clinical features Symptoms vary
from mild to fulminant hepatic failure
Incubation period 15-150 days
15% have spontaneous resolution
and 85% go into chronic HCV.HCC
devlops in 1-2% of patients

Hepatitis C
Diagnosis by Anti HCV ab, HCV
RNA
Treatment
Interferons
Ribavarin
Liver transplantation

Hepatitis D
Small RNA virus
Presents as coinfection with
Hep. D
Diagnosis by HDV RNA or HDV
antigen
Chronicity same as hepatitis B
Mode of transmision- paraentral
Treatment Interferons

Hapatitis E
RNA virus
Most commonly seen in India
Feco-oral mode of transmission,
causes epidemics
No chronic infection with Hep. E
No prophylaxis known
Treatment is supportive.
High fatality in pregnant women.

Thanks