Inflammation of the liver Can have many causes viral infections specific to liver (A, B, C, D, E ..) drugs toxins alcohol other infections (viruses,parasites, bacteria) Infection of the liver caused by group of viruses having a particular affinity for liver Hepatitis A Hepatitis B Hepatitis C Hepatitis D ( B + D ) Hepatitis E Hepatitis G A . Acute Asymptomatic infection serologic evidence only B. Acute Viral Hepatitis Short-term hepatitis. Body’s immune system clears the virus from the body within 6months C. Chronic hepatitis Long-term hepatitis. Infection lasts longer than 6 months D. Fulminant Hepatitis hepatic failure in less then 2 weeks Acute Viral Hepatitis - 4 phases 1) Incubation period 2) asymptomatic pre icteric phase- non-specific constitutional symptoms - fever, malaise, weight loss, muscle and joint pains, diarrhoea Physical examination : mildly enlarged, tender liver 3) a symptomatic icteric phase Jaundice- conjugated and unconjugated hyperbilirubinemia Other symptoms abate Physical examination- liver mildly enlarged ,and tender urine- dark Serum Bilirubin ↑ ↑ , ALT, AST ↑ ↑ 4) Convalescence Recovery Evidence of continuing or relapsing hepatic disease for more than 6 months Clinical features: The most common symptom is fatigue Malaise, loss of appetite, and bouts of mild jaundice. Physical findings : Mild hepatomegaly , hepatic tenderness Laboratory findings: Bilirubin AST, ALT Prothrombin time Patients harbor replicating virus and therefore can transmit the infection - Healthy carrier - Chronic disease Severe hepatic insufficiency from onset of symptoms to hepatic encephalopathy within 2 to 3 weeks Jaundice, encephalopathy and fetor hepaticus. Life threatening complications – bleeding, hepatorenal syndrome Prognosis: Fulminant hepatitis carries a bad prognosis. Many patients die due to hepatic failure If the patient survives for more than a week secondary regenerative activity takes place and then the prognosis is more favourable. Geographic Distribution of HAV Infection RNA virus ( picorna virus ) Single stranded, Non enveloped 27 nm in diameter • Mode of transmission : Feco-oral - ingestion of contaminated food and water - Close personal contact Consumption of raw oysters Cause for outbreaks Acute asymptomatic infection or Acute symptomatic hepatitis Protective antibodies develop in response to infection - confers lifelong immunity NO CHRONIC INFECTION OR CARRIER STATE RARELY FULMINANT HEPATITIS- 0.1% Incubation period from 15 - 45 days Fever, jaundice : main symptoms. 99.9 % cases recover completely ACUTE CONVALESCENCE Serologic diagnosis : INCUBATION AND RECOVERY PERIOD DISEASE HAVs JAUNDICE Shed in feces 2-3 weeks SYMPTOMS before & 1 week after the onset of jaundice IgM antibody: IgM –anti-HAV Declines in a few months IgG –anti-HAV Fecal IgG antibody HAV Appears soon after IgM appears, persists for life. Provides immunity against re- infection. 15-45 days Months 2-12 weeks Course of Hepatitis A Recovery Fulminant hepatitis 99.9% 0.1% Chronic Hepatitis NO NO CARRIER STATE NO ONCOGENIC POTENTIAL Prevention Vaccine – 2 doses questions?