Hepatitis

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  • Viral Hepatitis
    • Acute viral hepatitis is characterized by  (MCQ)
      • Jaundice
      • dramatically elevated AST and ALT
    • Chronic viral hepatitis requires symptoms persisting for longer than 6 months. (MCQ)
    • Hepatitis A virus (HAV) (MCQ)
      • spread through fecal-oral transmission.
      • It usually affects children and adolescents.
      • Serology demonstrates acute antibodies (IgM anti-HAV).
      • It is a self-limiting acute disease.
    • Hepatitis B virus (HBV) (MCQ)
      • a DNA virus. (MCQ)
      • The complete virion is known as the Dane particle. (MCQ)
      • Transmission may be through the blood and bodily fluids.
      • Vertical transmission (maternal-fetal) is common (90%).
      • incubation period averages 6–8 weeks. (MCQ)
      • causes acute hepatitis with resolution (> 90%).(MCQ)
      • cause chronic hepatitis, cirrhosis (5%), and cancer.
      • Fulminant hepatitis with extensive necrosis may occur (< 1%). (MCQ)
      • HBV causes characteristic ground-glass hepatocytes (MCQ)
      • Diagnosis is made by serology.
        • HBsAg (surface antigen) (MCQ)
          • provides the first evidence of infection
          • appears in the serum before symptoms.
        • HBcAg (core antigen) (MCQ)
          • may be the only evidence of infection during the “window period” between the disappearance of HBsAg and the detectability of anti-HBs.
        • HBsAB (hepatitis B surface antibody)  (MCQ)
          • does not rise until the acute infection is over
          • it represents recovery
          • it is detectable for years following vaccination. (MCQ)
    • Hepatitis C virus (HCV)
      • a RNA virus. (MCQ)
      • Transmission is primarily through the blood.
      • It was the cause of nearly all transfusion-related hepatitis
      • The incubation period is typically 6–12 weeks.
      • Most patients have only mild symptoms with waxing and waning liver enzyme levels. (MCQ)
      • Chronic disease develops in most patients with a significantly increased risk of cirrhosis and hepatocellular carcinoma (HCC). (MCQ)
      • Diagnosis is confirmed by detecting HCV by
        • reverse transcription–polymerase chain reaction (RT-PCR) (MCQ)
        • immunoassay for serum anti-HCV antibody. (MCQ)
      • Disease is monitored using liver function tests and serial liver needle core biopsies to score for grade of inflammation and stage of fibrosis, culminating in cirrhosis.
      • macronodular cirrhosis
        • defined as nodules larger than 3 mm, (MCQ)
        • Viral hepatitis classically causes
        • this pattern may also be seen in (MCQ)
          • Wilson disease
          • Alpha1-antitrypsin deficiency.
      • Chronic disease occurs in 85% of patients. (MCQ)
      • The leading cause is injection drug use.
      • Cirrhosis will develop in 20% of patients within 20 years.
    • Hepatitis D virus (HDV, delta agent)
      • can only infect hepatocytes in association with infection by HBV. (MCQ)
      • Viral replication is completely dependent on the HBsAg.
      • Coinfection of HDV and HBV (MCQ)
        • results in a more severe illness than HBV alone,
        • up to 5% of patients having fulminant disease (vs 1%).
      • Superinfection (HDV infection of a hepatitis B carrier)  (MCQ)
        • has an even higher rate of chronic progressive disease (80% vs 5%).
    • Hepatitis E virus (HEV)
      • an enterically transmitted infection
      • responsible for water-borne epidemics in equatorial regions. (MCQ)
      • The disease is usually self-limited. (MCQ)
      • In pregnant women, it is associated with a high mortality rate (20%).(MCQ)
    • Other causes of viral hepatitis
      • Epstein-Barr virus
      • Cytomegalovirus and herpes simplex virus type-1 may cause hepatitis in immunocompromised patients. (MCQ)
      • Adenovirus is an enteric virus
    • Fulminant hepatitis
      • There is rapid progression of acute liver failure.
      • More than 50% of cases are caused by viral hepatitis.
      • Other causes include acetaminophen, isoniazid, monoamine oxidase inhibitors, halothane, methyldopa, and mushroom toxins (eg, Amanita phalloides). (MCQ)
      • It is characterized by massive liver necrosis,causing jaundice and mental status changes without signs of chronic liver disease.
    • Autoimmune Hepatitis
      • It mostly affects young women with HLA-B8 or HLA-DRw3. (MCQ)
      • Histology shows chronic hepatitis with an infiltrate of lymphocytes and plasma cells. (MCQ)
      • Serologic diagnosis is based on
        • absent viral serologic markers
        • elevated titers for
          • antinuclear antibody (ANA)
          • anti-smooth muscle antibody (SMA)
          • anti-liver/kidney microsome (anti-LKM1) (MCQ)
    • Drug-Induced Liver Damage
      • Most important causes
        • alcohol (ethanol)
        • acetaminophen
        • salicylates.
