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Module ( principle of disease )

Activity research

Pathology of Viral Hepatitis

By
Moamen Nosshey Mohammed Hassan
Id: 23589
&
Mostafa Moaz Badry Mohammed
Id: 23581

For Year 2023/2024

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Content

Name page number

Introduction ..................................................................................................................................3

The 5 Known Types of Viral Hepatitis ......................................................................................5

Symptoms of Hepatitis ............................................................................................................ 13

Diagnosis of Viral Hepatitis .......................................................................................... 16

References ................................................................................................................................ 17

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Introduction

What is Viral Hepatitis?

The liver is a vital organ that processes nutrients, filters the blood, and fights infections.
Hepatitis means inflammation of the liver.
Viral hepatitis is an infection that causes liver inflammation and damage. Inflammation is
swelling that occurs when tissues of the body become injured or infected.
Inflammation can damage organs. When the liver is inflamed or damaged, its function
can be affected.

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Inflamed Liver

The Different Types of Hepatitis:

There are several types of hepatitis, which are categorized as viral hepatitis and non-
viral hepatitis.

The most common types of viral hepatitis are: A, B, C, D, and E.

Then there are non-viral causes of hepatitis, such as autoimmune hepatitis, alcoholic
hepatitis, and drug-induced hepatitis. These forms of hepatitis are not caused by viral
infections but rather by non-infectious causes such as autoimmune disorders, excessive
alcohol consumption, or certain medications or toxins.

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The 5 Known Types of Viral Hepatitis

Hepatitis A:

Hepatitis A is caused by the hepatitis A virus (HAV), which is typically transmitted

through the ingestion of fecal matter containing the virus.
The best way to prevent hepatitis A is through vaccination. Additionally, practicing good
hygiene—such as washing hands thoroughly and avoiding the consumption of
contaminated food or water can help reduce the risk of hepatitis A transmission.
In most cases, hepatitis A resolves on its own without specific treatment. The focus of
treatment is primarily on supportive care to relieve symptoms and aid in recovery.
“A healthy person generally doesn't get any treatment because they they will recover.
However, treatment is considered if it's a high risk patient, such as someone with a
weak immune system.”

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Hepatitis B

Hepatitis B is caused by the hepatitis B virus (HBV), which is primarily transmitted

through contact with infected blood, semen, or other bodily fluids. Additionally, an
infected mother can pass the virus to her baby during childbirth: “In some parts of the
world, especially the Far East, it is commonly transmitted from mother to child. Of
course, that problem is starting to improve now with diagnosis and vaccinations, but it's
still a significant issue.”

HBV can cause both acute and chronic infections, and chronic HBV infection can lead
to liver cirrhosis or liver cancer.

The symptoms of hepatitis B can vary widely, and some individuals may not exhibit any
symptoms at all. Even in chronic cases, individuals may remain asymptomatic for many
years while the virus continues to damage the liver: “Because you can be asymptomatic
for decades, it's worth getting tested,” cautions Dr. Yang.

Hepatitis B can be prevented through vaccination. The hepatitis B vaccine is

recommended for all infants, children, and adults who haven't been previously
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vaccinated. It can also be prevented by avoiding high -risk behaviors, such as engaging
in unprotected sex or sharing needles.

The treatment for hepatitis B depends on whether it is an acute or chronic infection and
the stage of the disease.

• Acute Hepatitis B: In most cases, acute hepatitis B does not require specific
treatment. The focus is on supportive care, such as rest, proper nutrition, and
staying hydrated. Monitoring liver function and regular follow-up with a healthcare
provider are important.
• Chronic Hepatitis B: Antiviral medications may be prescribed to suppress the
replication of the virus and reduce liver inflammation. These medications aim to
slow down the progression of liver disease and prevent complications. The
choice of medication and treatment duration will depend on various factors,
including the patient's liver function, HBV DNA levels, and the presence of other
liver conditions.

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Hepatitis C

Hepatitis C is caused by the hepatitis C virus (HCV). It is primarily transmitted through

blood contact via the sharing of needles although it can also be transmitted through
unsafe healthcare practices, including improper sterilization of medical equipment or
accidental needlestick injuries.

“Just a few decades ago—when I was a resident—hepatitis C was called Non-A Non-B
because it hadn't been identified yet and there was no way to screen for it, so it was
commonly transmitted through blood transfusions,” recounts Dr. Yang. “Then HCV was
discovered and now we can screen for it.”

Chronic hepatitis C infection can lead to long-term liver damage, including cirrhosis,
cancer, and even liver failure. It is a common cause of liver failure requiring liver

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transplantation. It's worth noting that symptoms of hepatitis C may not appear until the
liver has already been significantly affected.

While there is no vaccine for hepatitis C, treatment for the infection has advanced
significantly in recent years, thanks to the development of direct-acting antiviral (DAA)
medications. “For hepatitis C, we now have medications that are curative.”

