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HEPATITIS - VIRAL
The majority of acute viral hepatitis infections are asymptomatic or they can cause an anicteric illness that may not be diagnosed as hepatitis.
Hepatitis A generally causes minor illness in childhood with >80% of infections being asymptomatic but more likely to produce clinical symptoms in adults. 
Hepatitis B, C, and D may also be asymptomatic.
Hepatitis A is predominantly transmitted through oral-fecal route.
Hepatitis B is transmitted through perinatal, percutaneous, or sexual routes or close person-to-person contact via open cuts and sores.
Hepatitis C infections are transmitted through perinatal, percutaneous, or sexual routes, blood transfusions, or organ transplants.
Hepatitis D's route of transmission is sexual or percutaneous, especially IV drug use.
Hepatitis E is transmitted primarily through contaminated drinking water and oral-fecal transmission.

Introduction

  • A self-limiting disease that is usually caused by viruses. As it progresses, it causes fibrosis (scarring), cirrhosis and cancer of the liver

Signs and Symptoms

  • The majority of acute viral hepatitis infections are asymptomatic or they can cause an anicteric illness that may not be diagnosed as hepatitis
  • Hepatitis A generally causes minor illness in childhood with >80% of infections being asymptomatic
    • Adults are more likely to produce clinical symptoms
  • Hepatitis B, C and D may also be asymptomatic
  • Symptomatic hepatitis B will depend on the mode and time of transmission
    • Vertical transmission from mother to child is almost always asymptomatic
    • Other routes of transmission are more likely to produce symptomatic disease (30% of cases transmitted by IV drug use are icteric)
Preicteric Phase
  • Nonspecific systemic symptoms (eg myalgia, nausea, vomiting, fatigue, malaise with discomfort in the right upper quadrant of the abdomen)
  • Altered sense of smell or taste, coryza, photophobia, headache, cough, diarrhea, dark urine and serum sickness-like syndrome
  • Hepatomegaly, splenomegaly and lymphadenopathy may be seen on physical exam
Icteric Phase
  • Jaundice, usually noted after onset of fever or upon lysis of fever
Fulminant Hepatitis
  • Development of symptoms of hepatic encephalopathy (eg confusion, drowsiness within 8 weeks of symptoms or within 2 weeks of onset of jaundice)
  • Hypoglycemia, prolonged prothrombin time (PT)

Pathogenesis

Routes of Transmission of Hepatitis

Hepatitis A: Oral-fecal

Hepatitis B: Perinatal, percutaneous, sexual, close person-to-person contact ie by open cuts and sores

Hepatitis C: Blood transfusions, organ transplants, percutaneous (especially IV drug use), sexual, perinatal

Hepatitis D: Sexual, percutaneous especially IV drug use

  • Found only in patients with hepatitis B since it requires the hepatitis B outer coat

Hepatitis E: Oral-fecal, blood transfusion in endemic areas

Incubation Period

Hepatitis A: 15-50 days

Hepatitis B: 40-180 days

Hepatitis C: 20-120 days

Hepatitis D: 30-180 days

Hepatitis E: 21-60 days

Other Characteristics of Hepatitis Viruses

  • Hepatitis B virus contains a DNA nucleic acid while A, C, and E viruses have an RNA nucleic acid
    • Hepatitis D has an incomplete RNA and needs the B virus to replicate
  • Hepatitis A and E viruses cause epidemics
  • Hepatitis B, C, and D viruses may predispose to chronic disease and hepatic malignancy
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