1. Serologic diagnosis of HBVinfection

2. Clinical outcomes of HBV infection
Subclinical disease
Acute hepatitis, Fulminant hepatitis
Asymptomatic carrier
Chronic hepatitis >6 months necrosis and inflammation of the liver , actively replicating virus—source of infection
Cirrhosis, HCC

3. Outcome of hepatitis B infection

4. Chronic hepatitis Inflammation of the liver >6 mo (not alcoholic)
Mild-(chronic persistent hepatitis)
Inflammation confined to portal tract
Limiting plate preserved
Severe (chronic active hepatitis)
Inflammation spills into periportal liver
Interface hepatitis
Bridging necrosis Fatty change, lymphocytes (C) Periportal fibrosis Ground glass (B)

5. Chronic hepatitis

6. Hepatitis B infection

7. Carrier state Presence of HBsAg in serum >6 months
May be symptomatic /asymptomatic
More common following vertical transmission & immunocompromised

8. Biochemical abnormalities in chronic hepatitis
Elevation of AST,ALT
S. Bilirubin elevated at times

9. HCV Hepacivirus Enveloped single stranded RNA virus
Unstable virus with multiple genotypes and subtypes. (no vaccine)
Anti HCV IgG does not confer effective immunity
High risk of chronicity (80%),cirrhosis &HCC (10%)

10. Pathogenesis of HCV infection
Cytotoxic T cells response to virally infected hepatocytes
Not directly cytopathic
Defects in HCV specific cellular immunity

11. Clinical features of HCVdisease
Mild disease
Fulminant disease rare
Chronic disease is common (80% )
20% develop cirrhosis
5% of cirrhosis develop HCC
Extrahepatic manifestation-membranoproliferative glomerulonephritis,prophyria cutanea tarda, sicca syndrome

12. Serologic diagnosis of HCVinfection

13. HDV RNA virus Conifection HBV and HDV simultaneously
Superinfection: HBV followed by HDV
Serologic diagnosis: anti HDV IgM.

14. Clinical outcomes of HDV infection

15. HEV Oro-fecal transmission Asia,india,subsaharan africa, mexico
High mortality in pregnant women
Self limiting
No chronic phase,no viremia.

16. Comparison of hepatitis viruses

17. Clinical manifestations of hepatitis
Preicteric or palindromic phase
Precedes jaundice
1-21 days
Phase of maximum infectivity in HAV infection
Nausea, fever, anorexia, malaise
Serum sickness-like syndrome (B)

18. Hepatitis-clinical manifestations...
Icteric phase
Jaundice
Pruritis
Pale coloured stool,dark urine
Tender hepatomegaly

19. Clinical features of Chronic hepatitis
Variable
Not predictive of outcome
Fatigue,malaise .mild haundice’spider angiomas,mild tender hepatomegaly,
Occasionly, immune complex mediated disease (C&D)

20. Summary Definition of hepatitis Hepatitis viruses, serologic diagnosis
Clinical manifestations
Acute hepatitis,fulminant hepatitis,chronic hepatitis, carrier state.
Cirrhosis, HCC ……