This document summarizes the pathophysiology of viral hepatitis. It describes the main hepatitis viruses (A, B, C, D, E), their epidemiology, symptoms, structure, diagnosis and treatment. Over 1.3 million people die each year from hepatitis B and C infections. The viruses are transmitted through bodily fluids and cause inflammation of the liver. Diagnosis involves liver function tests and detecting viral markers in blood. Treatment depends on the virus but may include antiviral drugs and vaccination.

1. Pathophysiology of Viral Hepatitis
Under the guidance Presented By
Dr. Asis Bala Mr. Shivpal
Dept. of Pharmacology & Toxicology Dept. of Pharmacology
&Toxicology
NIPER Hajipur NIPER Hajipur
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2. Content
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 Introduction
 Epidemiology
 Hepatitis Virus
 Symptoms
 Structure of Virus
 Pathophysiology
 Diagnosis
 Treatment
 New drugs under the clinical trail
 Risk Factors
 Prevention
• Reference

3. Introduction
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 ‘Hepatitis’ derived from two words:-
Hepar – Liver
Titis – Inflammation
 Means- Inflammation in liver.
 The term viral hepatitis is used to describe infection of the liver caused by
hepatotropic viruses.
 Currently there are 5 main varieties of viruses causing viral hepatitis:
Hepatitis A virus (HAV),
Hepatitis B virus (HBV),
Hepatitis C virus (HCV),
Hepatitis delta virus (HDV) ,
Hepatitis E virus (HEV).
 Some other viruses:-
• cytomegalovirus(CMV)
• Herpes simplex virus (HSV) etc.
Figure 1

4. Epidemiology
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 The World Health Organization (WHO) estimated that 1 in 3
people in the world have been infected by either HBV or HCV.
 1.3 million people have died in 2015.
 2 billion people have been infected with HBV.
 Approximately 185 million people are infected with HCV and
20 million people are infected with HEV.
 In high endemic regions more than 90% children get infected
by HAV by the age of 10.
 Viral hepatitis results in around 1.4 million deaths each year,
HBV and HCV are responsible for about 90% .
 “2030 Agenda for Sustainable Development Goals” of WHO
has identified specific actions to prevent viral hepatitis.

5. Hepatitis Viruses
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Hepatitis
A
Hepatitis
B
Hepatitis
C
Hepatitis
D
Hepatitis
E
Type ssRNA dsDNA ssRNA ssRNA ssRNA
Incubation
Period
30 days 90 days 50 days 50days 40days
Route Feaco-oral Parentral Parentral Parentral Feaco-oral
Severity Mild Sever Mild Sever Mild

6. Symptoms
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 Fever, a flu-like illness
 Fatigue
 Dark urine
 Loss of appetite
 Nausea, Vomiting
 Joint pain
 Jaundice (yellowing of the skin and eyes)
 Pain in the upper right abdomen (due to the inflamed liver)
 People with chronic Hepatitis B develop serious liver conditions, such as
cirrhosis (scarring of the liver) or liver cancer.

7. Structure of Virus
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Figure 2

8. Pathophysiology
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Figure 3

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Figure 4

10. Diagnosis
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 Liver function Test.
 Total Bilirubin
 Serum glutamic pyruvic transaminase (SGPT)
 Serum glutamic oxaloacetic transaminase (SGOT)
 Cholesterol
 Albumin
 Total protein
 Ultrasound of liver.
 Serologic and viral markers:-
 1. HBsAg :-HBsAg appears early in the blood after about 6 weeks of infection and its
detection is an indicator of active HBV infection.
 2. Anti-HBs:- Specific antibody to HBsAg in serum called anti-HBs appears late, about 3
months after the onset. Anti- HBs response may be both IgM and IgG type.
 3. HBeAg:-derived from core protein is present transiently (3-6 weeks) during an acute
attack.
 4. Anti-HBe :-Antibody to HBeAg called anti-HBe appears after disappearance of HBeA.
 5. Antibody to HBcAg called anti-HBc can be detected in the serum of acute hepatitis B
patients.
 6. HBcAg:- derived from core protein cannot be detected in the blood.
 7. Anti-HBcV-DNA :-Detection of HBV-DNA by molecular hybridisation using the Southern
blot techniques.

11. Risk Factors
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 Have unprotected sex with multiple sex partners or with someone who's
infected with HBV.
 Share needles during IV drug use.
 Live with someone who has a chronic HBV infection.
 Are an infant born to an infected mother.
 Age.
 Any liver injury.

12. Treatment of Hepatitis B
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 Interferon alpha (α-IFN) is the first-line treatment.
 Anti viral drugs:-
lamivudine
Telbuvidine
Emtricitabine
Adefovir
 Liver transplantation.
 Hepatitis B vaccine(preventive).

13. New Drugs Under The Clinical
Trail
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 Total 263 drugs are ongoing clinical trail for HBV.
 ABI-H0731:- target viral core protein.
 Inarigivir:- to block replication of viral DNA.
 JNJ-3989:-Under the study.
 Bulevirtide:- under the study.

14. Prevention
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 WHO recommends that all infants receive the hepatitis B vaccine as soon as
possible after birth, preferably within 24 hours.
 Simple environmental procedures can limit the risk of infection to health care
workers, laboratory personnel, and others.
Examples
 Gloves should be used when handling all potentially infectious materials;
 protective garments should be worn and removed before leaving the work
area;
 masks and eye protection or droplets from infectious material.
 only disposable needles should be used;
 needles should be discarded directly into special containers.
 work surfaces should be decontaminated using a bleach solution; and
laboratory personnel should refrain from eating, drinking, and smoking in the
work area.

15. Reference
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 Mohan Harsh,’’A textbooh of Pathology’’,6th edition, Jaypee Brothers
Medical Publisher pvt. Ltd.
 Doo Hyun Kim, Hong Seok Kang, and Kyun-Hwan Kim ,Roles of
hepatocyte nuclear factors in hepatitis B virus infection, World Journal of
s.
 Intracellular interleukin-32γ mediates antiviral activity of cytokines
against hepatitis B virus, Nature communications.

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