Acute Hepatitis

Dr Chimezie Okwuonu
Gregory University Umuahia Campus
 Definition
• Hepatitis means inflammation of the liver

• Usually less than 6 months

• Basic functions of the liver are affected

 Causes
• Viral
• Non viral causes

• Viral causes- Hepatitid viruses A, B, C, D, E

• Non A-E viral hepatitis
• Other viruses
CMV
EBV
HSV
Yellow fever
 Non Viral causes

• Bacteria- Streptococcus sp, e coli

• Fungal- Aspergillosis
• Alcohol
• Drugs- alpha methyl dopa, ARV,
• Metabolic abnormalities- Wilson disease
• Toxins
 Viral Hepatitis
• Always caused by one of the specific hepatitis
virus

• All the viruses give rise to illness which are

similar in their clinical and pathological
features
 Global burden of hepatitis
• The global burden of disease due to acute hepatitis B
and C, and cancer and
cirrhosis of the liver, accounts for about 2.7% of all
deaths.

• This is expected to increase further in the next two

decades
• An estimated 57% of liver cirrhosis and 78% of primary
liver cancer are due to
hepatitis B virus (HBV) or hepatitis C virus (HCV)
infection
• In total, about 2 billion people have been infected
with HBV; about 600 000
people die each year due to the consequences of
hepatitis B

• About 150 million people are chronically infected

with HCV (about 10 times
higher than HIV estimates); more than 350,000
people die each year from hepatitis C-related liver
diseases
 Hepatitis A
• Hepatitis A virus (HAV) is a ribonucleic acid (RNA) virus that is
transmitted primarily through the fecal-oral route. Belong to
the Enterovirus group

• It frequently occurs in small outbreaks (epidemics) caused by

faecal contamination of food or drinking water.

• Poor hygiene, improper handling of food, crowded situations,

and poor sanitary conditions are contributing factors

• Incubation period is 15-45 days

• The virus is present in faeces during the incubation period,
so it can be carried and transmitted by persons who have
undetectable, subclinical infections. The greatest risk of
transmission occurs before clinical symptoms are
apparent.

• Detection of hepatitis A IgM indicates acute hepatitis. IgG

antibody provides lifelong immunity.

• Hepatitis A vaccination and thorough hand washing are

the best measures to prevent outbreaks
 Hepatitis B
• HBV is a deoxyribonucleic acid (DNA) virus belonging to
the Hepdna group.

• Transmission: This occurs when the virus (from infected

blood or body fluids) enters the body of an uninfected
person who has not received the HBV vaccine
 Perinatally by mothers infected with HBV;
 Percutaneously (e.g., IV drug use, accidental needle-stick
punctures)
 mucosal exposure to infectious blood, blood products, or
other body fluids (e.g., semen, vaginal secretions, saliva)
 Sexual intercourse
 Organ transplantation
 Who is at risk for hepatitis B?

• Infants born to infected mothers

• People who inject drugs or share needles, syringes, and other
types of drug equipment
• Sex partners of people with hepatitis B
• Men who have sex with men
• People who live with someone who has hepatitis B
• Health-care and public-safety workers exposed to blood on the
job
• Hemodialysis patients

 Vaccine preventable using HBIG given at birth, at risk people or on

exposure in the unvaccinated
• HBV can live on a dry surface for at least 7 days; it is much
more infectious than human immunodeficiency virus (HIV)
• Incubation period is 30-180 days
• Hepatitis B virus (HBV) can cause either acute or chronic
disease.

• Risk for chronic infection is related to age at infection:

about 90% of infants with hepatitis B go on to develop
chronic infection, whereas only 2%–6% of people who get
hepatitis B as adults become chronically infected.
 Hepatitis C
• An RNA Virus belonging to the Flavivirus group
• Has parenteral mode of transmission- Manly
via blood and saliva
• Incubatiion period is 15-160 days
• It progresses more toward chronic hepatitis
than hep B
• No vaccine available for its prevention
 Heptitis D
• RNA virus
• Incomplete
• Usually associated with HBV either as a super-
infection or a co-infection
• When a superinfection occurs, tendency to
chronic infection and fulminant hepatitis is worse
• However, super-infection results in reduction in
Hep B viral load
• Prevented by hepatitis B vaccination
 Hepatitis E
• RNA virus
• Belongs to family of Calcivirus
• Spread is feco-oral
• Tendency to fulminant hepatitis in pregnant
women
• No vaccine available for prevention
 Clinical features
• Prodromal phase – first two weeks

• Icteric phase – 3rd week

• Recovery phase- 4th -6th week

 Prodromal phase
• This is the phase before obvious manifestation
of jaundice
• Unspecific stage- Fever, vomiting, prostration,
abdominal pain

• Enlarged cervical lymph nodes,

hepatomegally, splenomegally
 Icteric phase
• Patients start feeling better but people who
see patients will start complaining
• Manifested by appearance of jaundice
• Lasts 2-4 weeks
• Thereafter jaundice start disappearing and
patients start recovering
• This is the natural history of uncomplicated
viral hepatitis
 Investigations
• LFT- A plasma transferase > 400 u/L even before
jaundice appears is striking; Rise in bilirubin is an early
finding
• Kidney function test- regular vomiting can lead to pre-
renal failure
• Urinalysis- Mild proteinuria
• FBC- WBC is normal, sometimes with relative
lymphocytosis
• Serology- looking for antibodies
• Liver biopsy
 Management
• Conservative management- Fever, vomiting etc
• Diet- 2000-3000 kcal da
• Drugs- As much as can be, avoid some drugs
due to metabolism in the liver. Alcohol must be
avoided
HepB- Interferon
HepC- Ribavirin
• Liver transplantation if indicated
 Complications
• Acute hepatic failure
• Cholestatic hepatitis
• Post-hepatitis syndrome
• Hyperbilirubinaemia
• Aplastic anaemia
• Renal failure
• Chronic hepatitis
• Cirrhosis (hep B and C)
• Hepatocellular carcinoma