Hepatitis: Types A, B, C, D & G | Clinical Features, Diagnostic Assessment, Prevention & Treatment

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The inflammation of the lever in human body is known as Hepatitis. Alcoholic substances, various kinds of drugs and certain medical conditions are the main causes of hepatitis. There are many kinds of hepatitis as per the effects on human health some do not cause serious problem while other is chronic types of hepatitis discussion below:

Hepatitis A

Hepatitis A is caused by an RNA virus of the genus Enterovirus. This form of the hepatitis is transmitted primarily through the faecal-oral route, by the ingestion of food or liquids infected by the virus. The virus is found in the stool of infected person before the onset of symptoms and during the first few days of illness. The incubation period is estimated to be 2-6weeks, with a mean pf approximately 4 weeks. The course of illness may last 4-8 weeks. The virus is present only briefly in the serum; by the time jaundice appears, the person is likely to be non-infectious. A person who is immune to hepatitis A may contact other forms of hepatitis. Recovery from hepatitis A is usual; it rarely progresses to acute liver necrosis and fulminant hepatitis.

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Clinical features

  • Many patients are anicteric (without jaundice) and symptomless
  • The appearing symptoms are of a mild, flu-like, respiratory infection with low-grade fever.
  • Anorexia is seen as early symptom and is present in severe form.
  • Later jaundice and dark urine may be apparent.
  • Indigestion is present in varying degrees.
  • Liver enlargement and splenomegaly are seen for few days after the onset.
  • Patient may have an aversion to cigarette smoke and strong odours; symptoms tend to clear when jaundice reaches its peak.
  • Symptoms may be mild in children; in adults they may be more severe as the course of disease prolonged.

Diagnostic assessment

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  • Stool analysis for hepatitis A antigen
  • Serum hepatitis A virus antibodies; immunoglobulin

Prevention

  • Hand-wash, safe water supply, proper control of sewage disposal
  • Hepatitis vaccine
  • Administration of immune globulin, if not previously vaccinated, to prevent hepatitis A if given within 2 weeks of exposure
  • Immune globulin is recommended for person who is in sexual contact with people with hepatitis A
  • Pre-exposure prophylaxis is recommended for those travelling to developing countries or settings with poor or uncertain sanitation conditions who do not have enough time to acquire protection by administration of hepatitis A vaccine.

Treatment

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  • Bed rest during the acute stage; encourage a nutritious diet.
  • Give small, frequent feedings supplemented by IV glucose if necessary during periods of Anorexia.
  • Promote gradual but progressive ambulation to hasten recovery. Patient is usually managed at home unless symptoms are severe.
  • Nutritional diet, bed rest, follow-up, blood work, avoidance of alcohol and sanitation are key to managing and to prevent spread  of disease to family members.

Hepatitis B

Hepatitis B virus (HBV) is a DNA virus transmitted primarily through blood. The virus has been found in body fluid secretions such as saliva, semen, and vaginal secretions and can be transmitted through mucous membrane and breaks in skin. Hepatitis B has a long Incubation period 1-6 months. It replicates in the liver and remains in the serum for long periods, allowing transmission of virus. Those at risk include all health care workers, patients in  haemodialysis and oncology units, sexually active homosexual and bisexual men, and IV drug users. About 10% of patients progress to a carrier state or develop chronic hepatitis. Hepatitis B remains a major worldwide cause of cirrhosis and hepatocellular carcinoma.

Clinical features

  • Symptoms may be insidious and variable; subclinical episodes frequently occur, fever, and respiratory symptoms are rare; some may have arthralgia and rashes.
  • Loss of appetite, dyspepsia, abdominal pain, general aching, malaise and weakness may occur.
  • Jaundice may or may not be evident. With jaundice there are light-coloured stools and dark urine.
  • Liver may be tender and enlarged; spleen is enlarged and palpable in a few patients.
  • Posterior cervical lymph nodes may also be enlarged.

Diagnostic tests

Hepatitis B surface antigen appears in blood up to 90% of patients. Additional antigens help to confirm diagnosis.

Preventive measures

  • Screening of blood donors
  • Good personal hygiene
  • Education
  • Hepatitis B vaccine

Treatment

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  • Alpha-interferon has shown promising results.
  • Lamivudine (epivir) and  adefovir (hepsera).
  • Bed rest and restriction of activities until hepatic enlargement and elevation of serum bilirubin and liver enzymes have disappeared.
  • Maintain adequate nutrition; restrict proteins when the ability of the liver to metabolize protein by-products is impaired.
  • Administer antacids and anti-emetics for dyspepsia and general malaise; avoid all medications of the patients is vomiting.
  • Provide hospitalization and fluid therapy if vomiting persists.

Hepatitis C

A significant portion of cases of viral hepatitis are not A,B, or D; they are classified as hepatitis C. It is the primary form of hepatitis associated with parenteral means (sharing contaminated needles, needle sticks or injuries to health care workers, blood transfusions) or sexual contact. The incubation period is variable and may from 15 to 160 days. The clinical course of hepatitis C is similar to that of hepatitis B; symptoms are usually mild. A chronic carrier state occurs frequently. High possibility  for cirrhosis and liver cancer after hepatitis C. A combination therapy using ribavirin (Rebetol) and interferon (intron-A) is effective for treating patients with hepatitis C and in treating relapses.

Hepatitis D

Hepatitis D (delta agent) occurs in some cases of hepatitis B. Because the virus requires hepatitis B surface antigen for its replication, only patients with hepatitis B are at risk. It is common in IV drug users, haemodialysis patients, and recipients of multiple blood transfusions. Sexual contact is an important mode of transmission of hepatitis B and D. Incubation period varies between 30 to 150 days. The symptoms are similar to those of hepatitis B except that patients are more likely to have fulminant hepatitis and progress to chronic active hepatitis and cirrhosis.  Even the treatment is similar to that for other forms of hepatitis.

Hepatitis E

The hepatitis E virus is transmitted by the faecal-oral route, principally through contaminated water and poor sanitation. Incubation is variable and is estimated to range between 15 and 65 days. Generally, hepatitis E resembles hepatitis A. It has a self-limited course with an abrupt onset. Jaundice is almost always present. Chronic forms do not develop. The major method of prevention is avoiding contact with the virus through hygiene (mostly hand wash). The effectiveness of immune globulin in protecting against hepatitis E virus is uncertain.

Hepatitis G

Hepatitis G (the latest form) is a post transfusion hepatitis with an incubation period of 14 to 145 days. Autoantibodies are absent. The risk factors are similar to those for hepatitis C.

 

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