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VIRAL HEPATITIS

By Shalini Hazael , Group 40a

INTRODUCTION
Hepatitis is an inflammation of the liver. Hepatitis can be caused by alcoholism, drug abuse, immunodeficiency or viruses such as mononucleosis and cytomegalovirus which inflame the liver. There are several hepatitis viruses: A,B,C,D,E,F and G. The most common hepatitis viruses are A,B and C.

VIRAL HEPATITIS
Viral hepatitis is liver inflammation due to a viral infection. It may present in acute or chronic forms. The most common causes of viral hepatitis are the five unrelated hepatotropic viruses Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, and Hepatitis E. Other viruses such as Herpes Simplex, cytomegalovirus and mononucleus virus may also attribute to viral hepatitis.

TYPES OF HEPATITIS AND ITS CAUSATIVE AGENTS


Hepatitis A Hepatitis a is an acute illnes. It can spread from one person to another like a viral infection It is spread by ingestion of food or water in areas of poor sanitary conditions especially if it comes in contact with human waste with Hepatitis A. It is typically spread amongst household members and close contact like intimate kissing or improper washing of hands. Incubation period is 2-6 weeks

HEPATITIS B
Hepatitis B can be spread by sexual contact, sharing of needles by drug abusers, hemodialysis, hemotransfusion , bodily fluids and from an infected mother to the unborn child. It also can spread by tattooing, sharing razors and toothbrushes. About 6-10% of patients develop the chronic form of Hepatitis B. Patients with chronic hepatitis B are at risk of developing liver

cirrhosis, liver failure and cancer

HEPATITIS C
Hepatitis Cs causative virus is unknown however it is known that it is not hepatitis A or B. Hepatitis C usually spreads amongst drug abusers who share

needles, hemodialysis and blood transfusion.


Almost 90% of transfusion associated hepatitis is caused by hepatitis C. Transmission by sexual contact is rare. Patients are at risk of developing liver failure, cirrhosis and cancer.

HEPATITIS D
Known as the Delta virus agent It is a small virus that requires the concomitant virus of hepatitis B to survive.

It needs the envelope protein in hepatitis B to infect the liver cells


Transmission is by sexual contact, blood transfusion and sharing of needles The combination of hepatitis B and hepatitis C is very difficult to treat.

HEPATITIS E
Transmisson is via fecal-oral pathway It is common in countries with hot climate The incubation period is 3-8 weeks Epidemic outbreaks usually occur after monsoon rains Also found in pigs and wild boars, infection occurs when meat is uncooked.

HEPATITIS F
Hepatitis F is a hypothetical virus, there have been several viral strains that were linked to it however, none of them have been substaciated.

HEPATITIS G
Hepatitis G was found to be not related to hepatitis so the virus was renamed GB virus C. From Flaviviridae family which has not yet been assigned to a genus, is known to infect humans, but is not known to cause human disease. There have been reports that HIV patients coinfected with GBV-C can survive longer than those without GBV-C, but the patients may be different in

other ways. There is current active research into the virus' effects on the
immune system in patients coinfected with GBV-C and HIV.

CLINICAL PICTURE
Early stage : fatigue, excessive tiredness, lack of appetite, nausea, diarrhea, fever, muscle pain, joint pain, sore throat, abdominal pain, dark urine and light coloured stools.

Jaudice usually appears several days to 2 weeks after signs of early


symptoms. Chronic stage : can cause liver cirrhosis, liver cancer or liver failure. The symptoms include : fatigue, exhaustion, jaundice, loss of appetite,

nausea, abdominal pain, spider-like blood vessels that develop on skin.

Late chronic stage : fluid build-up in stomach areas and legs, perforation of the intestines, mental retardation, itchy skin, diabetes, portal hypertension, gallstones and coma or death.

DIFFERENTIAL DIAGNOSIS
Liver abscess Drug induced hepatitis Autoimmune hepatitis Hepatocellular cancer Pancreatic cancer Abdominal aneurysm cholangitis

Cholecystitis Cholelithiasis Gasteritis Peptic ulcer disease Small bowel obstruction pancreatitis

DIAGNOSIS
hepatitis A : Detection of HAV-specific Ig-M in blood Presence of liver enzyme alanine transferase (ALT) in blood which are in higher amounts than usual Hepatitis A virus can be found in blood and stools up to 2 weeks before clinical illness develops

Hepatitis B: the test is called asseys for detection of hepatitis B virus in serum or blood Biopsy may be done to reveal inflammed liver. Test for elevated levels of alanine aminotransferase Polymerase chain reaction (PCR test) maybe be done to test the levels of HBV DNA in clinical specimens.

Hepatitis C : serological test blood test for presence of antibodies to HCV using enzyme immunoassay. Biopsy is done to determine the amount of damage of the liver Screening regular testing is recommended for those with tattoos and multiple piercings Screening is also recommended for those who show an increase in

liver enzymes

Hepatitis D; blood test , polymerase chain reaction test, enzyme immunoassay and serological tests.

TREATMENT
Hepatitis A there is no specific treatment ,patients are told to rest, eat a balanced diet and consume lots of water. Hepatitis B-antiviral drugs such as lamivudine (Epivir), adefovir (Hepsera), tenofovir (Viread), telbivudine (Tyzeka) and entecavir (Baraclude) Hepatitis C- combination of pegylated inteferon alpha with

ribavarin for a period of 24-48 weeks depending on genotype of


HCV.

There are side effects including flu-like symptoms and emotional disturbances Treatment is most effective during the first 6 months or before the disease progresses. Ribavarin proves to be useful in patients with thallasemia however it increases the need for transfusion

PROGNOSIS
Hepatitis A-typically a short term infection and people usually recover within a couple of months without treatment and without liver damage, after which they are immune to further infections. In a few number of cases HAC can cause acute liver failure when the liver suddenly stops working. At this point immediate hospitalization is required.

Hepatitis B-those infected by acute (short term) Hepatitis B will usually recover in a couple of months. However, acute Hepatitis B can sometimes cause significant liver damage and develop into chronic (long term) Hepatitis B. People with chronic HBV typically lead long, healthy lives but the risk remains that they will develop a more serious liver disease later. There are available vaccinations for Hepatitis A and B for prevention

Hepatitis C- his is a chronic (long lasting) disease that needs carefully monitoring as it can lead to cirrhosis (scarring) and liver cancer and cause death.

Hepatitis D- Hepatitis D (HDV) can occur only with a concomitant


hepatitis B infection, because HDV uses the HBV surface antigen to form a capsid. Co-infection with hepatitis D increases the risk of liver cirrhosis and liver cancer.Polyarteritis nodosa is more common in people with hepatitis B infection.

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