Hepatitis

Muhammad Jan Baloch

Medicine Unit-IV
LUMHS Jamshoro

Hepatitis
inflammation of the liver
Can have many causes

drugs
toxins
alcohol
viral infections (A, B, C, D, E)
other infections (parasites, bacteria)
physical damage

Liver
Functions

Stores sugar needed for energy

Absorbs good nutrients
Breaks down poisons (toxins) and drugs
Makes important proteins that help build new tissue
and repair broken tissue
Produces bile, which helps remove waste from the
body

Healthy Liver

Cirrhosis Liver

Hepatitis Terms
Acute Hepatitis: Short-term hepatitis.
Bodys immune system clears the virus from the body
within 6 months

Chronic Hepatitis: Long-term hepatitis.

Infection lasts longer than 6 months because the
bodys immune system cannot clear the virus from the
body

Hepatitis A
What is it?
Infection of the liver caused by Hepatitis A virus

Hepatitis A
Incubation period
30 days on average (range 15-50 days)
infectious latter half of incubation period while
asymptomatic through 1 week after having jaundice.

Hepatitis A

Symptoms
Nausea
Loss of appetite
Vomiting
Fatigue
Fever

Dark urine
Pale stool
Jaundice
Stomach pain
Side pain

A person may have all, some or none of t

Hepatitis A
How do you get it?
Feces (stool) on hands that gets on food or in water
Contaminated shellfish
Sex

A person is most contagious 2 weeks before

they feel sick
Not spread by kissing, sneezing, saliva

Hepatitis A
Diagnosis and Treatment
Blood test
No medicine or treatment to make it go away
Rest, fluids, treatment of symptoms
Most people recover completely and become immune
to reinfection

Hepatitis A
Prevention

Shot of immune globulin up to 2 weeks after exposure

Good hand washing
Cook food well
Good diaper hygiene
Only drink clean water
VACCINE!!!

Hepatitis A
Who needs immune globulin?

Living with someone with Hep A

Eaten food handled by someone with Hep A
Sexual contact with person with Hep A
Traveling to an area where Hep A is common
Child or employee at a child care program where
someone else has Hep A

Hepatitis B
What is it?
Hep B is a serious disease caused by a virus that
infects the liver
Can cause lifelong infection, cirrhosis (liver scarring),
liver cancer, liver failure and death

Hepatitis B
Incubation period
60-90 days on average (range 45-180 days)
infectious weeks before getting ill and for variable
period after acute infection
chronic carriers remain infectious

Hepatitis B

Symptoms
Nausea
Loss of appetite
Vomiting
Fatigue
Fever

Dark urine
Pale stool
Jaundice
Stomach pain
Side pain

A person may have all, some or none of t

Hepatitis B
Who is at risk?

Anyone can get it

In the USA, 200,000 people get B every year
5,000 people die every year of Hep B
If you have had other kinds of Hepatitis, you can still
get Hep B

Hepatitis B Infections
200,000 per year

Asymptomatic Cases
100,000 (50%)

Symptomatic Cases
100,000 (50%)

Clear Virus; Healthy

170 - 182,000 (90-94%)
Hepatitis B Chronic Carriers
12-20,000 (6-10%)

Death
100
(0.05%)

Chronic Liver Disease

Death from Cirrhosis

3400 (1.7%)

Death-Primary Liver Cancer

800 (0.4%)

Hepatitis B
Who is at highest risk?

Injection drug users

Sex partners of those with Hep B
Sex with more than one partner
Men who have sex with men
Living with someone with chronic Hep B
Contact with blood
Transfusions, travel, dialysis

Hepatitis B
How do you get it?
Direct contact with blood or body fluids of an infected
person
sharing injection equipment
sex
baby from infected mother during childbirth

Hepatitis B is not spread by food, water or

casual contact

Hepatitis B
Who is a carrier of Hep B virus?
Some people with Hep B never fully recover from the
infection (chronic infection)
They still carry the virus and can infect others for the
rest of their lives
There are about 1 million carriers of Hep B in the USA

HEPATITIS B

Hepatitis B

Diagnosis and Treatment

Blood test
There is no cure
Interferon/Ribaviron

Hepatitis B
What about Hep B and pregnancy?
A woman with Hep B can give it to her baby at birth
Babies with Hep B can get very sick, can develop
chronic infection and spread Hep B, can get cirrhosis
or liver cancer
Pregnant women should be tested for Hep B
Babies should get Hep B vaccine at birth

Hepatitis B

Who should get Hepatitis B vaccine?

