Viral Hepatitis Overview

Hepatology Overview

• Hepatology is the study of the liver.
• Viral hepatitis is a liver infection causing inflammation and damage.

Viral Hepatitis - Clinical Features

• Acute Viral Hepatitis:

  • Symptoms (within 6 months): Nausea, vomiting, right upper quadrant pain, elevated bilirubin (jaundice, dark urine, clay-colored stools), hepatomegaly (enlarged liver).
  • Non-specific initial symptoms: Headache, myalgia, arthralgia. Nausea and anorexia often precede jaundice. Vomiting and diarrhea may occur. Abdominal discomfort is common. Dark urine and pale stools may come before jaundice. Symptoms typically last 3-6 weeks.
  • Liver signs: tender and minimally enlarged liver; occasionally, mild splenomegaly; cervical lymphadenopathy; jaundice may be mild.

• Chronic Viral Hepatitis:

  • Symptoms (over 6 months): Sometimes asymptomatic, fever, fatigue, loss of appetite, extrahepatic symptoms (arthralgias, skin rashes).

Viral Hepatitis - Features

• Spread:
  • HAV: fecal-oral.
  • HBV: blood/blood products, sexual contact; vertical transmission; saliva.
  • HCV: blood/blood products, sexual contact; vertical transmission; rare saliva.
  • HDV: blood/blood products, sexual contact; vertical transmission; rare saliva.
  • HEV: fecal-oral.

Viral Hepatitis - Diagnosis

• Viral markers:

  • HAV: antibodies to HAV, IgM and IgG
  • HCV: HCV antibodies, HCV RNA (quantitative PCR)
  • HBV: HBsAg, HBV DNA

• Liver enzymes, liver function tests

• PCR

• Abdominal ultrasonography

• Liver biopsy

• Diagnosis Features:

• Moderate ALT and AST elevations

• Slightly elevated alkaline phosphatase

• Serum bilirubin is often normal.

• Liver biopsy may be needed for active treatment consideration

Viral Hepatitis - Treatment

• Acute HAV: Rest, a balanced diet, adequate fluids, avoid medications harming the liver (e.g., acetaminophen), corticosteroids are not beneficial; hospital admission is usually unnecessary. Immune serum globulin may be used during outbreaks to prevent secondary spread in institutions. Vaccination is important for those traveling to endemic areas.
• Chronic HBV: Prevention and prophylaxis; Prevention depends on avoiding shared needles, avoid contact with infected body fluids. Passive and active immunizations. Interferon sometimes used in acute cases to prevent chronic disease. Needle-stick injuries must be treated promptly.
• Chronic HCV: Combined pegylated interferon + ribavirin for 48 weeks (older approach). Newer drugs (Sovaldi, Harvoni, Olysio) have better outcomes.

Viral Hepatitis - Vaccination

• High-risk groups for HBV: healthcare personnel, emergency and rescue teams; patients on hemodialysis; homosexual individuals and prostitutes; intravenous drug users.
• Antiviral medications (Interferon, lamivudine).

Dental Management of Hepatic Patients

• Liver disorders and bleeding tendencies are important for dentists.
• Consult the patient's physician before using medications in patients with liver disease.
• Hepatic impairment can lead to drug metabolism failure and toxicity.
• Dose reduction may be needed, and some drugs should be avoided.
• Antifungal drug (miconazole) is contraindicated in hepatic impairment.
• Fluconazole needs dose reduction.
• Avoid erythromycin, metronidazole, tetracyclines, and non-steroidal anti-inflammatory drugs (NSAIDs).
• Reduce paracetamol dose as it's hepatotoxic.
• Avoid general anesthetic halothane twice within 3 months.

Explore the clinical features and aspects of viral hepatitis in this quiz. It covers both acute and chronic forms, detailing symptoms, potential complications, and the impact of the disease on liver health. Test your knowledge on hepatology and the liver's role in health and disease.