| ID | 50 |
|---|---|
| Name | ACUTE HEPATITIS A AND B |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | Investigations: 1. Serum bilirubin is variably modestly or markedly elevated. 2. Serum AST (SCOT) & ALT (SGPT) are elevated (200-400 U/L), (normal 35 U/L). 3. The prothrombin time is increased in severe cases. 4. Serum HBsAg & HBcAg test may be positive (in hepatitis B). 5. Ultrasonogramof hepatobiliary system 6. Liver biopsy (if needed) is confirmatory- usually not required 7. Blood count- lymphocytosis 8. Serological tests may be helpful (see below). |
| Management | |
| Introduction | ACUTE HEPATITIS A It is the most common type of viral hepatitis, caused by the picornavirus of entero virus group. The hepatitis A virus is very infectious and spreads mainly by the faecal-oral route, through ingestion of contaminated food or water. Overcrowding and poor sanitation helps in spreading the disease. After infection, the viruses replicate in the liver, excreted in the bile and then in the faeces of the infected patient for about 2 weeks before the onset of clinical illness and upto 7 days after. There is no carrier state of hepatitis A virus. The incubation period is about 30 day*, h is also called infectious, or epidemic or ‘short-incubation hepatitis ACUTE HEPATITIS B Hepatitis B is ths most serious viral hepatitis caused by the hepatitis B virus. This is the only hepadna virus causing infection in humans. And humans are the only source of infection as yet known. The incubation period is about 6 weeks to 6 months (but average 12-14 weeks). Hepatitis B also known as ‘serum hepatitis’ or long-incubation hepatitis’. The infective B virus, known as Dane particle’ (42 nm) has a partially double-stranded DNA genome, comprising an inner core protein or nucleocapsid (27 nm), known as ‘hepatitis B core antigen (or HBcAg)’ & an outer envelope or capsule of protein, known as “hepatitis B surface antigen (or HBsAg)’. HBeAg is a soluble protein found only in HBsAg-positive serum. It is a secretory form of HBcAg produced shortly after the detection of HBsAg. |
| History | |
| Etiology | |
| Clinical Features | Clinical features: ACUTE HEPATITIS A Symptoms: 1. The prodromal symptoms are gradual onset of fever with chills, headache and malaise. 2. Gastrointestinal symptoms are anorexia, distaste for cigarettes, nausea, vomiting and diarrhoea. 3. A steady upper abdominal pain occurs in upper right quadrant. 4. Patients may complain of dark urine & pale stools. Physical signs: 1. Appearence of jaundice with yellow discolouration of skin, sclera & mucus membrane. 2. The liver is usually tender; may or may not be readily palpable. 3. Cervical lymph nodes enlarged & may be palpable. 4. Splenomegally may occur. 5. Dark yellow urine & pale stool. The intensity of symptoms and signs gradually diminishes & in course of 3 to 6 weeks duration, the great majority of cases recover. Investigation & Management: See below under acute hepatitis B Clinical feature: ACUTE HEPATITIS B In many patients with hepatitis B infection, the features are subclinical. But, in others the clinical features are similar to but usually more severe than those of hepatitis A. In hepatitis B, transient rashes including urticaria may occur. Arthralgja is also a common feature. Majority patients with hepatitis B infection also recover gradually from the illness with general management like hepatitis A; but a consideral number of patients may develop serious complications with bad prognosis. |
| Preventions | Prevention: General preventive measure: 1. Hand washing before handling & eating of foods 2. Washing of hands of medical attendants & close contacts of patients. 3. Careful handling of disposable articles, beddings & clothings 4. Screening of donated blood for HBsAg & anti-HBc 5. All pregnant women should be tested for HBsAg. Specific measures: Hepatitis A 1. Non specific prophylaxis: All close contacts of hepatitis A patients should be administered a prophylactic dose of’Immune g globulin’ 0.02ml/kg i.m during incubation period. 2. Specific vaccination: Two specific inactivated hepatitis A vaccines are available Molecule 1 ml i.m followed by a booster dose at 6-12 months interval. This is recommended for persons living in or traveling to an endemic area. 3. Hepatitis A & B vaccine: A combined hepatitis A & B vaccine. Hepatitis B 1. Hepatitis B immune globulin: It is used to provide passive immunity to hepatitis B infection in the prophylactic treatment of individuals exposed to hepatitis B virus of HBsAg positive materials. Intramuscular injection of hyperimmune serum globulin (antibodies) prepared from blood containing anti-HBs, which then combine with HBsAg and neutralize the hepatitis B virus, so that its infective or pathogenic properties are inhibited. Preparation & dosage: See therapeutic section. 2. Hepatitis B vaccine: Usually 3 doses of hepatitis B vaccine are used for active immunisation of individuals in those at special risk of infection who are not immuned. Preparations & dosage: See therapeutic section. |
| Treatment | Treatment: Treatment of acute hepatitis is mostly supportive. In case of hepatitis B close monitoring for acute liver failure is also essential. 1. Absolute bed rest till serum bilirubin comes down to normal level and jaundice subsides. 2. In case of hepatitis B, the patient should be isolated. 3. Patients with serious illness should be hospitalized. 4. Plenty of water and glucose by mouth; if the patient vomits, glucose may be given by i.v route, 5% dextrose in aqua 500ml & 25% glucose 200-300ml daily. 5. Diet: all diet except excess amount of fatty diet and alcohol. Total calorie intake should be maintained within 2000-3000 kcal. 6. Bowel should be clear by using laxative, such as milk of magnesia (MgSO4) or lactulose 3-6 tsf daily in the morning in empty stomach. 7. Vitamin supplement e.g vitamin B complex may be given regularly. 8. Antibiotic- if the patient has got fever or any feature of secondary infection, a course of appropriate antibiotic (amoxycillin or cephalosporin etc) should be advised. 9. Alcohol should be restricted for 1 year or life-long (for non-habitual). 10. Drugs which are metabolized in the liver should be avoided, such as-a. Sedatives b. Antiemetics c. Analgesic as paracetamol d. Cotrimoxazole & other sulphonamides e. Hepatotoxic anti-T.B drugs |
| Complications | Complications of acute viral hepatitis:2 1. Acute hepatitic failure 2. Relapsing hepatitis 3. Cholestatic hepatitis 4. Post-hepatitis syndrome 5. Hyperbilirubinaemia 6. Aplastic anemia 7. Connective tissue disease 8. Renal failure 9. Henoch-Schonlein purpura 10. Papular acrodermatitis 11. Chronic hepatitis 12. Cirrhosis (hepatitis B,C and D viruses) 13.Hepatocellular carcinoma |
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