Please enable JavaScript.
Coggle requires JavaScript to display documents.
Viral hepatitis (Ductal anatomy (Portal triad (Portal vennule, Portal…
Viral hepatitis
Ductal anatomy
Bile duct (receives bile from canaliculi), fenestrated lining ( endothelial cells of sinusoids)
-
-
-
-
Hepatic macrophages, sinusoid walls
-
Viral hep
-
D
-
-
-
Pre/post exposure immuunisation, risk behaviour modification
- Defective RNA virus: helper function of hep B for expression and pathogenecity
- Superinfection hep B
- Blood transmission
- Needle-stick, IVDU and tattoos
- Sexual and vertical trans
- Incubation: 4-7 weeks
- HDV Ab, hep D PCR
Clin features
Superinfection
- Chronic HDV infection
- Higher risk severe chronic liver disease
- May present acute heaptitis
Coinfection
- Severe acute
- Lower risk chronic
Treatment
- Supportive
- interferon (not for decompensated)
B
-
-
-
-
- Needle stick,IVDU, tattoo
- Sexual and vertical transmission
- Incubation: 15-180 days
- Chronic hep - cirrhosis - hepatocellular carcinoma
- Acute liver failure
Serology
PCR
-
-
- HBcAb IgM: acute infection
- HBcAb IgG: with HBsAg: chronic
Without HBsAg: past infection
- HBeAg: infectivity
- HBeAb: lower infectivity
Screened
- All patients abnormal LFTs (liver function tests) or HCV+ (hep C)
- Foreign born, rate HBV infection hight
- Household + sex contacts infected persons
- Pregnant
- HIV +ive
- Haemodialysis
- IVDU
Medical constions: chemo, ISD
-
E
-
-
-
-
- Incubation: 15-65 days
- Acute liver failure esp pregnancy
- Chronic in immunocompromised patients
- HEV Ab, Hep E PCR
-
A
-
-
-
-
- RNA virus
- Incubattion: 15-50 days
- Excreted faeces 1 week before & after onset illness
- 0.5% acute liver failure
- Ab IgM, IgG = 0ast infection, now immunity
Complications
- Fulminant hep
- Cholestatic hep
- Relapsing hep
Fulminant: Severe imparitment hepatic functions/ severe necrosis hepatocytes absence of preexisting liver disease
Treatment
- Nutrition
- No vigourous exercise
- No alcohol
- Stop unnecessary medication
-
Liver function tests
Cholestatic
Alkalin phos, GGT: mildly elevated
-
Hepatitic
ALT, AST: raised in hepatitis
-
-
Chronic hep
B,C viruses
Usually asymptomatic can present as:
- Fatigue, extrahepatic manisfestations e.g. glomerulonephritis, vasculitis
- Progress to cirrhosis- HCC
-
Decompensated
- Jaundice, hepatic encephalopathy, Ascites, oesphageal varices: haematemesis and melena
Cirrhosis
Poor liver function
- Clotting factors
- Serum albumin
- Metabolism bilirubin
-
Portal hypertension
- Splenomegally
- Varices
- Ascites
- Encephalopathy
-
-
-
Acute Hep
- Flu like
- Nausea, Vom and malaise
- Fever, esp hep A
- Jaundice, dark urine and pale stools
- Hepatomegaly, can be tender
Encephalopathy, Coagulopathy - eventually liver transplantation
Investigations
- ALT (alanine transaminase): enzyme liver
- AST (asparte transaminase):
Serology for cause
Vaccines
- Travelling
- CLD
- Work in labs
- VAQTA and HAVRIX vaccine
- Vaccine/ immunoglobulin within 2 weeks exposure. E.g. serologically porven Hep A infection. Household contacts, daycare carers
- Second dose vaccine 6 months