-
hepatitis
inflammation of the liver
-
mechanisms that can cause hepatitis
- c)
- drugs, chemical, toxins
-
general symptoms of hepatitis
- i)
- enlarged and tender liver = jaundice
-
Acute hepatitis
- i)
- Symptomatic individuals may present after
- convalescent stage of 7-10 days, with total illness lasting 2-6 weeks
- ii)
- Wide range Symptoms: require no treatment to
- hepatic failure and need for transplant
- iii) Nonspecific
- flulike symptoms: malaise, muscle and joint aches, fever, nausea, vomiting,
- diarrhea, an headache
- iv) Specific
- symptoms: loss of appetite, aversion to smoking, jaundice, abdominal
- discomfort, hepatomegaly, splenomegaly
-
Chromic hepatitis
- i)
- Majority asymptomatic or mildly symptomatic
- ii)
- Abnormal blood test being only manifestation
- iii) Many
- experience return of acute symptoms
- iv) Jaundice
- can be late feature and indicator of damage
- v)
- Other: abdominal fullness from enlarged liver and
- spleen, low grade fever, fluid retention (ascites), extensive damage and
- scarring of liver (cirrhosis) leads to weight loss, easy bleeding and bruising
- tendencies
-
Hepatitis A route of transmission
- b)
- Virus infects GI tract and is shed in feces.
- Contaminated feces ingested by another
- c)
- Conditions of poor personal hygiene or
- contaminated water
-
Persons at increased risk of Hepatitis A
- a)
- Patients and staff at custodial institutions
- b)
- Person in close contact with an infected
- individual
- c)
- Travelers and military in areas where disease is
- widespread
- d)
- Children in child centers
-
Hepatitis A clinical course
- b)
- Highest infectivity is during late incubation
- period
- c)
- 20-40% no longer infectious when symptoms appear
- d)
- all considered to be infectious for up to 2
- weeks
- e)
- disease resolves itself (low mortality)
-
Hep A serological markers
- ii)
- Rises rapidly, last 3-6 mo
- iii) Used
- to diagnose an acute Hep A infection
- iii) Used
- to indicate past infection or immunity to HAV
-
-
Route of transmission Hep. B
- b)
- When contact with infected blood or fluids
- c)
- At birth, through sex contact, contaminated
- needles, open wound, cntact eith mucous memb, or blood tranfusion
-
Persons at increased risk of hep B
- b)
- Intravenous drug users
- c)
- Person born in endemic area
- d)
- Babies born to infected moms
- e)
- Household contact and sex partners of infected
- f)
- Medical and dental workers
-
Clinical course Hep B
- a)
- 50% acute w/symptoms for up to 4 weeks
- b)
- up to six months before feel “normal”
- c)
- most serious consequence are from chronic
- infection (40% hepatic cancer or cirrhosis)
- d)
- 6-10% rate of chronicity (infection doesn’t
- resolve)
-
HBV serological markers
- ii)
- Detectable 30-60 days after infected
- iii) Eventually
- disappears
- iv) If
- present consider infectious
- v)
- If marker persists loger than 6 mo then
- considered chronic
- i)
- Appears after HBsAg disappears
- ii)
- Time between loss of surface Ag and gain of
- surface Ab = convalescent window
- iii) This
- is the major protective Ab that gives immunity
- vi) Indicative
- of previous infection or exposure (vaccination)
- i)
- 2 wks-3 mo after patient becomes symptomatic
- ii)
- remains for up to 6 mo
- iii) used
- to diagnose acute case of HBV
- iv) does
- not give immunity
- i)
- Appears in about 6 mo to replace IgM
- ii)
- Used to indicate previous exposure or infection
- iv) Does
- not give immunity
-
Hep C transmission route
- a)
- Parenteral route: contact w/ infected blood or
- body fluids
- b)
- Birth, sex contact, contaminated needles, open
- wound, contact w/mucousal memb, or blood transfusion
-
Persons at increased risk of HCV
- a)
- Multi blood transfusion recipients
- b)
- Intravenous drug users
-
Clinical course HCV
- a)
- Incubation from 2wks to 1 yr
- d)
- Most common symptom is chronic asymptomatic
- increase in ALT & AST
- Leading reason liver
- transplant
-
HCV serological markers
- a)
- Hard to do due to high frequency of mutation
- i)
- Detect presence of Ab to virus
- iii) Cannot
- tell you if active infection (tests for IgG Ab)
- i)
- Confirms presence of Ab
- ii)
- Cannot tell you if you are currently infected,
- chronically, or resolves
- iii) Only
- tells you about exposure
- i)
- Identifies whether virus is in your blood
- ii)
- Indicates active infection
- iii) Molecular
- diagnostic technique: nucleic acid test
-
HBV and HDV
- a)
- Hep D relies on Hep B to replicate
-
-
Hepatitis treatments
- a)
- Prophylaxis (pre-exposure)
- b)
- Immunoglobulin for passive, short term
- prevention 80-90% effective for up to 3mo
- c)
- Mainly treat symptoms (mild to severe)
- d)
- Longterm treatments: alpha-interferon,
- corticosteroids
- e)
- Most likely to resolve with low viral load
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