Viral Hepatitis

Thanks Dr. Waseema for providing the reference material

Physiology of Liver 

https://youtu.be/rDjWrNRKfvg

Part 1 of a simple and clear explanation of liver anatomy, its functions and liver function tests

https://youtu.be/BTGkB8nOu7g

Pathophysiology of Hepatitis A, B, C, D, E

https://www.youtube.com/watch?v=Neqvdwi5fHc&feature=youtu.be

Hepatitis Serology | A, B, C, D, E

https://www.youtube.com/watch?v=KcHCBEngG9s&feature=youtu.be

How to screen for a HCV infection early.

https://www.youtube.com/watch?v=R3S4RditWug&feature=youtu.be

Viral Hepatitis made simple- pathology, clinical features & classifications

https://youtu.be/y6XfSQ_zQgQ

MRCP Paces Station 3 - Abdominal Examination

https://www.youtube.com/watch?v=w8Jo2xdxLXo&feature=youtu.be

MEDICAL EXAMINATION PEARL 

First OBSERVE 

Then AUSCULTATE 

 Next PALPATE 

Last ... Percussion 

Why? 

So you don't disturb the movements being auscultated or shake up anything with your palpation or percussion!

Hepatitis B and C Information Guide for Healthcare Professionals

	Hepatitis B		Hepatitis C
Pakistan statistics	The prevalence of hepatitis B in Pakistan is 2.5%*		The prevalence of hepatitis C in Pakistan is 4.8%*
Routes of transmission	Contact with infectious blood, semen, and other body fluids, primarily through: • Birth to an infected mother • Sexual contact with an infected person • Sharing of contaminated needles, syringes or other injection drug equipment • Needle sticks or other sharp instrument injuries		Contact with blood of an infected person, primarily through: •Sharing of contaminated needles, syringes, or other injection drug equipment Less commonly through: • Sexual contact with an infected person • Birth to an infected mother • Needle stick or other sharp instrument injuries
Persons at risk	• Infants born to infected mothers • Sex partners of infected persons • Persons with multiple sex partners • Persons with a sexually transmitted disease (STD) • Men who have sex with men • Injection drug users • Household contacts of infected persons •Healthcare and public safety workers exposed to blood on the job • Haemodialysis patients •Residents and staff of facilities for developmentally disabled persons •Travelers to regions with intermediate or high rates of Hepatitis B (HBsAg prevalence of ≥2%)		• Current or former injection drug users •Recipients of clotting factor concentrates before 1987 •Recipients of blood transfusions or donated organs before July 1992 •Long-term haemodialysis patients • Persons with known exposures to HCV (e.g., healthcare workers after needle sticks, recipients of blood or organs from a donor who later tested positive for HCV) • HIV-infected persons • Infants born to infected mothers
Life span of the virus outside the body	7 days		16 hours but no longer than 4 days
Incubation period	45 to 160 days (average: 120 days)		14 to 180 days (average: 45 days)
Symptoms of acute infection	Symptoms of all types of viral hepatitis are similar and can include one or more of the following: • Fever • Fatigue • Loss of appetite • Nausea • Vomiting • Abdominal pain • Gray-coloured bowel movements • Joint pain • Jaundice
Likelihood of Symptomatic Acute   infection	• < 1% of infants < 1 year develop symptoms • 5%–15% of children age 1-5 years develop symptoms • 30%–50% of persons > 5 years develop symptoms Note: Symptoms appear in 5%–15% of newly infected adults who are immunosuppressed	• 20%–30% of newly infected persons develop symptoms of acute disease
Potential for Chronic Infection	• Among unimmunized persons, chronic infection occurs in >90% of infants, 25%–50% of children aged 1–5 years, and 6%–10% of older children and adults	• 75%–85% of newly infected persons develop chronic infection • 15%–25% of newly infected persons clear the virus
Severity	• Most persons with acute disease recover with no lasting liver damage; acute illness is rarely fatal    • 15%–25% of chronically infected persons develop chronic liver disease, including cirrhosis, liver failure, or liver cancer   • Estimated 3,000 persons in the United States    die from HBV-related illness per year	• Acute illness is uncommon. Those who do develop acute illness recover with no lasting liver damage    • 60%–70% of chronically infected persons develop chronic liver disease    • 5%–20% develop cirrhosis over a period of 20–30 years    • 1%–5% will die from cirrhosis or liver cancer    • Estimated 12,000 persons in the United States die from HCV-related illness per year
Serologic Tests for Acute Infection	• HBsAg in acute and chronic infection • IgM anti-HBc is positive in acute infection only	• No serologic marker for acute infection
Serologic Tests for Chronic Infection	• HBsAg (and additional markers as needed)	• Screening assay (EIA or CIA) for anti-HCV • Verification by an additional, more specific assay (e.g., nucleic acid testing for HCV RNA)
