GIT Lecture Dr. Encarnacion

1. Acute Viral Hepatitis Elmer R. Encarnacion,MD

2. Types of Hepatitis CDC fact sheets, available at www.cdc.gov A B C D E G Source of virus Feces Blood, body fluids Blood, body fluids Blood, body fluids Feces Blood Route of Transmission Fecal-Oral Childbirth, needles, sex, transfusion Needles, transfusion (sex, childbirth) Needles, sex, transfusion (requires HBV co-infection) Fecal-Oral Transfusion (requires HBV, HCV, or HIV co-infection) Chronic Infection No Yes Yes Yes No No (whether it’s pathogenic to humans remains unclear) Prevention Vaccine Immuno-globulin Vaccine Immuno-globulin Blood donor screening, risk management, education HBV Vaccine Ensure safe drinking water Blood donor screening

11. Acute vs Chronic Hepatitis B Acute Chronic Definition disease in which HBsAg persists for less than 6 months Persistence of HBsAg for more than 6 months Phases Incubation Prodromal Icteric Immune Tolerance Clearance Non-replicative Characteristics 1. Usually subclinical in children 2. 30%-50% of adult patients develop clinical manifestations 3. May become fulminant 1. Can be HBeAg (+) or (-) 2. Viral load is associated with disease activity 3. May progress to fibrosis, cirrhosis, or HCC

12. Signs and Symptoms Acute Chronic May be asymptomatic Usually asymptomatic Flu-like symptoms Malaise/Fatigue Skin Rash Extra-hepatic symptoms Jaundice Signs/symptoms of liver failure Light-colored stools Hepatocellular carcinoma Dark-colored urine

14. Pathogenesis of HBV Infection Averett DR and Mason WS. Viral Hep. Rev. 1995; 1 :129–42 Clinical hepatitis HBV-infected hepatocytes Inflammation and cell death HBV production Hepatocyte regeneration Uninfected hepatocytes Infection Immune response Re-infection Alcohol, co-infection etc.

15. Pathogenesis of Chronic HBV Infection Viral replication Transplant or Death Immune response Tissue damage Scarring HCC Cirrhosis Evidence of disease Adapted from Dr Z Goodman, Armed Forces Institute of Pathology, Washington, DC Host and environmental factors (e.g. alcohol, co-infection)

18. Treatment Algorithm