      • Alcohol (ethanol) abuse
        • Hepatic steatosis
          • begins as tiny fat droplets (microvesicular steatosis)
          • progresses to large globules that fill the cytoplasm that displaces the nucleus (macrovesicular). (MCQ)
          • Steatosis is reversible. (MCQ)
          • Steatosis may progress to hepatitis and cirrhosis.
        • Alcoholic hepatitis
          • may present acutely, especially following excessive alcohol intake.
          • Biopsy reveals
            • ballooning degeneration of swollen hepatocytes (MCQ)
            • protein tangles (Mallory bodies) (MCQ)
            • cell necrosis (acidophil bodies) (MCQ)
            • steatosis, and inflammation (MCQ)
        • Alcoholic cirrhosis
          • irreversible end-stage form of alcoholic liver disease.
        • Alcohol abuse is a leading cause of cirrhosis.
          • Classically, alcohol causes micronodular cirrhosis (regenerative nodules are less than 3 mm in size). (MCQ)
          • Biopsy reveals nodular hepatocyte regeneration surrounded by bridging bands of fibrosis (MCQ)
          • Patients present with the stigmata of chronic liver disease, or compli- cations of portal hypertension.
          • There is also an increased risk of HCC.
          • However, most patients die of hepatic failure, variceal bleeding, or infection.
      • Nonalcoholic steatohepatitis (NASH)
        • clinically and histologically similar to alcoholic liver disease
        • occurs without heavy alcohol consumption
        • NASH is associated with obesity, dyslipidemia, and diabetes. (MCQ)
      • Reye syndrome
        • Aspirin treatment of children with a viral illness
        • Leads to potentially fatal, acute mitochondrial disorder(MCQ)
        • involves the liver and brain.
    • Fatty liver of pregnancy
      • Acute fatty liver of pregnancy presents in the third trimester. (MCQ)
      • Symptoms range from mildly elevated liver function tests to fulminant hepatitis.
      • Mechanism :  defective mitochondrial fatty acid oxidation, leading to steatosis. (MCQ)
    • Hereditary hemochromatosis
      • inherited disorder of iron absorption and accumulation,
      • causes cirrhosis, diabetes, and heart disease
    • Wilson disease
      • autosomal recessive disorder of copper accumulation(MCQ)
      • presents in adolescents and young adults.
      • Copper deposits in the liver, eye, brain, and kidney.
      • Liver findings range from chronic hepatitis to cirrhosis.
      • Kayser-Fleischer rings
        • circumferential copper deposits at the periphery of the cornea. (MCQ)
      • Involvement of the lenticular nucleus of the putamen, a portion of the basal ganglia, causes a movement disorder.
      • Dementia and psychosis may develop. (MCQ)
      • Serum studies show decreased levels of the copper-binding protein, ceruloplasmin. (MCQ)
    • Alpha 1-Antitrypsin (A1AT) deficiency
      • causes pan-lobular pulmonary emphysema and chronic liver disease.
      • The A1AT gene
        • located on chromosome 14(MCQ)
        • The most severe disease is associated with PiZ homozygotes. (MCQ)
      • Alpha 1-Antitrypsin deficiency is the most common chronic liver disease in children. (MCQ)
      • Cholestasis is present in infancy, with 75% of patients having an elevated ALT. (MCQ)
      • Symptoms and liver function tests usually resolve by adolescence, before a second peak in late adulthood.
      • Late complications include
        • cirrhosis, which develops in 15–20% of those over age 50
        • increased risk of HCC. (MCQ)
      • Liver biopsy reveals red cytoplasmic globules of A1AT highlighted by pe- riodic acid-Schiff (PAS) stain (MCQ)
      • Diagnosis can be confirmed by low serum A1AT levels.


Hepatitis A and B
This 3D medical animation describes Hepatitis A and B. This animation begins by showing a healthy liver and explaining its function. The animation then goes on to explain the causes of Hepatitis A and B, how these viruses may be transmitted, the effects the virus can have on the liver as well as possible treatments.
Viral Hepatitis Made Simple!
This video covers the basics of hepatitis, specifically focusing on the 5 viral hepatitis subtypes.
What are the Types of Hepatitis?
Learn what the 5 types of hepatitis are. Shilpa explains the transmission, prevention and treatment of the different types of hepatitis, including Hepatitis A, B, C, D and E. New video every Monday, Wednesday and Friday.
Hepatitis C
The Liver and Hepatitis
Community Response is a partnership of Statutory, Voluntary and Community interests concerned with issues of problem drug use, drug related hep C, HIV/AIDS and drug related crime in the South Inner City area of Dublin. This video was produced in conjunction with Roche.
Hepatatis B Awareness
Hepatitis B is an infectious illness caused by hepatitis B virus (HBV) which infects the liver of hominoidea, including humans, and causes an inflammation called hepatitis. Originally known as “serum hepatitis”, the disease has caused epidemics in parts of Asia and Africa, and it is endemic in China. About a third of the world’s population, more than 2 billion people, have been infected with the hepatitis B virus.[3] This includes 350 million chronic carriers of the virus.Transmission of hepatitis B virus results from exposure to infectious blood or body fluids.
hepatitis
importante video de como se produce el virus de la hepatitis