hepatitis diagnosis in clinical chemistry.pptx

DODOMA REGIONAL REFERRAL
HOSPITAL
Department; clinical chemistry
Topic; Hepatitis
Presenter-A. richard
Committed To Learn (COmItLe) consultancy

 INTRODUCTION
 VIRAL HEPATITIS
 HEPATITIS A
 HEPATITIS B
 HEPATITIS C
 HEPATITIS D
 HEPATITIS E
 PATHOPHYSIOLOGY
Presentation outline

Hepatitis is a broad term that means inflammation of liver.
It is most commonly caused by viruses but also can be caused by
drugs(alcohol), chemicals, autoimmune diseases and abnormalities.
Introduction..

Infection with Hepatotropic viruses [HAV, HBV, HCV, HDV, HEV].
Hepatitis A is always an acute, short-term disease, while hepatitis B, C, and
D are most likely to become ongoing and chronic.
Hepatitis E is usually acute but can be particularly dangerous in pregnant
women.
Five types of hepatitis have been identified: Hepatitis A, B, C, D , E.
The hepatitis A and E viruses typically cause only acute, or short-term,
infections.
Other less common viruses can also cause liver disease. These include
Cytomegalovirus(CMV), Herpes virus, Rubella virus, Epstein-barr
virus(EBV).
Viral hepatitis

A highly contagious liver infection caused by the hepatitis A
virus(HAV).
Hepatitis A virus is a ribonucleic acid(RNA) virus of the
enterovirus family.
It can cause acute hepatitis with jaundice. Also cause acute
liver failure. It does not cause long term infection.
Incubation period is 3-5 weeks with an average of 28 days.
1.Hepatitis A

It is transmitted primarily through the fecal-oral route.
Source of infection is Crowded conditions, poor personal hygiene,
Poor sanitation, Contaminated food, water, shellfish, infected food
handlers.
More prevalent in underdeveloped countries. People who travel to
developing countries more likely to get Hep A.
Hepatitis A cont.…

Symptoms for hepatitis A infection;
Fatigue
Fever
Abdominal pain
Nausea
Jaundice
Weight loss
Itching
Sharp pain in right upper quadrant of abdomen
Hepatitis A cont..

Hepatitis A cont..
 Laboratory diagnosis;
Blood tests: 2 kinds of antibodies to the virus
IgM antibodies and IgG antibodies.
 IgM antibodies show acute infection
 IgG antibodies show previous infection or
immunization(vaccination).

Treatment and management;
There are no drug therapies for the treatment of acute hepatitis A.
The disease usually recovers itself and does not develop to
chronic stages
Small, frequent feedings of a high calorie, low fat diet, proteins are
required.
Hepatitis A cont..

 It is an infection which is caused by the Hepatitis B virus (HBV)
which is a small partially double stranded circular
Deoxyribonucleic acid (DNA) virus that belongs to the family
Hepadnaviridae.
 Hepatitis B virus can cause acute and chronic infection.
 Acute hepatitis B infection may last up to 6 months (with or without
symptom) and infected persons are able to pass these virus during
these time.
 Chronic hepatitis B is defined as persistence of HBsAg for 6
months or more after acute infection with HBV.
2.Hepatitis B

 Incubation period is 2-5 months.
 Hepatitis B virus is a complex structure with 3 distinct antigens:
 HBcAg- Hepatitis B core antigen.
 HBsAg- Hepatitis B surface antigen.
 HBeAg- An independent protein circulating in the blood.
Hepatitis B cont..

Mode of transmission is mainly sexual contact. Recognized as STD.
It is much more infectious than HIV
Further mode of transmission are Parenteral or exposure to blood or
blood products, perinatal transmission.
Occurrence is for all ages, but mostly affects young adults
worldwide and serious public health problem globally with over 240
million people being affected and causing 650,000 deaths annually.
It is the main cause of cirrhosis and hepatocellular carcinoma
worldwide.
Hepatitis B cont..

 Symptoms;
 Abdominal pain
 Dark urine
 Fever
 Joint pain
 Loss of appetite
 Nausea/ vomiting
 Fatigue
 Jaundice
Hepatitis B cont..

Laboratory diagnosis;
Urobilinogen, Total serum bilirubin, liver transaminase(ALT and
AST), direct and indirect bilirubin levels in blood.
Serological tests: HBsAg, Anti-HBs, HBeAg, Anti-Hbe, Anti-
HBe IgM, Anti- Hbe IgG,
HBV genotyping (sequencing).
Liver ultrasound: Transient elastography can show the amount
of liver damage
Liver biopsy.
Hepatitis B cont..

Management and treatment
Treatment of acute hepatitis B is indicated only in patients with
severe hepatitis and liver failure
Treatment of chronic hepatitis B :
Nucleoside and Nucleotide analog such as Tenofovir, adenofovir,
lamivudine.
Liver transplant.
The vaccine for hepatitis B introduces the HBsAg in the body
and the body responds by producing antibodies Anti-HBs mainly
the IgG type as memory cells which prevents the body any
coming infection.
Hepatitis B cont..

