23 y/o male admitted to the hospital with 1 week hx of fever, RUQ pain,…
23 y/o male admitted to the hospital with 1 week hx of fever, RUQ pain, nausea and lethargy. he is also jaundice 3 days prior to admission
Full blood count
Liver function test
Hepatitis and HIV serology
Serological profile of Hep B
Hepatitis B surface antigen
(HBsAg)Appears during incubation period (1-6 months)
Peaks when the patient is most ill.
Becomes undetectable in 3-6 months.
Indicates infection – recent or chronic.
Hepatitis B surface antibody (anti-HBs)
Arises once the acute disease has resolved.
Hepatitis B core antibody (anti-HBc)
- Anti-HBc IgM and elevated serum transaminases also appear shortly before the symptom onset.
Hepatitis B e-antigen (HBeAg)
Shortly after HBsAg appears, HBeAg and HBV DNA can be detected in the serum and are markers of the acute viral replication.
Predictor of infectivity.
Hepatitis B e-antibody (anti-HBe)
Anti-HBe appears shortly after HBeAg vanishes
Predictor of low infectivity.
a) Interferon (combined antiviral & immunomodulatory effect)
b) Nucleoside/nucleotide analogues (direct antiviral effect)
c) Liver transplant
b) Hepatitis B Ig
Screening of blood donors
Blood & body fluid precaution
Practice safe sex
Don't become IVDU
causative agent of viral hepatitis
Metabolism of bilirubin
Function of liver - Metabolism of carbohydrates, lipid and protein,
Catabolism of steroid hormone,
Storage and metabolism of vitamins and mineral,
Storage of iron and copper
Diagnosis: HBV infection
Immune Response to Hep B
Innate and the adaptive immune system are important.
The innate immune system is responsible for early containment of the viruses and initial activation of adaptive immune responses.
It is generally thought that HBV is poorly sensed by the innate immune system and can escape innate immune recognition at the early stages of infection.
Natural killer (NK) cells, are activated early during infection, before HBV-specific T cells arise.
As time goes, functionally active HBV-specific T cells (especially cytotoxic CD8+ T cell) can be detected, which are thought to play an important role in viral clearance, there are also B cell being activated to mature into plasma cell for HBV antibody production (dendritic > T helper > B cell activation).
During chronic infection, HBV-specific T cells are exhausted and their function is impaired.
infiltration of inflammatory cells
Possible outcome of HBV infection
Nonprogressive Chronic Hepatitis
Progressive Chronic Hepatitis to Cirrhosis
Asymptomatic Hep B carrier
Pathogenesis & clinical manifestation
immune mediated cytotoxic killing of hepatocytes is that cause of inflammation of the liver
hepatocytes are further damaged -the cell lyses releasing the cell contents = aspartate aminotransferase & alanine amino transferase
fatigue, nausea, vomiting, fever, hepatomegaly, jaundice, dark urine, anorexia, and rash
loss of appetide
Risk factors for viral hepatitis
Lack of sanitation
Contact with used needles, syringes
Engaging in unsafe sexual contact
Large quantities of alcohol
Working around toxic chemicals
Not being vaccinated
Mother who has hepatitis