Hepato-billiary diseases

Tutor: Dr Socdaal
 Hepatitis
• Inflammation of the liver
• Commonly caused by viral infection
• 5 pathogenic hepatotropic viruses recognized
(Hepatitis, A,B,C,D,E)
• All cause similar acute clinical illness
• Hepatitis B,C and D can cause chronic hepatitis
Hepatitis 2
• Acute response of the liver to hepatotropic
viruses involves a direct cytopathic and an
immune-mediated injury.

• Acute liver injury caused by the hepatotropic

viruses results in raise in serum levels of
alanine aminotransferase (ALT) and aspartate
aminotransferase (AST).
• Viral Hepatitis may result in acute liver failure

• Liver morphology usually returns to normal

within 3 mths of the acute infection.

• If chronic hepatitis develops, the inflammatory

infiltrate settles in the periportal areas and
often leads to progressive scarring/fibrosis.
Hepatitis A (HAV)
• HAV is an RNA virus (member of the
picornavirus family).

• The virus is stable at low pH and moderate

temperature, but it is inactivated by high
temperature, chlorine, and formalin.

• Transmission is almost always by person to

person contact through the fecal–oral route.
• Mean incubation period 14-28 days.

• Fecal excretion starts late in the incubation

period, reaches its peak just before the onset
of symptoms (resolves by 2 wk after the onset
of jaundice in older subjects).
HAV Clinical features
• Responsible for acute hepatitis only (mild to severe).
Duration of Illness 7-14days.

• Anicteric illness with clinical symptoms (fever,

malaise, anorexia, nausea, diarrhea, abdominal
pain) indistinguishable from other forms of viral GE.

• Young children less likely to have jaundice (only 10%

develop jaundice Vs 70% in older children & adults).
HAV Diagnosis

•Detection of HAV-specific
antibodies in blood (IgM
and IgG).
IgM is positive at the onset
of symptoms, peaks during
the acute or early
convalescent phase , &
remains positive for
approximately 4 to 6
months.
IgG appears at ̴8wks of
symptom onset & confers
long-term protection.
•PCR to detect HAV RNA.
HAV treatment
• No specific treatment for hepatitis A.

• Supportive treatment (fluid replacement,

nutritional support, control fever)

• Monitor and manage any complications

including ALF.
HAV Prevention
• Improved sanitation and food safety (e.g safe
drinking water, hand washing, proper sewege
disposal)

• Immunization (passive and active)

Immunoglobulin prophylaxis (Ig G)
HAV vaccine: inactive, 2doses IM 6-12mths
apart, not given <1yr.
 Hepatitis B
• DNA virus of Hepadnaviridae family

• Globally, 240 million people chronically infected

with HBV

• 780,000 people die every year due to

complication of HBV

• Highest prevalence in sub-Saharan Africa & Asia

• Can cause both
acute & chronic
infection
• Chronic infection
is defined as
persistance of a
positive HBsAg for
6months or more
HBV Transmission
HBV can survive out side the body for at least 7 days
• Perinatal transmission (MTCT)

• Childhood transmission (exposure to infected

blood)

• Percuteneous or mucosal exposure to infected

blood and other body fluids (vaginal/seminal fluids,
saliva, menstrual fluids)
Interpretations
HBV Diagnosis/Serological markers
HBV Treatment
Acute HBV
• Mainly supportive management; Fulminant hepatitis
may benefit from antiviral therapy.

Chronic HBV
• Tx goal is to halt the progression of chronic hepatitis B-
associated liver disease.
• Drugs used; Antiviral (Lamivudine, Tenofovir, adeforvir,
entecavir, emtricitabine, & telbivudine); interferon
HBV Prevention

• Vaccination with HBV vaccine

• Passive immunization with immunoglobulin in

infants born to mothers with CHB
• HBV risk reduction
 Hepatitis C
• HCV is a single stranded RNA virus
• Can cause both acute and chronic infection
• 130-150 million people globally have chronic
HCV

• Appx 500,000 people die each year from HCV

related liver diseases.
• Most affected regions are Africa and central &
east Asia.
 HCV Transmission
HCV is a bloodborne virus.
• Unsafe injections
• Inadequate sterilization of medical equipment
• Transfusion of unscreened blood & blood
products
• Sexual transmission
• Perintal(mother to child) up to 5% of infants born
to viremic mothers.(HIV co-infection can ↑20%)
HCV clinical progression
HCV Screening &
Diagnosis
•Screening using
anti-HCV
antibodies.
•If positive, do HCV
RNA to confirm
chronic HCV ( anti-
HCV abs may still
be positive even
after sponteneous
clearance)
HCV Treatment
• HCV genotype important in treatment.
Genotype 1 is poorly responsive; genotypes 2
and 3 are more reliably responsive to therapy.
• Current treatment; Interferone and ribavirin

• Newer agents: direct-acting antivirals,

including telaprevir & boceprevir (viral
protease inhibitors),
HCV Prevention
• No HCV vaccine
• 1⁰ Prevention; reduce risk of exposure
• 2 ⁰& 3⁰ Prevention; immunization HBV &HAV,
regular monitoring & early dx of chronic liver
disease, early treatment.
 Hepatitis D
• A defective RNA virus
• Requires help of HBV for its own replication
• Worldwide distribution parallels that of HBV
infection
• Either co-infection (HBV & HDV) or super
infection (HDV infection of chronically infected
HBV)
• Infection with both HBV and HDV is associated
with more severe liver injury than HBV
infection alone. (HDV causes injury directly by
cytopathic mechanisms)

• Transmission is similar to that of HBV

(percutaneous, sexual, blood products, rarely
perinatal)
• Diagnosis
Detecting IgM antibody to HDV
RT-PCR
• Treatment
No effective antiviral therapy
Promising; interferon
• Prevention
No HDV vaccine
Measures preventing HBV
 Hepatitis E
• RNA virus
• Transmission is fecal–oral (often waterborne)
and is associated with shedding particles in
the stool.
• Outbreaks & sporadic cases of HEV can oocur
especially in resource limited settings.
• The clinical illness associated with HEV
infection is similar to that of HAV but is often
more severe.

• chronic illness does not occur

• HEV tends to affect older patients, with a peak

age between 15 and 34 yr.
• Diagnosis: Detection of IgM & IgG antibodies
to HEV, PCR for HEV RNA.
• No available treatment. Supportive
management
• Prevention;
Improved sanitation and safe water
Recombinant hepatitis E vaccine is highly
effective in adults.