Infection due to hepatitis C virus (HCV) virus is an RNA virus
Incubation period is 14-180 days(average 56).
In most cases it is transmitted through blood or contaminated or
unsterile needles.
It is found in I.V. drug users and renal dialysis patients.
It can result in both acute and chronic illness.
Chronic HCV infection results in liver cirrhosis.
3.Hepatitis C

 Symptoms
 Jaundice (yellow discoloration of the skin and eyes)
 Easy bruising and bleeding
 Dark-colored urine, light-colored stools
 Fatigue
 Abdominal pain
 Loss of appetite
 Nausea
 Diarrhea
 Fever
Hepatitis C cont..

 Laboratory diagnosis of hepatitis C involves 3 general categories
of tests:
 Screening: Screening for hepatitis C virus (HCV) is done with a
serologic test for the HCV antibody (Ab).
 Confirmatory: Diagnosis of chronic hepatitis C requires the
presence of HCV RNA,
 Genotype: Once it is determined that HCV RNA is present, the
specific genotype and subtype of the virus can be determined with
a genotype test.
Hepatitis C cont..

 Treatment and management
 In a patient with acute hepatitis C , treatment with Pegylated
interferon within the 12-24 weeks of infection reduce the
development of chronic hepatitis C.
 Chronic HCV: Pegylated interferon, Ribavirin Rebetol,
Protease inhibitors such as incivek and Boceprevir
 There is no Vaccine for HCV.
Hepatitis C cont..

 HDV is a defective single – stranded RNA virus that can not survive on
its own. It requires hepatitis B to replicate. Also called the Delta virus
 Incubation period is 2-26 weeks.
 Chronic carriers of HBV always at risk for transmission. Source of
infection are same as HBV.
 HDV infection is only possible if a person is already infected with
hepatitis B or a person can be infected with both viruses at the same
time.
4.Hepatitis D

 Laboratory diagnosis;
 The diagnosis of hepatitis D is made by the detection of HDV
RNA in circulation, with RT-PCR.
 HDV infection is diagnosed by high levels of anti-HDV
immunoglobulin G (IgG) and immunoglobulin M (IgM), and
confirmed by detection of HDV RNA in serum.
 The management of hepatitis B will also manage Hepatitis D
since it occurs as co-infection or super infection.
Hepatitis D cont..

 Hepatitis E virus(HEV) is an RNA virus and incubation
period is 15-64 days.
 HEV has a fecal-oral transmission route.
 Source of infection is contaminated water, poor sanitation. Found
in Asia, Africa and Mexico.
 More common in adults and severe in pregnant women.
 Hepatitis E usually resolves on its own within four to six weeks.
Treatment focuses on supportive care, rehydration and rest.
5.Hepatitis E

 Laboratory diagnosis of hepatitis E virus (HEV);
 Detection of specific anti-HEV immunoglobulin M (IgM)
antibodies to the virus in a person’s blood.
 Antibody detection by ELISA & Western Blotting Assay.
 Detection of HEV RNA by PCR2.
 If IgM anti-HEV is positive, then the person is likely to have a
recent or current HEV infection. If IgM anti-HEV is negative, then
there is no evidence of recent HEV infection3.
 There is no specific treatment capable of altering the course of
acute hepatitis E. As the disease is usually self-
limiting,
Hepatitis E cont..

 HBV integrates itself into the host's DNA and uses the host's
replication machinery to replicate.
 The pathogenesis and clinical manifestations are due to the
interactions of the HBV and the host's immune system.
 HBV does not directly kill liver cells but as it replicates inside liver
cells, it triggers the host's cellular immune system to recognize it.
 In fact, it is the host's immune system that causes liver injury.
 The host's immune system recognizes HBcAg and HBsAg as
foreign antigens and react by inducing the antigen-specific T
lymphocyte response.
Pathophysiology

 These antigen-specific T lymphocytes mature, proliferate, and
migrate to the liver where HBV resides.
 The CD8+ T lymphocytes causes down-regulation of viral
replication within the host's cells by direct lysing of infected liver
cells (cytotoxic killing) and eventually cell apoptosis which lead
to liver damage.
Pathophysiology

 Hepatocytes that undergo cell apoptosis are sometimes referred as
councilman bodies
Pathophysiology

 Self protection to any hepatitis infection
 Screening
 Vaccination
 Create and increase awareness to the society
Key points to note

1. Tanzania National Strategic Plan for Control of Viral Hepatitis 2
018/19-2022/23 | Coalition for Global Hepatitis Elimination
2. Kilonzo, Gunda, Mpondo, Bakshi, & Jak, 2018). ...
3. CDC current data for hepatitis .
References

hepatitis diagnosis in clinical chemistry.pptx

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