These medications specifically target the replication process of the virus and are highly
effective in curing hepatitis C. The specific hepatitis C medication regimen will depend
on the HCV genotype, prior treatment history, and the presence of liver cirrh osis or
other underlying liver conditions.

The primary aim of hepatitis C treatment is to achieve SVR (Sustained Virologic

Response), which means that the virus is no longer detectable in the blood six months
after completing treatment. However—during and after treatment—regular monitoring of
liver function, HCV RNA levels, and other relevant markers is important to assess
treatment response and detect any potential complications.

Hepatitis D

Hepatitis D—also known as delta hepatitis—is caused by the hepatitis D virus (HDV).
Unlike other types of viral hepatitis, HDV cannot cause infection on its own. Also called
a satellite virus, it only occurs in individuals who are already infected with the hepatitis B
virus (HBV).

“The reason that you can only get delta if you have hepatitis B is because the delta virus
is defective and doesn't make its own shell. It's just a piece of genetic information, so it
uses the hepatitis B shell. So that's why if you prevent hepatitis B, you'll also prevent D.”

Similar to HBV, HDV is transmitted through contact with infected blood or other bodily
fluids during unprotected sexual intercourse or the sharing of needles. Additionally, an
infected mother can pass both HBV and HDV to her baby during childbirth.

HDV infection can worsen the outcomes of HBV infection and increase the risk of
severe liver disease. Therefore prevention is crucial for hepatitis D, and the best way to

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prevent HDV infection is by preventing hepatitis B infection. This can be achieved

through HBV vaccination, practicing safe sex, avoiding needle sharing, and following
appropriate infection control measures in healthcare settings.

The treatment for hepatitis D is primarily focused on managing the underlying hepatitis
B infection, as there are no specific antiviral medications available to treat HDV directly.
The treatment approach for hepatitis D includes:

• Antiviral medications used to treat hepatitis B can also help suppress the activity of
HDV. These medications are aimed at reducing HBV viral replication and liver
inflammation, which indirectly helps control HDV infection.
• Pegylated interferon is another treatment option for hepatitis D. It is administered
as an injection and can help control HDV replication in some individuals.
• In severe cases of advanced liver disease caused by chronic hepatitis D, a liver
transplant may be considered as a treatment option.

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Hepatitis E

Hepatitis E is caused by the hepatitis E virus (HEV). Like hepatitis A, it is primarily

transmitted through the consumption of contaminated water or food, particularly in areas
with inadequate sanitation and poor hygiene practices.

Prevention of hepatitis E primarily involves ensuring access to safe drinking water and
practicing good hygiene and sanitation measures. In areas with a high prevalence of
hepatitis E, it is advisable to drink boiled or treated water, avoid consuming raw or
undercooked meat, and practice thorough hand washing before handling food.

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Much like hepatitis A, a hepatitis E infection usually resolves on its own without specific
treatment and most individuals recover without long-term complications:

“Clinically hepatitis A and E behave similarly in terms of their routes of transmission and
outcomes. They tend to be milder and a certain percentage of people often recover
spontaneously without any noticeable symptoms, especially with E.”

However in some patients hepatitis E can lead to severe complications, warns Dr.
Yang: “Of course, some people are still at serious risk. For example, transplant patients
whose immune systems are weak because they get drugs to prevent rejection. And
pregnant women who naturally dampen their immune system, so they don't reject the
baby.” In these situations, medical attention and specialized management may be
necessary.

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Symptoms of Hepatitis

The symptoms of hepatitis can vary in severity, and some individuals may not exhibit
any symptoms at all. However, common symptoms include:

• Loss of appetite

• Nausea and vomiting

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• Abdominal pain or discomfort

• Pale or clay-colored stools

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• Dark urine

• Jaundice (yellowing of the skin and eyes)

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• Joint pain

Diagnosis of Viral Hepatitis

Even if an individual is asymptomatic, blood tests can be administered to assess liver

health. Liver Function Tests (LFTs) measure the levels of liver enzymes and other
substances in the blood, such as alanine aminotransferase (ALT), aspartate
aminotransferase (AST), alkaline phosphatase (ALP), and bilirubin. Abn ormal levels of
these markers can indicate liver inflammation or damage.

If hepatitis is suspected, additional blood tests can detect specific antibodies (Viral
Hepatitis Serologic Tests) or viral genetic material (Polymerase Chain Reaction or PCR
Tests) to identify the type of viral hepatitis (A, B, C, D, or E) and determine whether it is
an acute or chronic infection.

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References

1. National Institute of Diabetes and Digestive and Kidney Diseases

(NIDDK).
https://www.niddk.nih.gov/health-information/liver-disease/viral-
hepatitis/what-is-viral-hepatitis

2. Centers for Disease Control and Prevention.

https://www.cdc.gov/hepatitis/abc/index.htm

3. UCLA David Geffen School of Medicine.

https://medschool.ucla.edu/news-article/the-different-types-of-hepatitis

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