“ Clinical experience may be define as making the same mistake with increasing confidence over an impressive number of years”
Definition
A group of systemic infections involving the liver with similar clinical manifestations and caused by different viruses with typically distinctive epidemiological pattern, A,B,C,D,E and G (See Tabular column at the end of unit for comprehensive check).
Prognosis
Depends upon the nature of causative virus, but overall morality is less than % with old people faring worst. Hepatitis A (mokrtallity less than 0.2% \\) does not progress to chronic liver disease. 10% of Hepatitis B and 50% of Hepatitis C, regardless of severity of acute illness progress to chronic (persistence for more than 10 weeks) liver disease and hepatocellular carcinoma. The mortality for acute Hepatitis B is up to 1%, whenever for Hepatitis E in pregnant women it is 10-2-%. With chronic HDV, 70% develop cirrhosis. HEV does not lead to chronic disease. Alcohol abuse is a major contributing factory for chronicity in HBV and HCV. (Autoimmune non-viral Hepatitis simulates chronic active hepatitis and occurs mostly in young to middle-aged women, with features of autoimmunity like hyperglobulinemia, high titre circulating NA, arthralgia, lymphadenopathy, fever, rash amenorrhoea, etc., with mortality. If untreated, as high as 40%. This condition is uncommon and is not detailed).
Treatment
If patient with jaundice is Hepatitis-B positive: Treat the acute phase of jaundice as above. Treating physician and paramedical staff must be immunized against Hepatitis-B: Inj. Energix-B 1 ml IM at 0,1, and 6 months, Booster 5 years. Take universal precautions to protect yourself from needle pricks and destroy all used needles, syringes etc. Continue Tab. Essentiale (Phospholipids) and Tab. Hepatinic (Ayurvedic) for 6 months as a supportive treatment. After 6 months Repeat HBsAg test. In 90% patients will become negative in normal course. Temaining 10% develop chronic hepatitis or a carrier state. Patients with chronic hepatitis, need specific treatment. Interferon-alpha 30 million IU/ week (as 10 million IU on alternative days) x 16 weeks (very costly-Rs.12,000/- per week.) Tab. Lamivudine 100 mg 1 OD x 1year.
If mother is HBsAg positive:
The child should receive. Inj. Hepatitis B Immunoglobulin 0.06 ml.kg immediately after birth. Inj. Energix-B 0.5ml 1st dose, within 12 hrs of birth.
Correction of abnormal fluid or electrolyte states. Correction of any coagulation defects, acid base disturbances, hypoglycaemia, and impairment of renal function. Normal diet should be given. Fat restriction in unnecessary. High calorie, high protein diet beneficial. Restriciton of fat makes food unpalatable and aggravates anorexia.
Advice to Patient
Proper hygiene by patients and food handlers. Proper use of needles used by HBV, HCV HDV patients HBV is sexually transmitted, and appropriate advice. Sexual transmission of HCV is low.
Follow Up
Monitoring clinical progress weekly. Symptomatic patients need watching out for metabolic complications. Serial measurement of serum aminotransferases. Chronic disease may require multiple liver biopsies. WBC and Platelet counts to be monitored in patients on interferon therapy.
Prevention
Screening of bllod products. Careful disposal of syringes, apparatus in use on patents.