All babies, at birth
All children 11-12 who have not had vaccine
People at risk

MSM
Multiple sex partners
Injection drug users
People with jobs where exposure to blood might happen

Hepatitis C
What is it?
Hep C is a liver infection caused by a virus
Also known as non A, non B hepatitis

Hepatitis C
Incubation period
6-7 weeks on average (range 2-6months)
infectious one or more weeks before getting ill
chronic carriers remain infectious

Hepatitis C

Symptoms
Nausea
Loss of appetite
Vomiting
Fatigue
Fever

Dark urine
Pale stool
Jaundice
Stomach pain
Side pain

3 out of 4 persons have no symptoms

and can infect others without

Hepatitis C
Who is at risk?
About 35,000 people get Hep C every year
down from 180,000 in the 1980s

About 3.9 million people in the USA are infected with

Hep C.
It can cause liver failure, cirrhosis, liver cancer
Responsible for 8,000 to 10,000 deaths/year.

Hepatitis C
Who is at highest risk?
Injection drug users
Estimated that over 75% of injectors nationwide have
Hep C
In Seattle/King County, 86%

Hepatitis C
How do you get it?
Shared injection equipment (60% of new infections)
Blood transfusion before May, 1992 (now only 1 in
100,000 chance of transmission)
Blood transfer (HCW, tattoo, piercing )
Sex? (HCV in semen and vf but only 1.5% rate of
transmission for long-term partners)
Mother to child (<5%)
10-20% of infections have no identifiable risk factors

Hepatitis C
Diagnosis
There is a blood test that screens for Hep C antibodies
(ELISA or RIBA)
Antibodies usually develop within 3 months
HIV+ persons may not develop detectable antibodies
There is a PCR test (detects parts of actual virus) for Hep
C but it is not yet FDA approved
If infected, liver enzyme tests or a liver biopsy can check
liver function

Hepatitis C

What happens when you have Hepatitis C ?

85% of people develop chronic infection (infected for the
rest of their life)
Rapid progression, slow progression, no progression
HCV subtype
Alcohol consumption (alcoholics 3 times more likely to develop
cirrhosis after 20 years)
age (older at time of infection more rapid)
gender (men faster progression than women)

HEPATITIS C

Hepatitis C

Long term pathogenesis

Over time progressive liver damage may occur
20 -30 % of those infected will develop cirrhosis over
10 - 30 years
Of those with cirrhosis 25-30% (5% of overall) will
develop end-stage liver disease or liver cancer
Many live without symptoms for decades
Others experience mild symptoms --intermittent
fatigue, nausea, and muscle aches

Hepatitis C
Treatment
Interferon/Ribaviron (suggest 40% cure rate)
Peginterferon Alfa-2a (still in studies - not yet FDA
approved)

Hepatitis C
What should a person do who has Hep C?
Get regular medical care--tell doctor about ALL drugs
(including herbs)!!!
Have a healthy diet (no iron supplements, reduce salt
intake, no large doses of vitamin A)
Get needed rest
No alcohol or Tylenol, cut back on other drug use
Avoid chemical fumes and other environmental toxins
Get vaccinated for A and B!!!

Hepatitis C

What should a person do who has Hep C?

Do not share injection equipment.

Do not donate blood or plasma, organs or sperm
Do not share toothbrushes, razors
Cover areas of open skin
Use safer sex?

Hepatitis C and HIV

30 - 40% of HIV+ people in US also infected with
Hep C
More rapid progression of Hep C (twice as fast)
Little to no affect on HIV progression (still
inconclusive)
Complications of medication regimens
Increases risk of perinatal transmission

Hepatitis

A Virus

Symptoms
of
I nitial
I nfection

Chronic
I nfection

No chronic disease 10% Chronic

85% Chronic

How is it
Spread?

Can cause:
Liver cell damage
Cirrhosis
Liver cancer
Fecal/ oral
Blood and body
fluid contact
Contaminated
food and water Sex
Oral/Anal sexual Needles
contact
Mother to baby
Human bite

Can cause:
Liver cell damage
Cirrhosis
Liver cancer
Blood and body fluid
contact
Needles
Mother to baby
Sex (minimal)

Vaccine

Yes

No

(I nfection for
life)

B Virus

C Virus

Some people have no symptoms (especially HCV)

Eyes or skin may turn yellow (jaundice)
Loss of appetite
Nausea, vomiting, fever, stomach or joint pain
Fatigue (can last weeks or months)
Dark urine & pale bowel movements

Yes