HEPATITIS

Hep Transmission Epidemiology Incubation Prodrome /Symptoms Diagnosis Treatment

A Fecal-oral Egypt, most 0.5 - 2 mo. Flu like prodrome: fever,
common in malaise, aches, anorexia (+/-
world dyspeptic), Jaundice
(when jaundice (icteric
phase) appears, all other
symptoms disappear)
• Anti-HAV IgM = active
• Anti-HAV IgG = recovery or vaccination
Always acute: Tx not needed
Vaccine: Pre & post exposure
o For all children from 1yr old
o Those at risk (travellers, lab workers,
homosexuals)

B Parenteral Asia, Africa 2 - 5 mo. Rheumatic prodrome: • HBs Ag = acute, but if seen for >6 months= Acute: Tx not needed
(perinatal, arthralgia, myalgia, urticaria, chronic Supportive: high protein diet, ↓ alcohol,
drugs, sexual) fatigue, • Anti HBs IgG =cured/vaccinated hepatotoxic drugs
maculopapular/urticarial • Anti HBc IgM = active/acute
rash, • Anti HBc IgG = previous infection Chronic: antiretrovirals
• HBV-DNA = active replication o 1st line : Lamivudine
Icteric phase: jaundice, RUQ • HBeAg = active replication o 2nd line: Entecavir
pain, hepatosplenomegaly, • Histology o If intolerant to lamivudine/ unsuccessful:
dark coloured urine o Mild: infiltration of portal triad Adefovir
o Moderate: infiltrate extends to parenchyma
Chronic infection: o Severe: multilobular or confluent necrosis Vaccine: Pre & post exposure
Usually asymptomatic until Acute Chronic (>6m)
HCC/ cirrhosis and its HBsAg + HBsAg +
complications develop.- e.g. HBc IgM + HBc IgG +
palmar erythema, spider HBV DNA + HBV DNA +
angioma, HBe Ag +/-
Signs of portal hypertension: + Histology, ↑ALT/AST
• Ascites Recovered Vaccinated
• Jaundice HBc IgG + HBc IgG –
• Hepatomegaly HbsAg – HbsAg –
HBs IgG+ HBs IgG+

C Parenteral Egypt, 1 - 5 mo. Asthenic prodrome: *Always screen haemodialysis pts. For HCV Acute: (should treat as will most likely progress to
(blood - Central/East weakness, malaise, anorexia • Anti-HCV IgG chronic!) - Pegylated Interferon alpha
dialysis, Asia • HCV RNA-Confirmatory (detects viral load) Chronic: depends on genotype
transfusions) Chronic infection: same as If both detected >/= 6 months after initial o Direct acting antivirals (DAA):
HCV infection: chronic ledipasvir/sofosbuvir +/- Ribavarin (genotype
→6 1,4,5,6)
• Viral genotype testing
o Interferon + Ribavirin for 2,3
genotypes • Histology (same as HBV)
Genotype 1,4 (higher cure rates)–Tx for48w
Genotypes 2,3 (Lower cure rates)-Tx for24w
 No Vaccine

D Parenteral 0.5 - 3 mo. • Coinfection: unusually If serological tests for HBV confirm infection, and Supportive: e.g. cholestyramine for itching,
(with Hep B) severe acute Hep B clinical features are severe, anti-HDV levels are Vaccine: pre & post exposure
tested.
• Superinfection: acute
exacerbation of chronic • Anti-HDV IgM For chronic:
Hep B (silent periods • Anti-HDV IgG • Interferon alpha OR
between waves of Both show active infection. • Pegylated IFN-alpha
jaundice)
• Chronic HDV: aggressive
E Fecal-oral India, Africa, 0.5 - 2 mo. Mostly asymptomatic, but • Anti-HEV IgM if acute: not needed, only supportive
(water, food) South America can be Similar to A • Anti-HEV IgG if chronic: ribavirin
IgM to HEV is measured if the tests for hepatitis No Vaccine
→4 A,B & C are negative but the patient has typical
genotypes symptoms & has recently travelled to an
endemic area.

HBV SEROLOGY EXPLAINED

• 4 main phases: Incubation, Prodromal, Icteric and Recovery

• Prodromes aren’t 100% specific and can always be asymptomatic or present as mixed!
• Dyspeptic: anorexia, nausea, vomiting, diarrhea, abdominal pain

• Icteric Phase is same in all and usually include: Jaundice, UQ pain, hepatosplenomegaly,
dark coloured urine. In Hep A & E prodrome DISAPPEARS when icteric phase starts
 AUTOIMMUNE HEPATITIS
Etiology Clinic Diagnosis Treatment
Epidemiology- Female: Male = 4:1 Can range from asymptomatic to Immunosuppression:
fulminant. Physical: spider nevi, palmar erythema, Prednisone + Azathioprine
Types: • lethargy, fatigue hepatosplenomegaly, jaundice
According to autoantibodies: • myalgia, arthralgia (small joints), Initial prednisone: 40-60mg
• recurrent fever (rheumatic + flu- Labs: ↑AST & ALT, ↓Albumin, ↑PTT, mildly ↑
Type I- like) Bilirubin, ALP Maintenance:
ANA - antinuclear antibodies • anorexia Prednisone: 10mg/d
Anti-SMA - anti- smooth muscle • abdominal pain Serology: Azathioprine: 50-100mg/d
antibodies • mild pruritis ↑ gamma-globulin & IgG >1.5x,
• jaundice ↑ ANA/SMA (type 1) or Anti-LKM (type 2) Drugs given od x 2-4years, until
Type II- • hepatosplenomegaly Absent viral markers remission
Anti-LKM - antibodies to liver & kidney • spider angiomas
microsomes Biopsy: inflammatory infiltrates, interface
hepatitis, bridging necrosis
Type III-
Anti-SLA- anti- soluble liver antigen *Check for presence of other autoimmune
Anti-LP – anti- liver pancreas antibody disorders (eg. DM 1, RPGN, Hashimtoto, UC,
coeliac disease)