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HEPATITIS
Guide : Dr. Anjali Metgudmath
co guide : Dr. Dnyanesh
morkar
Dr. Santosh hazare
Presenter :Dr Yeshavanth G
Scheme of presentation
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Introduction
Epidemiology
Chronic Hepatitis B
Epidemiology
Definitions
Diagnostic criteria
mode of transmission
Symptoms and signs
Extrahepatic manifestations
Natural history
diagnosis
Complications and sequelae
Vaccination.
Treatment.
Chronic Hepatitis C
1.
Epidemiology
2.
Definitions
3.
mode of transmission
4.
5.
Extrahepatic manifestations
6.
Natural history
7.
diagnosis
8.
9.
Treatment.
Introduction
Epidemiological patterns of
HEP B infection
Prevalenc
e
High
Intermedi
ate
Low
3-7%
0.1-2%
Geography
Southeast
asia
Predominan
t age at
infection
perinatal
Mode of
Maternal
transmissio infant
n
early
childhood
adult
sexual
percutaneo
us
Chronic hepatitis B
Chronic necroinflammatory disease of the liver caused by
persistent infection with hepatitis B virus. Chronic hepatitis B
can be subdivided into HBeAg positive and HBeAg negative
chronic hepatitis B.
Resolved hepatitis B
Previous HBV infection without further virological, biochemical
or histologic evidence of active virus infection or disease.
1. HBsAg+ >6 m
2. Serum HBV DNA >105 IU/mL (may be
lower for HBeAg negative patients)
3. Persistent or intermittent elevation in
ALT/AST levels
4. Liver biopsy showing chronic hepatitis
(necroinflammatory score 4)
1. HBsAg+ >6 m
2. HBeAg, anti-HBe+
3. Serum HBV DNA <105 Iu/ml (usually
<1000 IU/mL)
4. Persistently normal ALT/AST levels
5. Liver biopsy confirms absence of
significant hepatitis (necroinflammatory
score <4)
RESOLVED HEPATITIS B
Mode of transmission
Extrahepatic
Manifestations
1.
2)GLOMERULONEPHRITIS:
-more in children.
-membranous most common.
-children usually undergo spontaneous
remission.
-30% adults progress to renal failure.
-steroids are ineffective.
-IFN can be tried as rx.
NATURAL HISTORY
80
60
40
Chronic Infection
Chronic Infection (%)
20
100
80
60
40
20
Chronic Infection
(%)
100
Symptomatic Infection
0
Birth
0
1-6 months 7-12 months 1-4 yearsOlder Children
and Adults
Age at
Infection
Diagnosis serologic
markers
Hepatitis B surface
antigen
Hepatitis B e antigen
Anti-HBe
Anti-HBc (IgM)
Anti-HBc (IgG)
Anti-HBs
Diagnosis of Hepatitis B
Virus
(HBV)
Infection
Chr HBs HBeA IgM IgG
Anti
Anti HBV
Interpreta
oni
c
HB
V
Ag
anti anti
HBc
HBc
HBs
Hbe
Dna
tion
Infe
ctio
n
+++
HBeAG+
chronic
hepatitis
Inactive
carrier
state
++
HBeAgchronic
hepatitis
++
Exacerbatio
ns of
chronic
95% of infantacquired
infections
Chronic HBV infection
Chronic hepatitis
12-25% in 5
years
Cirrhosis
20-23% in 5
6-15% in 5 years
years
Hepatocellular
Liver failure
carcinoma
Deat
h
Liver transplant
Death
Sequelae of Chronic
Hepatitis B Virus Infection
Vaccination contd
1.
2.
CHRONIC VIRAL
HEPATITIS
Guide : Dr. Anjali Metgudmath
co guide : Dr. Dnyanesh
morkar
Dr. Santosh hazare
Presenter :Dr Yeshavanth G
Treatment of Chronic
Hepatitis B
Definition of Response to
Antiviral Therapy of
Biochemi
Decrease
in serum ALTB
to within the
Chronic
Hepatitis
cal
normal range
Interferons
Lamivudine
Famciclovir :
1)oral prodrug of penciclovir, an acyclic
deoxyguanosine analog.
2) low efficacy, need for administration thrice
daily, and potential for crossresistance with
lamivudine.
Adefovir Dipivoxil
1)inhibit reverse transcriptase
2) effective in suppressing wild type as well as
lamivudine-resistant HBV
3) 10 mg daily PO
Chronic Hepatitis C
infection
Transfusion associated
Natural History
Extrahepatic manifestations
1. Mixed cryoglobulinemia
2. Chronic glomerulonephritis
these respond to interferons.
Risk of developing
Survival in patients
decompensated liver
with cirrhosis due to
disease among
chronic hepatitis C.
patients with stable
Effect of complications
cirrhosis due to chronic
and decompensation
hepatitis
Prevention and
Treatment
Public health guidelines have been issued for HCV-INFECTED
PERSONS
Treatment
Major goal is to prevent the development
of decompensated liver disease and
death.
In chronic infection, goal
1. eradicate or prolonged suppression of
viral replication,
2. reduction of hepatic inflammation,
3. slowing the rate of progressive liver
injury
Definitions of Treatment
Responses
Hepatitis D
Hepatitis G
asymptomatic course
Role in liver disease not yet proven
co infection with HGV and HIV has been
shown to improve mortality and
morbidity for the HIV-infected individuals
and slow the progression to AIDS.
Herpes viruses also cause hepatitis.
REFERENCES
Thank you