Hepatitis

Hepatitis

Inflammation of liver damage to liver cells  cell death. Most common causes are viral, alcohol and drugs.

Acute Viral Hepatitis:
Clinical syndrome of variable severity caused by hepatotropic virus. Often asymptomatic – 40% of adults can have antibodies to hepatitis ( subclinical infection)

5 types: HAV, HBV, HCV, HDV, HEV (up to 2% of cases due to other viruses, eg cytomegalovirus, Epstein-Barr virus).

Hepatitis A (HAV):
RNA virus; Short incubation (15-30 days) - spread primarily by faecal-oral contact, often in institutions; highly infectious; children more commonly affected; overcrowding and poor sanitation increase risks;
Short duration mild fever with vomiting, loss of appetite, jaundice, joint pain, tender hepatomegaly and adenopathy – recovery in a few days  good prognosis
Treatment – reassurance; avoid alcohol
Prevention – after initial infection  immunity

Hepatitis B (HBV):
Double shelled DNA virus; Incubation 40-180 days – follows blood transfusion or sexual contact; higher risk in homosexuals, those with haemophilia, IV drug users, institutionalised (eg prison) and health care workers
Three phases:
• preicteric – weakness, nausea, vomiting, enlargement and tenderness of liver; may be skin rash; darkening of urine; jaundice (<30% after 2 months) • icteric • convalescent Treatment – supportive; avoidance of alcohol; immunisation of sexual partner(s) Complications – liver failure; chronic hepatitis; glomerulonephritisHepatitis C (HCV): From blood transfusion or contact with infected blood Clinically similar to HBV, but generally less severe 50%  chronic hepatitis; 5%  cirrhosisHepatitis D (HDV): Needs HBV for replication as it is in incomplete RNA virus (delta agent)  has same sources of spread as HBV Increases incidence of acute liver failure and cirrhosis in those with HBV infectionHepatitis E (HEV): Non-enveloped single strand RNA virus; Similar to HAV. Transmitted by the faecal-oral route – causes water borne epidemics during rainy seasons in parts of Africa, Asia and South AmericaGeneral clinical features: Usually get prodromal features (headache, malaise, chills) from 2-3 days up to two weeks prior to onset of jaundice; gastrointestinal symptoms; nausea; vomiting; diarrhoea; upper abdominal painDifferential diagnosis – drugs, alcohol, infectious mononucleosis, malaria, leptospirosisManagement: No specific treatment; adequate diet; interferon is helpful in some typesChronic Hepatitis: Hepatitis >6 months considered chronic.
HBV & HCV main causes

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