Hepatitis B – Symptoms And Causes and Treatment

Hepatitis B.
Or
Describe briefly viral hepatitis B.
Or
Discuss the mode of transmission and clinical features of hepatitis B infection. 

Answer. Hepatitis B is a virus that results in the causing of the disease known as hepatitis in men.

Hepatitis B Route of transmission or Hepatitis B etiology

1. Horizontal transmission
   • By use of drug injection
   • Infected unscreened blood products
   • By tattooing and acupuncture needles
   • In sexually active individuals, i.e. either homosexuals or heterosexuals
2. Vertical transmission
   • By HBsAg positive mother
   • High-risk groups for HBV infection are patients of hemodialysis, physicians, dentists, surgeons, paramedical staff, and persons in laboratory and blood banks.

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Clinical Features Hepatitis B The cases of hepatitis pass through three phases:

1. Preicteric phase: Hepatitis B

• Prodromal period of 4 to 7 days
• Mild fatigue and fever for 2 to 5 days
• Anorexia, nausea and vomiting
• Distaste for smoking
• Abdominal distress

2. Icteric phase: Hepatitis B

• Jaundice on the third or fourth days deepens or rapidly increases
• Tea-colored urine is present
• Loss of weight
• The stool becomes light in color
• Spleen is palpable

3. Posticteric phase: Hepatitis B

• Jaundice recedes and all features come back to normal in 3 to 6 weeks
• My appetite is good.
• Stool and urine regain their natural color.
• Investigations

4. Serology Hepatitis B

• HBV consists of a number of antigens. The three important antigens are hepatitis B surface antigen (HBsAg), core antigen (HBeAg) and hepatitis e antigen (HBeAg).
• The appearance of hepatitis B surface antigen (HBsAg) in serum is the first evidence of infection. It normally persists for 3–4 weeks but can persist for up to 6 months.
• After the disappearance of HBsAg, antibodies against HBsAg (Anti­HBs) appear and persist for years and confer immunity. The presence of Anti­HBs antibodies means either previous infection or vaccination.
• HBeAg is not seen in the blood. However, antibody to it (anti­HBc) appear early during the illness.
• The presence of IgM anti­HBc indicates acute infection and IgG anti­HBc suggests chronic infection (when HBsAg positive) or recovery (when anti­HBs positive).
• The presence of HBeAg indicates active viral replication and a high degree of infectivity.
• Anti­HBe appears as HBeAg disappears and its presence suggests a low level of viral replication and decreased infectivity.
• Above mentioned serological tests are done to identify the cause of hepatitis.

Viral Blood Hepatitis B

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

Other Investigations Hepatitis B

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

Management Hepatitis B

1. Hepatitis B Supportive treatment: Viral Blood Hepatitis B This is given in acute hepatitis
   • Restricting the physical activity and bed rest is strictly recommended.
   • A high-calorie diet is given. Good protein intake should be there. Hospitalization and intravenous fluid (10% glucose) are indicated if oral intake is not proper or there is marked nausea and vomiting.
   • Avoid the drugs which are hepatotoxic or those that are metabolized in the liver.
   • A bile salt sequestering agent (cholestyramine) decreases pruritus in cases with cholestasis.
   • Patients having features of severe hepatic failure such as alteration in mental status (hepatic encephalopathy) and prolonged prothrombin time or bleeding time should be hospitalized.
   • No specific therapy is recommended for acute viral hepatitis except in acute HCV infection. Subcutaneous interferon alpha has been shown to reduce the rate of chronicity in acute HCV hepatitis.
2. Specific management: Viral Blood Hepatitis B
   • It is done in case of chronic hepatitis B Interferon inhibits the division of virus and antiviral
   • drug lamivudine 100 mg OD is given.
   • Interferon is given in doses of 5 MU daily or 10 MU three times per week for 16 days.
   • Lamivudine is an anti-DNA polymerase agent. It has shown significant improvement but when the drug is stopped HBV replication recurs and resistance to lamivudine is another problem.

