Hepatitis. Dr. Mohamed. A. Mahdi 5/2/2019. Mob:

Transcription

1 Hepatitis Dr. Mohamed. A. Mahdi Mob: /2/2019

2 Hepatitis Hepatitis means the inflammation of the liver. May cause by viruses or bacteria, parasites, radiation, drugs, chemical and toxins (alcohol). Types of viruses: A,B,C,D,E, cytomegalovirus (CMV), Epstein-Barr virus. Hepatitis may or can healing on its own or progress to fibrosis then to cirrhosis. Hepatitis is acute when last less than 6 months or chronic > 6 months.

3 Acute: Cause by viral A, B, C, D, E. Chronic: Viral : HBV with or without D, HCV, autoimmune, alcohol, drugs.

4 Hepatitis A * RNA virus. * Fecal-oral route but also sexual, and most common in USA international travel. * Incidence has significantly decreased with vaccination. Usually acute self limited. Manifestations vary with age, more silent in children. * Incubation period of 30 days followed jaundice.

5 IgM anti HAV is the gold standard for diagnosis. Start at the onset of symptoms and remain positive 4-6 months. Infected individuals are contagious during incubation and for a week after jaundice appears. Hand washing is very important!!! As HAV survives for up to 4 hrs on fingertips. Treatment is usually supportive. Prevention is mainly by good hygiene and vaccination ( travel to high risk areas). * IM Immunoglobulin are available for people allergic to vaccine, they provide passive immunity for up to 6 months.

6 Hepatitis C Flaviviridae family; the prototype Hepacivirus (RNA virus). Rapid replication rate. High mutation rate that allows him to escape the immune system. * Hep C infection can present as acute hepatitis, chronic hepatitis, cirrhosis, HCC or extrahepatic. Incubation period : 6-7 weeks and seroconversion time 8-9 weeks. Acute symptomatic cases occur in 10-30% while fulminant hepatitis occurs almost especially in patients with HBV. * Most cases progress slowly to chronic infection. Mechanism is unknown. Viral, host and other factors play role.

7 Resolved Exposure (acute phase) 15-45% (15-45) 55-85% (55-85) Stable Chronic 80% (44-68) Slowly Progressive 20% (9-14) Cirrhosis 75% (7-11) HIV, HBV, Alcohol 25% (2-3) HCC Transplant Death

8 Hepatitis C Diagnosis Elisa PCR-RNA Genotype Liver biopsy

9 Hepatitis B: (DNA virus) Is known as serum hepatitis or long-incubation hepatitis. Transmitted by: 1- GIT 2- sexual 3- fecal or oral route. Infected patients manifest HB by all fluids (blood, urine, saliva, semen, tears, and milk). HBcAg: Ag is present in the core of virus (indicate active viral replication). HBsAg: Ag is present on the surface (indicate current HB infection).

10 Hepatitis B

11 Hepatitis D (HDV): Only in patients who are currently infected with HBV. Can not cause illness without HBV. RNA virus

12 Hepatitis E (HEV): RNA virus Transmitted by fecal-oral it found in underdeveloped countries. Incubation is short days. The virus may detect in feces or bile about 7 days after infection.

13 Cirrhosis Cirrhosis is a complication of many liver disease. That is characterized by abnormal structure and function of the liver. The diseases that lead to cirrhosis do so because they injure and kill liver cells. The inflammation and repair that is associated with the dying liver cells causes scar tissue to form. The liver cells that do not die multiply in an attempt to replace the cells that have died. This results in clusters of newly-formed liver cells (regenerative nodules) within the scar tissue.

14 Causes: There are many causes of cirrhosis; they include chemicals (such as alcohol, fat, and certain medications), viruses, toxic metals (such as iron and copper that accumulate in the liver as a result of genetic disease, and autoimmune liver disease in which the body's immune system attacks the liver. Symptoms: Yellowing of the skin (jaundice) due to the accumulation of bilirubin in the blood Fatigue Weakness Loss of appetite Itching

15 Complications: Edema and ascites Spontaneous bacterial peritonitis (SBP) Hepatorenal syndrome (This syndrome is a serious complication in which the function of the kidneys is reduced. It is a functional problem in the kidneys, that is, there is no physical damage to the kidneys. Instead, the reduced function is due to changes in the way the blood flows through the kidneys themselves. The hepatorenal syndrome is defined as progressive failure of the kidneys. Liver cancer (hepatocellular carcinoma) Hypersplenism (rise of blood pressure in portal vein)

16 Diagnosis and evaluation: The single best test for diagnosing cirrhosis is biopsy of the liver. Jaundice (yellowness of the skin and of the whites of the eyes due to elevated bilirubin in the blood) is common among patients with cirrhosis. Advanced cirrhosis leads to a reduced level of albumin in the blood and reduced blood clotting factors due to the loss of the liver's ability to produce these proteins. Abnormal elevation of liver enzymes in the blood (such as ALT and AST) Patients with elevated levels of iron in their blood may have hemochromatosis. Auto-antibodies (antinuclear antibody, anti-smooth muscle antibody and anti-mitochondrial antibody) sometimes are detected in the blood and may be a clue to the presence of autoimmune hepatitis or primary biliary cirrhosis, both of which can lead to cirrhosis