ViralHep2010 - Viral Hepatitis Medicine Student Lecture...

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Viral Hepatitis Viral Hepatitis Medicine Student Lecture Medicine Student Lecture David R Nelson, M.D. Professor of Medicine Associate Dean, Clinical Research University of Florida
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Case 1: Case 1: 29 y/o female came to your clinic with: Jaundice, Abdominal pain, Nausea / Vomiting AST-2,000 ALT- 2,500, Total bili 1.8 She denies IVDA or any recent drug/medicine exposure, but had unprotected sex about 6 weeks ago Ultrasound shows normal appearing liver and blood flow Her diagnosis is……
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Causes of Acute Hepatitis Causes of Acute Hepatitis Acute Hepatitis Viral Hepatitis A, B/D, C, E EBV Drugs Ethanol Tylenol Halothane Toxins Jamaica Bush Tea Mushrooms Vascular Hypotension Budd-Chiari Autoimmune Hepatitis Metabolic Wilson's Disease A1AT
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Case: Case: 38 y/o male with past medical history of abnormal ALT for past 4 years. He had a blood tx as a child due to MVA. Patient came to your clinic with: ALT 150, AST 100 HBsAb +, HBcAb + HCV Ab + HAV IgG + What is your dx?
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Causes of Chronic Hepatitis Causes of Chronic Hepatitis Chronic Hepatitis Viral Hepatitis Hep B Hep C Drugs MTX INH Amiodarone Alcohol NAFLD Autoimmune AIH PBC PSC Metabolic A1AT HHC Wilson's Abbreviations: NAFLD: nonalcoholic fatty liver disease; AIH: autoimmune hepatitis; PBC: primary biliary cirrhosis PSC: primary sclerosing cholangitis, A1AT: alpha-1 antitrypsin deficiency, HHC:hereditary hemochromotosis
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47% 34% 16% 3% Hepatitis A Hepatitis B Hepatitis C Hepatitis Non-ABC Source: CDC Sentinel Counties Study on Viral Hepatitis Acute Viral Hepatitis by Type, USA: 1982-1993
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27 nm Transmission route: fecal-oral Transmission route: fecal-oral Clinical presentation Clinical presentation - Jaundice: Adults- 30%, Children- <5% - Jaundice: Adults- 30%, Children- <5% - Fulminant: <1% - Fulminant: <1% Diagnostic tests Diagnostic tests - Acute infection: IgM anti-HAV - Acute infection: IgM anti-HAV - Chronic infection: Not applicable - Chronic infection: Not applicable Immunity: IgG anti-HAV Immunity: IgG anti-HAV Case-fatality rate: 0.1 – 2.7% Case-fatality rate: 0.1 – 2.7% Chronic infection: Chronic infection: None None Nucleic Acid: 7.5 kb ssRNA Hepatitis A Virus
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HAV Prevalence High Intermediate Low Very Low Global Prevalence of Hepatitis A Infection
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Fecal HAV Symptoms ALT IgM anti-HAV Total anti-HAV Months after Exposure Titer Typical Serologic Course 0 1 2 3 4 5 6 12 Hepatitis A Virus Infection
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Hepatitis A Prevention - Immune Globulin Preexposure Preexposure Travelers to high HAV-prevalence regions Travelers to high HAV-prevalence regions Postexposure (within 14 days) Postexposure (within 14 days) Routine Routine Household and other intimate contacts Household and other intimate contacts Selected situations Selected situations Institutions (e.g. daycare centers) Institutions (e.g. daycare centers) Common source exposure (e.g. food prepared Common source exposure (e.g. food prepared by infected food handler) by infected food handler)
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ViralHep2010 - Viral Hepatitis Medicine Student Lecture...

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