Acute Viral Hepatitis.ppt

AcuteViralHepatitis,Etiology,Majoragents:HAVHBVHCVHDVHEV,HGVTTVHFV?,Etiology,Minoragents:EBV,CMVHSV,VZVRubella,MeaslesCoxsackieBAdenovirus,Transmission,Epidemiology,HAV:fecal-oralHEV:fecal-oralRarelybloodborneHBV:percutaneouscontactMucousmembranecontactSexualcontactPerinatal:thirdtrimesterand2monthspostpartumHDV:likeHBV,Epidemiology,HCV:PercutaneoustransmissionTransfusion(0.1%),needlestick(1.8%)Mucousaltransmission(rare)Sexualtransmissionisrare(monogamy)Perinataltransmissionisuncommon(HIVcoinfection,lessthan5%),SexualtransmissionofHCV,MultiplesexualpartnerHIVandSTDAnalsexOpensoreSexduringmenstruation,Pathology,InfiltrationofmononuclearcellsHepaticcellsnecrosisKupfercellshyperplasiaVariabledegreesofcholestasisInmoreseverecases;Bridgingnecrosis,ClinicalStages,IncubationperiodProdromal(preicteric)phaseIctericphaseconvalescence,Variationinstaging,AsymptomaticAnictericFulminantChronic,IncubationPeriod,HAV:15-45days(30)HBV:30-180days(60-90)HCV:15-160days(50)HDV:30180days(60-90)HEV:14-60days(40),IncubationPeriod,ConsiderableoverlapAsymptomaticperiodViralreplicationexcepthemorrageNormalplatelet;exceptDICESRisnormal,LaboratoryFindings,Serumbilirubin:5-20mg/dlDirectbil=indirectbilSGOT,SGPT=400-4000iuAlk.phosphatase:mildelevationPTisusuallynormal:inseverehepatitis,PTisprolongedHypoglycemia,SerologicDiagnosis,IgManti-HAVHBsAgandIgManti-HBcHCVAb,HCVRNAPCRanti-HDVanti-HEV,Complications,HepatitisA:RelapsinghepatitisCholestatichepatitisHepatitisB:serumsicknessChronicity:HBV,HCV,HDVfulminancy:HAV,HBV,HDV,HEV,ProgressionofAcutetochronicHepatitis,Lackofresolutionofsymptoms(WL,fatigue,anorexia,hepatomegaly)FailureofBil.,LFT,Glutonormal(Within6-12m)PersistenceHBsAgbeyond6morHBeAgbeyond3mPresenceofbridgingormultilobularnecrosis,DiferentialDiagnosis,ViralhepatitisbyminoragentGramnegativeSepsisCholangitis,cholecystitisFlareupchronichepatitisDrug-relatedhepatitisIschemichepatitis,Management,Indicationofadmission:Bilirubin20mg/dlHypoglycemiaAbnormalPTHypoalbuminemia,Management,Indicationofadmission:PoororalintakeMentalchange,letargyLowcomplianceOtherchronicdisease,Management,CBRisnotmandatoryRestrictionactivityNospecialdietFordaycarecenters,familymembersVaccine?,Prevention,HBV:Pre-exposureprophylaxis:Vaccine:months0,1,6BoosterisnotrecommendedPost-exposureprophylaxis:HBIG:0.06cc/kgandcompletecourseofvaccine,Prevention,Post-exposureprophylaxisinvaccinatedperson:Responder:NotreatmentNonresponder:HBIG+Vaccine(3)ORHBIG(2)inonemonthResponse:anti-HBs10miu/ml,Prevention,Abresponse