Viral Hepatitis: Types, Symptoms, Diagnosis, and Complications

Viral Hepatitis: Types, Symptoms, Diagnosis, and Complications

Question. Write a short note on viral hepatitis.
Or
Discuss clinical features, diagnosis, management, and complications of viral hepatitis.

Answer.

Viral hepatitis is a clinical entity where systemic infection causes inflammation and hepatic cell necrosis.

Viruses causing viral hepatitis are:

• Hepatitis A virus
• Hepatitis B virus
• Hepatitis C virus
• Hepatitis D virus
• Hepatitis E virus

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Other viruses are:

• Cytomegalovirus
• Epstein­Barr virus
• Herpes simplex virus, etc.

Clinical ManifestationsViral Hepatitis Are

Prodromal symptoms proceed the development of jaundice in sclera and behind the tongue from few days to two weeks and common symptoms are:

• Mild fever with or without chills
• Headache
• Malaise
• Arthralgia and skin rashes particularly in HBV infection
• Prominent gastroenteritis symptoms like anorexia, nausea and vomiting
• Steady upper mild abdominal pain in right hypochondrium
• Liver is not palpable.

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Physical signs Viral Hepatitis Are

• The liver is usually tender but is not palpable initially.
• Enlarged cervical nodes may be found.
• Splenomegaly is present, particularly in children.
• Dark urine and a yellow tint of sclera held the onset of jaundice.

Features of Jaundice

• It is fist observed in sclera in bulbar conjunctivitis
• Jaundice deepens following obstruction of bile canaliculi.
• Stool become pallor
• Urine is dark
• Liver is tender and is easily palpable
• At this time appetite often improves
• Gastrointestinal symptoms diminished intensity.

Thereafter jaundice recedes and all features comes to normal in 3 to 6 weeks of time which can be revealed by:

• Normal skin, sclera and urine color
• Normal stool color
• Appetite improves
• Liver enlargement regresses.

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Diagnosis Viral Hepatitis Are

Diagnosis of viral hepatitis is done in a patient with history of severe anorexia, nausea, vomiting and fever for a few days,elevated serum bilirubin and value of SGPT over 500 indicates viral hepatitis. The etiological agent is detected by serological markers.

1. Hepatitis A:

1. Non specifi lab tests
   • Raised serum bilirubin within few days and remain high up to 12 weeks.
   • Serum AST and ALT levels remain high for 1 to 3 weeks.
   • Alkaline phosphatase level is mildly elevated,though it remains persistently high, it suggest hepatitis associated cholestasis.
2. Specifi test
   • Hepatitis A specifi IgM antibody can be detected at the onset of symptoms and at fist rise in serum ALT.
   • It peaks within first month and remain positive for 3 to 6 months.
   • IgG and hepatitis A virus become positive at onset of illness and is detectable for many years
   • Nucleic acid based test like PCR.

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2. Hepatitis B: In a patient with history of severe anorexia, nausea,vomiting, fever for few days, elevated serum bilirubin and value of SGPT over 500 indicates HBV. The etiological agent is identifid by serological markers.

Following is the serological diagnosis ofhepatitis B:

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Viral Blood  Hepatitis B:

• HBV DNA is measured by polymerase chain reaction in blood.
• Viral loads are in excess of 105 copies/mL in presence of active viral replication.

Other Investigations Hepatitis B:

• During early phase of hepatitis there is an increase in more than 400 units/L increase in plasma alaline aminotransferase and aspartate aminotransferase.
• High levels of alkaline phosphatase is suggestive of cholestasis.
• Prothrombin time is increased which indicates severe liver damage.

3. Hepatitis C

1. Antibodies to HCV (anti­HCV)
   • Detection of antibodies to recombinant HCV polypeptides. Enzyme immunoassay measures antibodies against two antigens NS4 and NS3.
   • These assays can detect antibodies within 6 to 8 weeks of exposure.
   • Average time for seroconversion is 2 to 3 weeks
2. Recombinant immunoassay
3. Hepatitis C virus RNA testing qualitative test
4. Hepatitis C virus RNA testing quantitative test
5. HCV genotyping is helpful in predicting response to therapy.

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4. Hepatitis D

• During Hepatitis D viral infection both IgM and IgG antibodies can be detected in serum in acute phase.
• HDV infection can also be detected using reverse transcriptase polymerase chain reaction (RT­PCR)

5. Hepatitis E

• Identifiation of IgM antibodies to HEV from acute plasma serum samples. Antibodies detected are against ORF-2 and ORF-3

Management  Hepatitis E

• Only the more severely affcted patients require care in hospital.
• Posthepatic syndrome is treated by reassurance.

Diet Hepatitis E

• Nutritious diet containing 2000–3000 Kcal daily is given.
• Light diet supplemented with glucose and food debris is acceptable.
• A good protein diet should be encouraged.
• In case of severe vomiting, IV flids and glucose may be required.
• Highly fatt diet should be avoided however complete restriction of fatt diet is not required.

Drugs Hepatitis E

1. Drugs should be avoided, especially in severe hepatitis.
2. Sedative and hypotonic drugs, alcohol, oral contraceptives should be especially avoided.

Surgery Hepatitis E

1. During acute viral hepatitis surgery carries a signifiant role of post operative liver failure. Only life saving operation should be carried.

Liver transplantation 

This may be required in acute or chronic liver failure due to hepatitis virus.

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Prevention of viral Hepatitis

Prophylaxis of only hepatitis A virus and hepatitis B virus is present, i.e. active immunization.

In active immunization recombinant hepatitis B vaccine which consists of HBsAg is available and produce active immunization in 95% of individuals.

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The complications ofviral hepatitis are:

• Acute hepatic failure: Fatalities are rare and usually occur in this case.
• Relapsing hepatitis: There is return of signs and symptom during recovery. It can be detected by
• clinical signs and biochemical tests. It resolves jaundice.
• Cholestasis: It can develop at any stage of illness and gives features of obstructive jaundice.
• Gillbert’s syndrome: It may come into picture during viral hepatitis.
• Connective tissue disease such as polyarthritits nodosa is observed in HBV and HCV infection.

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• Renal failure, i.e. glomerulonephritis can occur also in relation to HBV and HCV infection.
• Henoch­Schönlein purpura and papular *acrodermatitis is repeated in children.
• Chronic hepatitis is observed with HBV infection with or without HDV and HCV viruses.
• Cirrhosis is also the complication of HBV and HCV and follows chronic hepatitis.
• Hepatocellular carcinoma: It is also the complication of HBV and HCV following cirrhosis of liver.