Liver Disease Hepatitis (PDF)

Viral Hepa**s Viral hepa**s Viral infec+on of liver Hepa++s viruses A, B, C, D, E Most relevant ones to den+stry are Hep A, B, C. Hepa**s A Caused by the hepa++s A virus Faeco-oral route. Caught by consuming food and drink contaminated with the faeces of an infected person Most common in cou...

Viral Hepa**s Viral hepa**s Viral infec+on of liver Hepa++s viruses A, B, C, D, E Most relevant ones to den+stry are Hep A, B, C. Hepa**s A Caused by the hepa++s A virus Faeco-oral route. Caught by consuming food and drink contaminated with the faeces of an infected person Most common in countries where sanita+on is poor. Symptoms pass usually within a few months No speciGc treatment for it, other than to relieve symptoms like pain, nausea and itching. Prevented by vaccina+on before travel to high risk countries. Hepa**s B Caused by the hepa++s B virus Common infec+on worldwide Spread in the blood of an infected person. Spread from infected pregnant women to their babies Can be spread through unprotected sex, sharing needles in drug use, needles+ck injuries, sharing razors/toothbrushes 5% become chronic carriers Some develop cirrhosis and liver cancer Hepa**s B In children it can persist for years and cause signiGcant liver damage 90% infected babies develop chronic hepa++s Vaccina+on for all healthcare workers Since 2017 added to child immunisa+on list Concentra*on of hepa**s B virus in body :uids  Low/not detectable: High: Urine Blood Faeces Serum Sweat Tears Wound exudates Breast milk Moderate: Semen Vaginal fluid Saliva Transmission con*nued….. Very infec+ous - more easily spread than HIV Can live outside the human body for up to 7 days Click to add text People with chronic hepa++s B can have very large amounts of the virus in their blood Not spread by hugging, kissing, sneezing, coughing or sharing ea+ng utensils AVer needles+ck injury, seroconversion risk is 1 in 3 if not Pathogenesis Incuba*on – 45 to 180 days (average = 60 days) Virus enters hepatocytes via blood Immune response to viral an+gens expressed on hepatocyte cell surface is responsible for clinical syndrome 5% become chronic carriers (have a higher risk of hepatocellular carcinoma) Hepa++s B surface an+body probably confers lifelong immunity Symptoms of Hepa**s B  Symptoms of Hepa**s B May be asymptoma+c. If symptoms develop, they tend to happen 2 or 3 months aVer exposure to the hepa++s B virus. Flu-like symptoms, including +redness, a fever, and general aches and pains, loss of appe+te, nausea, diarrhoea, gastric pain, Jaundice. Symptoms will usually pass within 1 to 3 months (acute hepa++s B), although occasionally the infec+on can last for 6 months or more (chronic hepa++s B). Diagnosis Blood tes+ng – serological tests. Hep B an*gens used as a general marker of infec+on Hep B an*bodies - used to document recovery and/or immunity to HBV infec+on Virus persists at low levels even aVer recovery Reac+va+on can occur spontaneously, par+cularly if immune system depressed Treatment for Hepa**s B Emergency treatment following exposure to Hep B Dose of Hep B vaccination Dose of immunoglobulin Acute Hepa++s B Rest, analgesia, symptom-relief e.g. metoclopromide for nausea Chronic Hepa++s B Peginterferon alfa-2a stimulates the immune system to attack the hep B virus, given by weekly injection, flu-like side effects Anti-viral medication e.g. tenofovir or entecavir, side effects nausea, vomiting, dizziness Treatment for Hepa**s B con*n/ avoid unprotected sex partners should be vaccinated against hepa++s B avoid sharing needles avoid sharing toothbrushes or razors eat a healthy balanced diet avoid drinking alcohol Preven*on Vaccina*on – for those at increased risk of HBV infec+on 3 doses: month 0, 1, 6 Immune response: 50% after 1 dose, 95% after 3 doses Duration of protection: >15 years, dependent on initial antibody response PREVENTION ( CONT'D) Hepa++s B immunoglobulin To protect people exposed to Hep B.....most ebec+ve within 48hrs of contact. Other: Screening of blood donors, blood and body duids precau+ons Remember! Hepa++s B carries a deGnite mortality risk As health care professionals you are poten+ally at risk and should be immunised All pa+ents should be treated as poten+al carriers of the disease - universal precau+ons Always wear your PPE – saliva to eye is a poten+al route of infec+on as well as the more obvious Always avoid the chance of needles+ck injury, and always report them if they do happen Hepa**s C Single-stranded RNA virus Pathogenesis, symptoms and routes of transmission same as Hep B Occupa+onal transmission – needles+ck injury case reports of transmission from blood splash to eye. UNIVERSAL PRECAUTIONS!! No vaccine against Hep C Long term complica+ons are cirrhosis, liver failure, liver cancer Chronic hep C is treated with direct ac+ng an+-viral medica+on for 8-12 weeks e.g. ribavarin, simeprevir, sofosbuvir, some+mes combina+ons of drugs. Side ebects include nausea and insomnia Lifestyle changes – stop alcohol, healthy diet, more exercise, stop smoking, don’t share razors and toothbrushes, don’t share needles  Hepa**s D and E Hepa++s D is a delta virus Only infects people who already have Hep B Chronic infec+ons cause liver scarring, cirrhosis and cancer Spread with contact with bodily duids Seen mainly in IV drug users Vaccine available Hepa++s E is an RNA virus Transmiied by faeco-oral route Similar to Hep A No vaccine