Basics of Hepatitis B for Esproute

1. Basics of
hepatitis B

2. Agenda
•Liver basics
•Hepatitis B basics

3. The Liver
•The liver is the second largest (after the skin) organ in the
human body and the largest gland
• It is pinkish brown in color, with a soft consistency
•Normally you can't feel the liver, because it's protected by
the rib cage.
•The liver has two large sections, called the right and the
left lobes.

4. The Liver
•The liver's main job is to filter the blood coming
from the digestive tract, before passing it to the
rest of the body
•The liver also detoxifies chemicals and
metabolizes drugs. As it does so, the liver secretes
bile that ends up back in the intestines
•The liver also makes proteins important for blood
clotting and other functions

5. Anatomy of the liver
•Each lobules contain the functional cells
of the liver knowns as hepatocytes
•Hepatocytes make up 70-85% of the
liver's mass
•They play an important role in
building proteins; producing bile, and
chemically processing molecules found
normally in the body, like hormones, as
well as foreign substances like medicines
and alcohol
Each lobe is divided into smaller functional units known as Lobules

6. What does the liver do?
More than 500 vital functions
Secretion: Bile for fat digestion
Excretion: excretes waste via
bile
Detoxification and
metabolism: alcohol,
chemicals, drugs
Storage : Vitamins,
minerals
Regulation and synthesis : Glucose,
fats, proteins ,clotting factors
In abnormal liver functioning all these functions are disturbed

7. Hepatitis
•Means inflammation of liver
•It impairs the important liver functions
•Caused by various agents like
 Infections: Viral
 Excessive alcohol intake
 Medications
Diseased

8. Liver – healing
•Liver has a unique ability to regenerate
•This ability allows the liver to grow back even after it has been
damaged
•It also has the ability to function inspite of liver damage to some
extent.
•When the liver is able to cope with or compensate for some damage
and carry out most functions it is known as compensated liver
disease.
• It this state the liver is able to regrow
•When the liver stop functioning due to extensive damage and the
hepatocytes are replaced by fibrotic tissue it is known as
decompensated liver disease
• In this state the damage is too much for the liver to cope with

9. Hepatitis
•Hepatitis can be caused by a variety of factors
•Viruses infecting the liver are amongst the most important reasons for hepatitis
Type Also Known as Transmission Mortality Chronicity
A Infectious Oral/faecal Low no
B Serum Parenteral High yes
C Post transfusion non-A, non-B Parenteral Moderate/
High
yes
D Delta With hepatitis B High yes
E Enteric Oral/faecal High in pregnancy no
Viral hepatitis refers to infection caused by viruses

10. Hepatitis B
Hepatitis B is caused due to Hepatitis B virus
It is 100 times more infectious than HIV
There are in 10 HBV Genotypes (A-J)
◦ Types of hepatitis B viruses
In India genotype A & D are most common
Genotype
A & D

11. Since the concentration of the virus is high in the blood, contact with infected blood can transmit
the virus

12. Mode of transmission
Transfusion: blood transfusions
Percutaneous transmission: contaminated needles
for tatoos, injections
Sexual transmission
Transplantation: from HBV-infected donor
Occurs in children (from cuts, wounds, toys sharing)
 Perinatal transmission:
infected mother to child
Horizontal transmissionVertical transmission
Hepatitis B spreads through contact with infected blood. There are two main
types of transmission, vertical and horizontal

13. HBV can cause acute or chronic infection
Time Of infection 6 months
Acute Hepatitis Chronic Hepatitis
Symptomatic/asymptomatic
95% of adults clear virus
within 6 months
Many diagnosed during a routine
check up/ asymptomatic
90% of children and <5% of
adults develop chronic hepatitis B
Some may develop
complications
If the infection last for less than six months it is a acute
infection.
If the infection last for more than six months it is a chronic
infection.

14. Chronic hepatitis B
•It is the 10th leading cause of death worldwide
•Currently around 240 million people worldwide are chronically
infected with hepatitis B virus
1.India's Hepatitis B Virus Drug Market Will Grow Ten-Fold By 2012 18 August 2008 http://www.decisionresources.com/

15. Geographic Distribution of Chronic HBV
infection
India lies in the Intermediate zone of Chronic Hepatitis B
infection

16. What is the problem with chronic
hepatitis B?
•Chronic hepatitis B leads to chronic inflammation in the liver
•The immune system constantly tries to get rid of the virus but is not successful
•The sustained attack on the liver leads to complications

17. Complications of Chronic Liver Damage
1. Cirrhosis
◦ Chronic Inflammation and cell death eventually
give rise to fibrosis, or scar formation
2. Hepatocellular Carcinoma
◦ Cirrhosis may progress to the development of the
tumor
3. Liver failure
◦ Liver stops functioning

18. What are the makers of hepatitis B
infections
There are four types of markers of hepatitis B
infections
◦Serological
◦Virological
◦Biochemical
◦Histological

19. Phases of chronic hepatitis B infection
4 phases
Immune tolerant
Immune clearance
( HBeAg+ hepatitis)
Residual phase
Reactivation phase
(HBeAg- hepatitis)

20. Should all chronic hepatitis B patients
receive treatment?
No
Only some patients with chronic hepatitis B need treatment
Current treatment doesn’t cure hepatitis B
◦ Hence treatment is reserved for those who continue to have liver
damage