General measures to reduce the risk of occupational	Testing is recommended for: •All pregnant women • Persons born in regions with intermediate or high rates of Hepatitis B (HBsAg prevalence of ≥2%) •U.S.–born persons not vaccinated as infants whose parents were born in regions with high rates of Hepatitis B (HBsAg prevalence of ≥8%) •Infants born to HBsAg-positive mothers •Household, needle-sharing, or sex contacts of HBsAg-positive persons •Men who have sex with men •Injection drug users •Patients with elevated liver enzymes (ALT/AST) of unknown etiology •Hemodialysis patients •Persons needing immunosuppressive or cytotoxic therapy •HIV-infected persons •Donors of blood, plasma, organs, tissues, or semen	Testing is recommended for: •Persons born from 1945–1965 •Persons who currently inject drugs or who have injected drugs in the past, even if once or many years ago •Recipients of clotting factor concentrates before 1987 • Recipients of blood transfusions or donated organs before July 1992 •Long-term Hemodialysis patients •Persons with known exposures to HCV (e.g., healthcare workers after needle sticks, recipients of blood or organs from a donor who later tested positive for HCV) •HIV-infected persons •Children born to infected mothers (do not test before age 18 mos.) •Patients with signs or symptoms of liver disease (e.g., abnormal liver enzyme tests) •Donors of blood, plasma, organs, tissues, or semen
Treatment	•Acute: No medication available; best addressed through supportive treatment    • Chronic: Regular monitoring for signs of liver disease progression; some patients are treated with antiviral drugs	• Acute: Antiviral and supportive treatment    •Chronic: Regular monitoring for signs of  liver disease progression; some patients are treated with antiviral drugs
General measures to reduce the risk of occupational exposure	·        Wash hands before and after contact with each patient, and before putting on and after removing gloves ·        Wear gloves where contact with blood can occur, when cleaning equipment prior to sterilisation or disinfection, when handling chemical disinfectant and when cleaning up spillages; change gloves between patients ·        Cover existing wounds, skin lesions and all breaks in exposed skin with waterproof dressings ·        Exercise particular care in handling and disposal of Sharps; place all disposable sharps in sharps containers immediately after use; provide sharps containers in adequate numbers and never overfill. ·        Avoid resheathing needles manually. ·        Specimens from patients with known or suspected BBV infection should be conspicuously labelled or marked "danger of infection" ·        Avoid wearing open footwear in situations where blood may be spilt, or where sharp instruments or needles are handled ·        Clear up spillage of blood promptly and disinfect surfaces ·        Collect and seal all disposable items contaminated with a Hep B or C patient and send for incineration. ·        Seal all non-disposable items in a bag, mark Hep B or C and send for sterilization. Double bag it. ·        Follow safe procedures for disposal of contaminated waste and soiled dressings/beddings
Advice to be given to infected patients	·        Inform the people you live with and/or have sex with about your illness as soon as possible. ·        Do not donate blood or blood products, organs, semen, or eggs (ova). ·        Do not share your personal toiletry articles, such as razors, toothbrushes, towels that may contain trace of blood, with anyone else. ·        Cover all cuts, etc., with dressing. Do not allow others to touch your wounds without gloves on. ·        Clean any soiled cloth, toilet seats, countertops, floors, and other surfaces that have your blood or any other body fluid (semen and vaginal fluids, including menstrual blood) on them with a solution that is 1 part bleach to 10 parts water. Dispose off any blood soiled cloth by burning. ·        It does not spread through hugging, kissing, sharing utensils/glasses/food/ drinks ,sneezing, coughing, sharing a house, using same toilet seat, breastfeeding a baby (unless nipples are cracked or bleeding). ·        During home deliveries, insist the Dai to wear gloves. And body tissues and soiled cloth should be burnt. ·        Child born to an infected mother should be screened and then vaccinated. ·        In the event of exposure to the body secretions of an infected patient by sharps, squeeze out the blood and secretions and wash   generously under tap water and apply antiseptic solution.

References:

·        *Hepatitis B and hepatitis C in Pakistan: Prevalence and risk factors Syed Asad Ali a,Rafe M.J. Donahue b, Huma Qureshi c, Sten H. Vermund a ,International Journal of Infectious Diseases (2009) 13, 9—19 ,

·        CDC 

·        WHO

·        Webmd

·        UK Health Departments Guidance for Clinical Health Care Workers