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Hepatitis

Definition
  • Hepatitis: Inflammation of the liver, which can be caused by various agents.
Types of Viral Hepatitis
  • Hepatitis A (HAV) – primarily spread through faecal-oral route.
  • Hepatitis B (HBV) – transmitted through blood and bodily fluids.
  • Hepatitis C (HCV) – primarily bloodborne transmission.
  • Hepatitis D (HDV) – requires HBV for replication; co-infection or superinfection with HBV.
  • Hepatitis E (HEV) – primarily spread through faecal-oral route, similar to HAV.
Non-Viral Causes of Hepatitis
  • Alcoholic hepatitis: Due to excessive alcohol consumption.
  • Drug-induced hepatitis: Certain medications (e.g., paracetamol overdose, isoniazid).
  • Autoimmune hepatitis: Immune system attacks liver cells.
  • Non-alcoholic fatty liver disease (NAFLD): Fat accumulation in liver cells.
  • Toxic hepatitis: Caused by chemicals or toxins.
Clinical Features
  • Jaundice (yellowing of skin and eyes).
  • Fatigue.
  • Abdominal pain.
  • Nausea and vomiting.
  • Dark urine.
  • Pale stools.
  • Joint pain.
Investigations
  • Liver function tests (LFTs): Elevated liver enzymes (ALT, AST) indicate liver inflammation.
  • Serology tests: Detect specific viral hepatitis antibodies and antigens.
  • PCR: Detects and quantifies viral RNA/DNA.
  • Liver biopsy: In certain cases to assess severity.
Management
  • Supportive care: Rest, hydration, and nutrition.
  • Antivirals: For HBV (e.g., entecavir, tenofovir) and HCV (e.g., sofosbuvir).
  • Vaccinations available for HAV and HBV.
  • Avoid alcohol if alcohol-related or drug-related.
  • Immunosuppressants for autoimmune hepatitis.
Complications
  • Chronic hepatitis: Persistent inflammation can lead to cirrhosis and liver cancer.
  • Fulminant hepatitis: Severe, rapid deterioration of liver function.
  • Extrahepatic manifestations: Including arthralgia, vasculitis, and glomerulonephritis.
Prevention
  • Vaccination against HAV and HBV.
  • Safe practices: Hand hygiene, safe food and water, safe sex, no sharing of needles, limited alcohol intake, regular monitoring of medications affecting the liver.
  • Screen blood donors.

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