hepatitis

By DR. Maeen Gamal AL-Hadhrami

❖ Hepatitis:
➢ Is the inflammation of the liver.
➢ There is two types of hepatitis:
1- Acute hepatitis: and its causes are:
a. Viral:
i. Hepatitis virus (A, B, C, D and E)
ii. Cytomegalovirus
iii. Yellow fever virus
b. Non-viral:
i. Toxoplasma gondi
ii. Leptospira
c. Poison:
i. Carbon tetrachloride
ii. Mushrooms
d. Drugs:
i. Paracetamol
ii. Halothane
e. Alcohol.
f. Others:
i. Pregnancy as in preeclampsia
ii. Shock
iii. Wilson disease
2- Chronic hepatitis: and its causes are:
a. Viral: as Hepatitis B and C
b. Autoimmune hepatitis
c. Drugs as: Methyl dopa
d. Alcoholic liver disease
e. Wilson disease

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 ❖ Viral hepatitis:
➢ Is a viral infection that causes inflammation of the liver
➢ There are five main types of viral hepatitis: A, B, C, D, E
➢ Hepatitis A and E are typically caused by ingestion of contaminated food or
water.
➢ Hepatitis B, C and D are typically caused by contact with contaminated blood
or body fluids
➢ In particular viral hepatitis types B and C lead to chronic disease in hundreds
of millions of people and, together, are the most common cause of liver
cirrhosis and cancer.
❖ Hepatitis A (HAV):
✓ The most common type of viral
hepatitis.
✓ Is RNA virus.
✓ No chronic hepatitis.
✓ Common in children and young adults.
➢ Mode of transmission:
• Fecal-oral route by in gestion of
contaminated water and food.
➢ Incubation period:
• 2-6 weeks
➢ Clinical picture:
1- Pre-icteric phase:
a. Before the onset of jaundice by 1-2 week
b. The onset may be acute or gradual
c. The patient feels flu-like illness as malaise, easy fatigability, headache,
arthralgia, myalgia, and upper respiratory symptoms as nasal discharge, cough
and pharyngitis.
d. Anorexia
e. Nausea and vomiting are frequent
f. Mild fever
g. Mild abdominal pain in the right upper quadrant of abdomen
h. Dark colored urine before the jaundice by 1-5 days.

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 2- Icteric phase:
a. Jaundice
b. Liver may become enlarged and tender with
pain
c. Dark color urine and pale stool
3- Convalescent phase:
a. This is the recovery stage
➢ Investigations:
1- CBC: lymphocytosis
2- Liver function test:
a. Bilirubin is elevated (both direct and
indirect) more than 2.5 mg\dl
b. Liver enzymes: AST and ALT are elevated 20-fold
3- Prothrombin time may be elevated
4- Urine analysis:
a. Bilirubinuria – high
b. Microscopic hematuria
5- Serology for viral markers:
a. Anti-hepatitis A antibody (anti-HAV) IgM is positive
➢ Management:
1- Bed rest
2- Diet:
a. High carbohydrates
b. High protein
c. Low fat diet
3- Drugs:
a. Should be avoided in sever hepatitis because they are metabolized in
liver especially sedatives and hypnotics
b. Paracetamol should be administrated in caution
c. Antiemetics for vomiting
d. Vitamins: multivitamins especially B complex and vit. K
➢ Prevention:
1- Control of the source such washing hands
2- Active immunization:
a. Hepatitis A vaccine (Havrix inj.)

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➢ Complications:
1- Fulminant hepatic failure.
2- Acute renal failure.
3- Pancreatitis.
4- Guillain-Barre syndrome.
5- Death.
❖ Hepatitis E:
✓ Is RNA virus.
✓ Is similar in hepatitis A in mode of transmission.
✓ Is similar in hepatitis A in clinical picture but more sever.
✓ No chronic hepatitis
Investigation:
1- Similar to HAV
2- Serology by anti-HEV antibody IgM
❖ Hepatitis B (HBV):
✓ Is DNA virus.
✓ High risk group are IV drug abusers,
patients and staff at hemodynamic
center.
✓ Can lead to chronic hepatitis
➢ mode of transmission:
1- Intravenous route: as blood
transfusion, contaminated needles
2- Sexual intercourse
3- From infected mother to the child at the time of delivery
➢ Incubation period:
• 1-6 months.
➢ Hepatitis B viral markers:
1- Hepatitis B surface antigen (HBsAg) .
2- Antibodies to Hepatitis B surface antigen (anti-HBs).
3- Hepatitis B core antibody (anti-HBc).
4- Hepatitis B e antigen (HBeAg).
5- Hepatitis B virus DNA (PCR for hepatitis B)

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➢ Clinical picture:
• Is similar in hepatitis A in clinical picture but more sever.
➢ Investigation:
1- Similar to HAV.
2- Serological tests:
a. HBsAg and anti-HBc IgM
b. PCR
➢ Complications:
1- Fulminant hepatic failure.
2- Chronic hepatitis.
3- Cirrhosis.
4- Hepatocellular carcinoma
➢ Treatment:
1- Acute hepatitis B: as of HAV
2- Chronic hepatitis B:
a. Interferon: interferon alpha
b. Nucleoside analogue (anti-viral): lamivudine and adefovir
❖ Hepatitis C:
✓ Is RNA virus.
✓ Mode of transmission same as HBV.
✓ chronic hepatitis is common
➢ incubation period:
• 6-7 weeks
➢ clinical picture
1- Often mild illness and may be asymptomatic.
2- Most of patients are diagnosed late with complications of chronic liver
disease.
➢ Diagnosis:
1- Same as HBV.
2- Serology:
a. Anti HCV antibody
➢ Treatment:
1- Acute hepatitis C:
a. As hepatitis A

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 b. Alpha interferon for 6-24 weeks may decrease the risk of chronic
hepatitis C
2- Chronic hepatitis:
a. Interferon: interferon alpha-2b
b. Ribavirin.
❖ Hepatitis D:
✓ Require hepatitis B virus.
✓ Is similar in hepatitis B in mode of transmission.
✓ Causes chronic hepatitis and cirrhosis in 65% of cases.

❖ Summary: