《临床表现》PPT课件.ppt

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1、Viral HepatitisDept. of Infectious Diseases SunYat-sen University Q.F.XIE Introduction Viral hepatitis are a group of diseases, Caused by A、 B、 C、 D and E 5 hepatitis virus Hepatitis A and E Transmitted by fecal-oral route, present acute and self-limited course Hepatitis B ,C and D Spread parenteral

2、ly easily lead to chronic hepatitis Clinical characters including fatigue, intestinal symptoms tender and enlarged liver abnormal LFTs jaundice in some cases very variable in severity SignificanceHighly endemicWide clinical spectrumHigh fatality rate in severe casesNo specific pathogenic therapy ava

3、ilable nowChronic hepatitis B and C very common, some may develop to cirrhosis even HCCSuccessful vaccination for HBV and HAV Etiology-HAVHeparnavirusAppeared in bile and feces, spreaded via fecesNo chronic carrier status observedAnti-HAV antibody to HAVAnti-HAV IgM indicative of current or recent i

4、nfection appeared very early, disappear in about 3months most useful for confirm the diagnosis Anti HAV IgG current or previous infection a protective antibody, conferring immunity persist for life long time Etiology-HBV Orthohepadnavirus, Dane particle 4 open reading frame: S,C,P,X 8 genotypes A-H,

5、 B and C predominantly in China Strong ability against to environment 3 antigen and antibody system HBsAg found in serum and other body fluid not infectious itself suggesting current infection and infectivity Anti-HBs a protective antibody to HBsAg an indicator of past infection and immunity to HBV

6、reinfection suggesting non-infectious HBeAg suggesting HBV replication and high infectivity negative when pre-C mutation but with high level of replication useful for evaluation of anti-HBV therapyAnti-HBe antibody to HBeAgHBe seroconversion HBeAg(+) (-)and anti-HBe(-) (+) HBcAg existing in the core

7、 of virion a marker of replication and infectivityAnti-HBc IgM a marker of acute primary HBV infectionAnti-HBc IgG appeared in almost all HBV present and past infection host body HBVDNA the genome of HBV suggesting active virus replication and infectivity useful for diagnosis and evaluation of anti-

8、HBV therapy Hepatitis B Virus Etiology-HCV RNA virus, 6genotypes, mainly 1b in the country Molecular heterogeneity driven by high mutation rate usually proceed to chronic course Anti-HCV IgM and IgG types antibody to HCV suggesting HCV infection HCVRNA the genome of HCV suggesting replication and in

9、fectivity of HCV useful for the diagnosis and evaluation of antivirus treatment Etiology-HDV An incomplete RNA virus Causes hepatitis only patients with either acute(coinfection) or chronic (superinfection) hepatitis B HDVAg and anti-HDV both the markers of HDV infection HDVRNA the genome of HDV a m

10、arker of existing HDV infection suggesting virus replication and infectivity Etiology-HEVNonenveloped RNA virusAppeared in bile and feces, spreaded via fecesNo chronic carrier status observedAnti-HEV IgM and IgG both appeared in acute infection useful for the diagnosis of HEV infection HEVRNA the ge

11、nome of the virus suggesting existing of HEV infection not available for routine clinical diagnosis Epidemiology Source of infection Patients with acute or chronic viral hepatitis Carriers of hepatitis virus, particularly asymptomatic carriers Transmission Hepatitis A and E transmitted by the fecal-

12、 oral route, water-borne and food-transmitted infection in epidemics Hepatitis B transmitted parenterally mother-to-infant play a key role in China blood ,blood products and body fluid othersHepatitis C and D similar to hepatitis B intravenous drug abusers most common hepatitis C for the time being

13、Prevalence rate in China 1992 Hepatitis A anti-HAV+ 80.90% Hepatitis B HBsAg + 9.75% (2006) 7.18% Hepatitis C anti-HCV+ 3.20% Hepatitis D anti-HDV+ 1.15% Hepatitis E anti-HEV+ 17.2% Pathogenesis Hepatocellular damage produced by viral replication directly only in hepatitis D Other types of viral hep

14、atitis induced mainly by immune-mediated attack on the liver Pathology The varying lesion could be seen in entire liver, but variable in severity and in different stages of the disease No specific lesion suggesting etiologic type of hepatitis virus Clinical manifestations Wide clinical spectrum from

15、 asymptomatic form to fatal outcome such as liver failure Similar clinical course in different etiological type of viral hepatitis The clinical types viral hepatitisAcute hepatitisChronic hepatitisLiver failure (severe hepatitis)Cholestatic viral hepatitisHepatitis cirrhosisAsymptomatic virus carrie

16、r status (usually only in HBV) Incubation period Hepatitis A 2-6w 4w Hepatitis E 2-9w 6w Hepatitis B 1-6m 3m Hepatitis C 2w-6m 6w Hepatitis D 4-20w Acute hepatitis 3 phases of the icteric hepatitis Prodromal phase sudden or insidious onset, lasting 3-7d constitutional symptom: malaise, fatigue, mild

17、 fever some time, dark urine gastrointestinal symptoms: anorexia, nausea, vomiting serum ALT level rise deeply Jaundice phase jaundice appeared and peak level often in 2 weeks after the onset other symptoms subside after jaundice tender liver palpable serum bilirubin elevated lasting for 26 weeks Co

18、nvalescent phase symptoms and jaundice gradual resolution liver return to normal size serum ALT and bilirubin decreased 1 to 2 months neededAnicteric acute viral hepatitis more common, mild manifastation Chronic hepatitis Seen only in hepatitis B,C and D, virus infection over 6 months Severity varia

19、ble, 3 subtypes: mild, typical and advanced Common manifestations: malaise, fatigue, poor appetite, nausea, distension of abdomen Jaundice seen in some cases Enlargement of liver and/or spleen Spider naevi, hepatic palms in cases with long history Abnormal LFTs: transaminase, bilirubin A/GPrognosis

20、different: stable, breakthrough or flare, develop to Cir or Ca Liver failure (severe hepatitis) Bad prognosis Pathological basis: extensive necrosis of hepatic cells 4 subtypes: acute liver failure, subacute, acute-on-chronic, chronic Clinical syndrome including: jaundice deepen rapidly liver size b

21、ecome smaller bleeding, prolonged prothrombin time, PTA less than 40% cerebral edema, high intracranial pressure complicated infection: SBP hepatic encephalopathy toxic abdominal distension and ascites hepatic-renal syndrome Cholestatic viral hepatitis acute and chronic mild manifestation but deepen

22、 jaundiceHepatitis cirrhosis hepatic fibrosis compensated cirrhosis decompensated cirrhosis Asymptomatic HBV carrier HBV infection more than 6 months have no symptoms and signs normal LFTs 70%-80%have no pathologic change in liver biopsy DiagnosisClinical DataEpidemiological evidencesLaboratory inve

23、stigationsUltrasoundBiopsy Differential diagnosisJaundice caused by other etiological agentsHepatitis caused by other etiological agents TreatmentBasic principles of management guideline for daily living, physical activity , food and drink intake of the patients supportive and symptomatic treatment

24、Hepatic function protective agentsAnti-virus therapy most important treatment for chronic hepatitis B、 acute and chronic hepatitis C hepatitis B indication: HBVDNA 10 5copies/ml for HBeAg, HBVDNA 104copies/ml for HBeAg+; ALT 2ULN, or biopsy G2S2 Drugs: interferon-(typical or pegylated) or, nucleotid

25、e analogues:3TC,adfovir, entecavir,Ldt Hepatitis C indication: HCVRNA+ drugs: interferon-(typical or pegylated) +ribavirin Traditional Chinese medicineManagement for liver failure basic supportive therapy treatment of complications bleeding infection complications encephalopathy renal failure Hepati

26、c transplantationManagement of asymptomatic HBV carrier medical check up periodically no any alcohol intake liver biopsy when patients age more than 40 years and HBV replication in high level PreventionImprovement of sanitationBlood screening of donorsAnti-virus treatment for hepatitis B and hepatitis C Immunoprophylaxis active immunization vaccines for hepatitis A and B are available around world, very successful for pre-exposure prevention passive immunization IG for hepatitis A, HBIG for hepatitis B; post-exposure Thanks !