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ICTERUS
CAUSED BY :
Hepatic disorder
Viral infection ( cmv, hav, hbv..)
Bacterial infection
Toxic agent or drug
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HEPATITIS
Inflammation on the liver
Ussually caused by:
Viral infection
Toxic agent
Drug abuse
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EPIDEMIOLOGY
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PATHOGENESIS
Patholical changes : parenchymal cell
inflamation and necrosis, also
periportal inflamtion
Serum billirubin may be elevated
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CLINICAL FEATURES
Commonly after 4 weeks incubation
periode
Non spesific symptoms : fever, chill, muscle
aches / pain, headache, fatigue, malaise.
Followed by spesific symptoms : anorexia,
nousea, vomitt, and right abdominal pain.
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DIAGNOSIS
1. Detection of the virus or antigen
Can be detected in feces, until 2 weeks after
joundice dissapear, also in serum, saliva, urine
2. Antibody detection
Choiced metode for diagnosis of acute
hepatitis A
IgM anti HAV will be detected on recent
infection
IgG anti HAV is used to determining immune
status
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PREVENTION
Symple hygienic
Sanitary disposal of feces
Vaccine from killed or live attenuated virus
Immunoglobulin anti HAV
For closed personal contact with patients
Prophylaxis for traveler to high endemic area
Valid until 6 months
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HEPATITIS B VIRUS
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EPIDEMIOLOGY
Hepatitis B is common / high incidence in
asia, africa, south america. Low in europe
and north america
Estimated more than 5 % the global
population were infected by HBV
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Replication
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HBV ANTIGENS
1. HBV DNA
2. HBV DNA Polymerase
3. Hepatitis B surface (HBsAg)
4. Hepatitis B core (HBc Ag)
5. Hepatitis B envelope ( HBe Ag)
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1. HBV DNA
indicate how fast the virus is replicating.
However, the test for HBV DNA is
expensive and difficult, there for not
frequently used.
2. HBV DNA Polymerase
This enzym also not frequently used
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3. HBs Ag
Frequently used
After infection and 1-6 weeks before symptoms
occur this antigen could be detected
HBs Ag possitive is indicate current infection
4. HBc Ag
Not detectable on blood stream
Can detected by liver biopsy
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5. HBe Ag
HBe Ag is a peptide and detectable in
bloodstream when the HBV reproducing
actively
In Acute infection HBe Ag generally only
transiently present
The presence of HBe Ag in cronic infection
indicate that HBV still actively reproducing
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TRANSMISSION
HBV transmitted by exchange of the body
fluids e.g.: blood, serum, semen, breastmilk,
saliva, vaginal fluids.
High risk people:
Unprotected sexual intercourse, hetero or homo
sexual
Drugs user who share needles
Babie born to mothers with the HBV
Health Care Worker
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Clinical Features
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Chronic infection:
Persistens chronic hepatitis
Progressive chronic hepatitis
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DIAGNOSIS
1.
2.
3.
4.
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5. HBe Ag
indicate active replication of the virus and
infectiveness
6. Anti HBe
virus no longer replicating.
7. HBV DNA
indicate active replication of virus. Rarely
used
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PREVENTION
Before infection
Give HBIG ( Hepatitis Immuno Globulin)
Vaccination
3 times sub cutaneous injection, in 6 months
(0,1,6)
Give immunity in 90 - 95 % of people treated
Booster dose every 5-10 years to ensure
immunity
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HEPATITIS C VIRUS
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Epidemilogy
Majority of infected people are from blood
transfusion
Transmission :
Trans venous drug admisssion, transfusion,
sexual intercourse, from mother to infant
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Clinical features
The symptoms are simmilar with Heaptitis
A and B infection
85% people who infected by HCV are
become chronic
Once chronically infection, the viru is
almost never cleared
Some go on to develop cirrhosis and Hepato
Cellular Carcinoma
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Diagnosis
Serologic test
Presence of anti-HCV antibodies
Liver biopsy to assess the degree of liver
inflammation and fibrosis and presence of
cirrhosis
Patients with advance cirrhosis should be
evaluated for possible liver transplantation
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Transmission
Parenteral exposure
Injection, transfusion, ect.
Permucosal exposures
Sexual contact
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Clinical features
HDV can be acquired either as:
A co-infection (occur simultaneously) with
HBV or
A super infection in persons with existing
chronic HBV infection
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HEPATITIS E VIRUS
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Epidemiology
Most outbreaks Associated with faecally
contaminated drinking water
Large epidemics have occurred in indian,
USSr, China, Africa and Mexico
Minimal person to person transmission
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Clinical features
Incubation period:
Average 40 days, range 15-60 days
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Prevention
Avoid drinking water ( and baverage with
ice) of unknown purity, uncooked shellfish
and uncooked fruits/vegetable not peeled.
Vaccine : ?
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