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Presentation on theme: "HEPATITIS."— Presentation transcript:


2 Definition & causative organisms
Infections of the liver caused by a group of viruses having an affinity for the liver Infection of the hepatocytes produces necrosis and inflammation of the liver Hepatitis virus A,B,C,D,E (G -no acute or chronic illness)….. EBV,CMV, yellow fever, HSV etc. Part of systemic infection

3 Epidimiology >500 million people infected
>350 million chronic carriers of HBV 200 million infected with HCV Highest HBV carrier rate in Africa, Asia,W Pacific Carrier rates 0.3 (US)-20(SE Asia)%

4 Clinico pathological outcomes of hepatitis
Acute asymptomatic infection with recovery: serologic evidence only Acute symptomatic hepatitis with recovery: anicteric or icteric Chronic hepatitis: without or with progression to cirrhosis Fulminant hepatitis: with massive to submassive hepatic necrosis Diagnosis of aetiology by serology,history etc

5 Hepatitis virus A,E : Oro fecal transmission
Acute phase and fulminant hepatitis No chronic phase B,C,D: parenteral transmission Acute, chronic, carrier phase Predisposes to HCC

6 Hepatitis A Hepatovirus RNA virus
Replication in hepatocyte (few in enterocyte) Oro fecal transmission,2-6 wks incubation No carrier state or chronic course Ig G Anti HAV + → immunity Fulminant liver failure rare % Worse outcome if superimposed on chronic hepatitis C,D or alcoholic Vaccine + .

7 Pathogenesis Immunologic reaction to virally infected hepatocytes.

8 Biochemical changes in viral hepatitis
Necrosis of hepatocytes, release of enzymes ALT ↑↑, AST ↑↑ S. biliribin ↑↑ 10 days-1 month –conjugated (disruption of bile canaliculi & interference with excertion) Alk phosphatase ↑ (interference with excertion) ↓ protein production ↑ prothrombin time

9 Serological markers of acute hepatitis A

10 Morphology of acute hepatitis
Gross Early stage Enlarged tender liver Later stage smaller greenish focal depressions due to areas of collapse may be seen

11 Microscopy of acute hepatitis
Ballooning degeneration Apoptosis (councilman bodies), Necrosis > zone 3 spotty,bridging,panacinar Inflammatory infiltrate Periportal,perihepatocytic Interface hepatitis Cholestasis Healing with mitotic activity in hepatocytes Lobular disarray hypertrophy and pigment in kupffer cells

12 Morphology of acute hepatitis

13 Fulminant hepatitis Entire/part of liver involved
Liver shrinks,limp,wrinkled capsule Microscopy: destruction of hepatocytes in contiguous lobules, collapsed reticulin framework,preserved portal tracts Regeneration +/- fibrosis C/F jaundice,encephalopathy etc

14 Acute yellow atrophy

15 Hepatitis B Hepadnaviridae, complete virion (Dane particle)
Parenteral transmission IV ,blood , body fluids, saliva, breast milk, semen, transplacental. 4-26 weeks incubation period HBV vaccination recombinant HbsAg or its immunogenic epitopes, lifelong immunity Immunization in infancy

16 DNA partly double stranded
Core protein (HBcAg) Lipo protein coat bearing Envelope glycoprotein (HBsAg) (Australia antigen Baruch S Blumberg in the serum of an aborigine) DNA polymerase HBx necessary for virus replication


18 Pathogenesis of hepatitis B
Proliferative phase: Episomal form produces complete viral particles (Infectivity) Target viral antigens(HBsAg,HBcAg )expressed on the surface in association with HLA class I Cytotoxic T lymphocytes directed against multiple HBV epitopes kill infected hepatocytes Antiviral Antibodies appear → infectivity ends, hepatitis ends Replication continues → carrier with chronic hepatitis Integrative phase: Integrated into the DNA (chronic hepatitis, HCC)

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