Hepatitis
Definition
Inflammation of the parenchyma of the liver
Viral hepatitis is a systemic viral infection in which necrosis and inflammation of liver cells are produced.
Aetiology
Infection : virus A, B, C, D, E, F
Drugs : alcohol, anti tuberculous drugs like rifampicin, ethambutol etc. . Halothane
Poisonous mushrooms
Incidence:
Any age.
Either sex.
Epidemics of infective hepatitis
o 5 types of viral hepatitis : hepatitis A, B, C, D and E
o Viral hepatitis is easy to transmit, has high morbidity
Route of spread :
Hepatitis A & E :
spreads through orofaecal contamination; water contamination. Shellfish from sewage contaminated waters ' hepatitis A'
Hepatitis B :
o B virus found in blood, saliva, semen and vaginal secretions
o Blood transfusion without proper screening, Drug addicts : through needle pricks
through blood (percutaneous and permucosal routes)
o The virus replicates in the liver and remains in the serum allowing transmission of the virus.
o Carrier mothers transmit to their babies - not through umbilical vein but from the mother at the time of birth and during close contact afterwards.
o Most people recover fully within six months.
o Mortality is as high as 10 %
o Another 10 % progress to a carrier state or develop chronic hepatitis
o Chief cause of cirrhosis and hepatocellular carcinoma
Clinical Features
Fever
Malaise
Pain in the epigastrium and right hypochondrium
Lack of appetite
Nausea
Vomiting
Yellowish discolouration of the conjuntiva and urine
Pale stools during the obstructive phase
Epigastric distress
Heartburn
Flatulence
Strong aversion to cigarette
Liver and the spleen are often moderately enlarged for a few days
Differential Diagnosis
Surgical jaundice. i.e., obstructive jaundice
Cirrhosis liver causing jaundice
Investigations
Liver function tests :
serum bilirubin : total and differential
Plasma proteins : albumin and globulin
HbsAg - hepatitis B surface antigen
( antigenic material on surface of HBV) it appears in blood 1 - 10 weeks after exposure to HBV.
Antibodies against C, D viruses
Medical management
o Administration of alpha interferon
o 10 % become spontaneously seronegative
o Interferon injected daily - significant side effects : fever, chills, anorsia, nausea, myalgia and fatigue. Serious side effects are bone marrow suppression, thyroid dysfunction, alopecia, and bacterial nfections.
o Bed rest
o Then graduated activities
o Adequate nutrition - proteins are restricted - protein metabolism by liver is impaired.
Prevention
Active immunization :
Vaccine for A, B viruses - injection - recommended for
o those at high risk for hepatitis B
o Health care personnel
o haemodialysis patients.
Yeast recombinant B vaccine - immunologic memory remains intact for 5 to 10 years. Ordinarily no booster dose is necessary except for those who are exposed constantly to the virus.
Hepatitis B vaccine is administered in three doses , the second and third doses 1 and 6 months after the first dose.
Passive immunization
Immune globulin used - recommended for
o household members
o Sexual contacts of people with hepatitis A,B.
o For accidental exposure to HBAg - positive blood through needle prick or splashes in contact with mucous membrane
o For perinatal exposure
If HBIG and hepatitis B vaccine are administered at the same time separate sites and separate syringes should be used.
Other measures
o Screen the blood before taking for transfusion
o Use disposable syringes needles and lancets
o Health care personnel should be careful in handling (use gloves) needles and other sharp materials and get active immunization.
o Eating is prohibited in places where patients' secretions, blood, or blood products.
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