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Causes:
Hepatitis may be due to:
1- Infections:
- Viral hepatitis.
Epidemiology:-
Hepatitis A virus:
- Mode of infection:- Faecal - oral route & rarely parenteral
transmission. It spreads into food & water (fresh & salty ones).
Shillfishs are a good source of infection.
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- The disease occurs as sporadic cases or in epidemics
Hepatitis B virus:
- Mode of infection:-
1- Parenteral transmission:-
2- sexual transmission .
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immunization for shistosomiasis & units for parenteral treatment of
diabetes.
Hepatitis C virus:
- Mode of infection:-
1- Parenteral transmission .
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- The case & carriers including incubatory & chronic ones are the
source of infection.
Hepatitis E virus:
- Mode of infection: Foecal-oral transmission.
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Clinical Findings:-
Hepatitis A virus:
Clinical picture:-
1- Asymptomatic cases.
2- Anicteric hepatitis.
3- Icteric hepatitis.
4- Fulminant hepatitis.
1- Anicteric hepatitis:-
* Symptoms:-
- Anorexia is marked.
*Signs:-
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- The liver is enlarged, soft, smooth & tender.
*Symptoms:-
- Jaundice appears with drop of fever & improvement of
general condition. Darkening of urine occures at first followed
by lightening of stools & then scleral icterus.
*Signs:-
- The liver is enlarged, soft, smooth & tender.
C- convalescence stage :-
Sequelae of hepatitis:-
(A) complete recovery:-
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(B) complications:-
1) Hepatic complications:-
1- fulminant hepatitis:-
2- cholestatic hepatitis :-
Hepatitis B virus:
Clinical picture:-
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Sequelae of hepatitis:-
(B) complications :-
1) hepatic complications :-
1- Fulminant hepatitis:-
2- chronic sequelae:
* chronic hepatitis:
*Hepatocellular carcinoma.
* carrier state.
Hepatitis c virus: *
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HBV.More than 40% of the infected cases become chronic, out of
them 20% develop cirrhosis & liver cancer.
*Hepatitis D virus:
- Delta agent causes infection at the same time of HBV infection
(co- infection). This induces the severity of acute sings of VBH &
the prevelance of liver fulminant.
N.B.
* clinical picture of chonic hepatitis:-
Symptoms:-
- may be asymptomatic.
Signs:-
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Diagnosis:-
Hepatitis A virus
1-liver function tests:-
2-Hepatitis A markers:-
- The IgG appears later & persists for years or life long.
Thus, its valuable in survey study rather than diagnosis.
Hepatitis B virus
1-liver function tests:-
2- Hepatitis B markers:-
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* Anti – HBs:-
* HBeAg:-
It indicates infectivity:
3-Liver imaging:
4- Blood picture:-
5- Urine analysis :-
- Urobilinogen is variable.
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6- Stool analysis:-
- Decreased strcobilinogen.
Hepatitis c virus
1- Liver function tests:-
2- Hepatitis C Markers:-
Hepatitis D virus
Hepatitis D Markers:-
* HBS Ag is positive.
Hepatitis E virus
Anti – HEV antibodies:-
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Treatment:-
Hepatitis A virus
1- Rest in bed: is advised until the patient becomes symptom
free, the liver is no longer tender & serum bilirubin is less than
1.5 mg/dl.
2- Diet:-
3- Symptomatic treatment:-
4- Treatment of complications:-
Hepatitis B virus
Treatment in general is made as described for hepatitis A.
interferon, adenine arabinoside, cortcosteroids & azathioprine
alone & in combinations may have a role to improve the
chronic active carriers.
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The response occure in about 50% of patients. When the drug
is stopped, 50% of responding patients experience a relapse.
Hepatitis C virus
Only the general measures like that of VBH must be followed.
Hepatitis D virus
No specific treatment for delta hepatitis.
Hepatitis A virus
1- Maintenance of good sanitary conditions.
Hepatitis B virus
A) General measures:-
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B) Specific measures:-
2- Active immunization:-
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Need of repeated blood transfusion.
Hepatitis C virus
Only the general measures like that of VBH must be followed.
No available vaccine. Immunoglobulin is not effective either
as immunotherapy or immunoprophylaxis, however its given
to workers of high risk.
Hepatitis D virus
General measures & vaccination against HBV protect against
delta virus infection.
Hepatitis E virus
- Improving sanitation is the most important measure which
consists of proper treatment & disposal of human waste,
higher standards for public water supplies, improved personal
hygiene procedures & Sanitary food preparation.
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Recent approaches in treatment
& prevention of hepatitis
Treatment of hepatitis B:-
- Current treatments for hepatitis B are very effective at
controlling or suppressing the HBV. However HB treatment
only rarely leads to (cure).
2- Lamivudine (EPIVIR)
3- Adefovir (HEPSERA)
4- Entecavir (BARACLUDE)
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- Chances of responding to treatment:-
-Duration of treatment:-
- Ascitis:-
- Furosemide (lasix)
- Spironolactone (Aldactone)
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- Encephalopathy:-
- Lactulose
- Rifaximin.
- Propranolol (indral)
- Nadolol
- Trimethoprim – sulfamethoxazole.
- Fluroquinolones.
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- Not every one with hepatitis C needs treatment. Only
patient with active liver disease or with scarring to liver
should be treated as long as they don’t have conditions that
prevent them from being treated successfully.
-Bile acids:-
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* Bile acids may decrease serum transaminase activities
in patients with acute hepatitis B, chronic hepatitis B or
chronic hepatitis C. However, bile acids have no effects
in eradicating viral markers.
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molecules called TF. It can also be derived from
eggyolk protein & human WBCs.
- For HC:- People who have HC can get into another infection
of one of other genotypes which can make the person sicker so
they should follow general guidelines for protection.
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