JAUNDICE AND

VIRAL HEPATITIS
CONTENTS

JAUNDICE
Definition
Types
VIRAL HEPATITS
Etiology
Modes of Infection
Clinical Features
JAUNDICE
Def: Yellowish pigmentation of skin,
mucous membranes and sclera due to
increased levels of bilirubin in the
blood.
Scleral involvement- Affinity of elastic
tissue for bilirubin
JAUNDICE
•Normal serum bilirubin- 0.3 to 1.2 mg/dl
•Jaundice- 2.0 to 2.5 mg/dl
•Severe disease- 30 to 40 mg/dl
TYPES OF JAUNDICE
1. PREHEPATIC JAUNDICE- Eg - Hemolytic anemia
2. HEPATIC JAUNDICE- Eg- Gilbert syndrome, Crigler Najjar syndrome,
viral hepatitis, alcoholic hepatitis
3. POST HEPATIC JAUNDICE- Eg- Gall stones/Stricture in CBD,
Carcinoma of head of pancreas, Carcinoma of Ampulla of Vater
 TYPES OF JAUNDICE
MECHANISM OF RAISED
BILIRUBIN
PREHEPATIC JAUNDICE HEPATIC JAUNDICE POST HEPATIC JAUNDICE
Hemolysis leading to Deficient Deficient excretion due to
excess production uptake,conjugation or obstruction of biliary tract
excretion by hepatocytes

Type of Sr bilirubin increased Unconjugated Unconjugated + Conjugated

Conjugated

Urine bilirubin Absent Present Present

Urine urobilinogen Increased Present Absent
Icterus Lemon yellow Yellow Greenish/dark yellow
Colour of stool Normal Normal Clay
Pruritis Absent Absent Present
VIRAL HEPATITIS
Viral infection of hepatocytes resulting in inflammation and necrosis
of the liver
ETIOLOGY- Hepatitis viruses A, B, C, D, E
All are RNA viruses ,except HBV
 VIRAL HEPATITIS
VIRUS MODES OF INFECTION

HEPATITIS A FECAL-ORAL ROUTE

HEPATITS  B • VERTICAL (CONGENITAL)- Mother to child (in utero,

parturition, soon after birth
• HORIZONTAL- Infectious body fluids ,minor cuts in
skin or mucous membranes, intravenous route,
     sexual contact

HEPATITIS C Parenteral route, sexual contact

HEPATITIS D Parenteral route, sexual contact

HEPATITS E  FECAL-ORAL ROUTE

CLINICAL FEATURES
1. Asymptomatic acute infection with recovery (serologic evidence only)
2. Acute hepatitis (anicteric or icteric)
3. Fulminant hepatitis with massive to submassive hepatic necrosis
4. Chronic hepatitis (without or with progression to cirrhosis)
5. Chronic carrier state
CLINICAL FEATURES
Acute Asymptomatic Acute Infection with Recovery
• Incidental
•Mild elevation of serum transaminases or
presence of antiviral antibodies.
CLINICAL FEATURES
Acute Hepatitis
•Caused by hepatotropic viruses.
• 4 phases:
1. Incubation period- variable.
Hepatitis A- 3 to 6 weeks ( 4 weeks)
Hepatitis B- 4 to 26 weeks.
Hepatitis C- 2 to 26 weeks ( 6 to 12 weeks)
CLINICAL FEATURES
Hepatitis D- Coinfection of HBV and HDV / Superinfection with HDV in
a chronic HBsAg carrier
Hepatitis E- 6 weeks
2.Symptomatic preicteric phase- Malaise, nausea, poor appetite,
and vague abdominal pain
CLINICAL FEATURES
3. Symptomatic icteric phase: Jaundice and yellow sclera, dark
colored urine (conjugated hyperbilirubinemia),

light-colored stool and pruritis (bile salt retention).

4. Convalescence
CLINICAL FEATURES
Investigations
• Raised serum bilirubin and aminotransferase levels
• Antibodies to viral antigens
CLINICAL FEATURES
Fulminant Hepatitis
• Hepatic insufficiency progresses within 2 to 3 weeks from onset of
symptoms to hepatic encephalopathy
• Patients who do not have chronic liver disease
CLINICAL FEATURES
Chronic Hepatitis
Symptoms
•Fatigue (most common)
• Malaise
•loss of appetite
•bouts of mild jaundice
CLINICAL FEATURES
Physical Findings
•Spider angiomas
•Palmar erythema
•Mild hepatomegaly
•Hepatic tenderness
•Mild splenomegaly
CLINICAL FEATURES
CLINICAL FEATURES
Laboratory Findings
•Raised serum transaminase
•Prolonged prothrombin time
•Hyperbilirubinemia
•Mild elevation of alkaline phosphatase
• Urine- increased bilirubin and urobilinogen
CLINICAL FEATURES
Carrier State in HBV
Harbors and can transmit an organism (HBV)
No symptoms.
Factors Determining Carrier State
•Age at infection: children perinatally(high rate)
adults (low rate)
•Impaired immunity
CLINICAL FEATURES
Types of Carriers
reservoirs for infection
1. Inactive carriers (healthy carriers):
•Carry viruses but have no liver disease
•Normal or mildly raised serum aminotransferase values
•No Hbe Ag
•Anti-Hbe present
•Majority do not progress to liver disease
CLINICAL FEATURES
2. Active carriers:
• Harbor the viruses
• Have non-progressive liver damage
• Usually asymptomatic
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