Complication/Fate of HBv

Complications of Viral Hepatitis B. The complications of viral hepatitis are:

• Acute hepatic failure: Fatalities are rare and usually occur in this case.
• Relapsing hepatitis: There is the return of signs and symptoms 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.
• Gilbert’s syndrome: It may come into the picture during viral hepatitis.
• Connective tissue disease such as polyarthritis nodosa is observed in HBV and HCV infection.
• 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 a complication of HBV and HCV and follows chronic hepatitis.
• Hepatocellular carcinoma: It is also the complication of HBV and HCV following cirrhosis of the liver.

Hepatitis B is a virus that results in the causing of the disease known as hepatitis in men.

Route of transmission or etiology

1. Horizontal transmission
   • By use of drug injection
   • Infected unscreened blood products
   • By tattooing and acupuncture needles
   • In sexually active individuals, i.e. either homosexuals or heterosexuals
2. Vertical transmission
   1. By HBsAg positive mother
   2. High-risk groups for HBV infection are patients of hemodialysis, physician, dentists, surgeons, paramedical staff and persons in laboratory and blood bank.

Clinical Features Viral Hepatitis B. The cases of hepatitis pass through three phases:

1. Preicteric phase:
   • Prodromal period of 4 to 7 days
   • Mild fatigue and fever for 2 to 5 days
   • Anorexia, nausea and vomiting
   • Distaste for smoking
   • Abdominal distress
2. Icteric phase:
   • Jaundice on the third or fourth days deepens or rapidly increases
   • Tea-colored urine is present
   • Loss of weight
   • The stool becomes light in color
   • Spleen is palpable
3. Posticteric phase:
   • Jaundice recedes and all features come back to normal in 3 to 6 weeks
   • My appetite is good.
   • Stool and urine regain their natural color.
   • Investigations
4. Serology
   • HBV consists of a number of antigens. The three important antigens are hepatitis B surface antigen (HBsAg), core antigen (HBeAg) and hepatitis e antigen (HBeAg).
   • The appearance of hepatitis B surface antigen (HBsAg) in serum is the first evidence of infection. It normally persists for 3–4 weeks but can persist for up to 6 months.
   • After the disappearance of HBsAg, antibodies against HBsAg (Anti­HBs) appear and persist for years and confer immunity. The presence of Anti­HBs antibodies means either previous infection or vaccination.
   • HBeAg is not seen in the blood. However, antibody to it (anti­HBc) appear early during the illness.
   • The presence of IgM anti­HBc indicates acute infection and IgG anti­HBc suggests chronic infection (when HBsAg positive) or recovery (when anti­HBs positive).
   • The presence of HBeAg indicates active viral replication and a high degree of infectivity.
   • Anti­HBe appears as HBeAg disappears and its presence suggests a low level of viral replication and decreased infectivity.
   • Above mentioned serological tests are done to identify the cause of hepatitis.

Viral Blood Viral Hepatitis B

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

Other Investigations Viral Hepatitis B

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

Management Viral Hepatitis B  

1. Supportive treatment: Viral Hepatitis B This is given in acute hepatitis
   • Restricting the physical activity and bed rest is strictly recommended.
   • A high-calorie diet is given. Good protein intake should be there. Hospitalization and intravenous fluid (10% glucose) are indicated if oral intake is not proper or there is marked nausea and vomiting.
   • Avoid the drugs which are hepatotoxic or those that are metabolized in the liver.
   • A bile salt sequestering agent (cholestyramine) decreases pruritus in cases with cholestasis.
   • Patients having features of severe hepatic failure such as alteration in mental status (hepatic encephalopathy) and prolonged prothrombin time or bleeding time should be hospitalized.
   • No specific therapy is recommended for acute viral hepatitis except in acute HCV infection. Subcutaneous interferon alpha has been shown to reduce the rate of chronicity in acute HCV hepatitis.
2. Specific management: Viral Hepatitis B
   • It is done in case of chronic hepatitis B Interferon inhibits the division of virus and antiviral
   • drug lamivudine 100 mg OD is given.
   • Interferon is given in doses of 5 MU daily or 10 MU three times per week for 16 days.
   • Lamivudine is an anti-DNA polymerase agent. It has shown significant improvement but when the drug is stopped HBV replication recurs and resistance to lamivudine is another problem.

Complication/Fate of HBv