K.14 Hepatitis Virus - Pemeriksaan diagnostik dan Penatalaksanaan (Suwandhi Widjaja) - Dept. Ilmu Penyakit Dalam.pdf

To Study Medicine Is A Long Life Study Because It Always Has New Discoveries Viral Hepatitis - Historical Perspective “Infectious” A Enterically E transmitted Viral hepatitis NANB...

To Study Medicine Is A Long Life Study Because It Always Has New Discoveries Viral Hepatitis - Historical Perspective “Infectious” A Enterically E transmitted Viral hepatitis NANB Parenterally “Serum” B D C transmitted F, G, TTV ? other  Incubation Incubation periods for: Hepatitis A range from 15 to 45 days (mean 4 weeks). Hepatitis B and D from 30 to 180 days (mean 4 to 12 weeks) Hepatitis C from 15 to 160 days (mean 7 weeks) Hepatitis E from 14 to 60 days (mean 5 to 6 weeks).  Prodromal symptoms Acute viral hepatitis are systemic and quite variable. Constitutional symptoms of anorexia, nausea and vomiting, fatigue, malaise, arthralgias, myalgias, headache, photophobia, pharyngitis, cough, and coryza may precede the onset of jaundice by 1 to 2 weeks. The nausea, vomiting, and anorexia are frequently associated with alterations in olfaction and taste. A low-grade fever between 38 and 39°C (100 to 102°F) is more often present in hepatitis A and E than in hepatitis B or C. Dark urine and clay-colored stools may be noticed by the patient from 1 to 5 days prior to the onset of clinical jaundice.  Clinical jaundice prodromal symptoms usually diminish, but in some patients mild weight loss (2.5 to 5 kg) is common and may continue during the entire icteric phase. The liver becomes enlarged and tender and may be associated with right upper quadrant pain and discomfort. Splenomegaly and cervical adenopathy are present in 10 to 20 percent of patients with acute hepatitis.  Variation of clinical manifestation Un-icteric type.[ in children] Icteric type[common type]. Cholestatic type. Fulminant type.  Fulminant Hepatitis Severe prodromal symptoms. Sign of liver failure: = dysorientation/somnolent/comatous. = bleeding tendency. = edema. = jaundice. = fetor hepatic/flapping tremor.  Recovery phase Constitutional symptoms disappear, but usually some liver enlargement and abnormalities in liver biochemical tests are still evident. The duration of the post-icteric phase is variable, ranging from 2 to 12 weeks, and usually is more prolonged in acute hepatitis B and C. Complete clinical and biochemical recovery is to be expected 1 to 2 months after all cases of hepatitis A and E. 3 to 4 months after the onset of jaundice in three-quarters of uncomplicated cases of hepatitis B and C. A substantial proportion of patients with viral hepatitis never become jaundice.  Out come of Hepatitis Virus infection Recovery[ HA(>95%), HE(>90%), HB(95% in adult, 5-10% in infant/children) and HC( 10- 25%). Chronic Hepatitis( HB and HC). Fulminant Hepatitis.(HA, HB and HE).  Hepatitis A Paling sering, terutama pada negara berkembang. Picorna virus[hepaRNAvirus] Acid stable Dry resistant[ for several weeks] Virus Hepatitis A [gambaran elektron mikroskop]  Hepatitis A Virus Transmission Close personal contact (e.g., household contact, sex contact, child day care centers) Contaminated food, water (e.g., infected food handlers, raw shellfish) Blood exposure (rare) (e.g., injecting drug use, transfusion)  Geographic Distribution of HAV Infection Anti-HAV Prevalence High Intermediate Low Very Low  Route of infection 1. Acquisation HAV : via oral-fecal route. 2. Passage of acid resistant through stomach. 3. Replication of the virus. 4. Transport to the liver and replication. 5. Shedding of virus from infected licer cells in the bile---excretion---feces.  Hepatitis A - Clinical Features Incubation period: Average 30 days Range 15-50 days Jaundice by