HEPATITIS - B

HEPATITIS - B


  • It is a viral infection that attacks the liver and can cause both acute and chronic disease
  • On electron microscope view virus is either spherical or tubular in shape


  • HBsAg  -  surface antigen
  • HBcAg  -  core antigen → found in nucleus of hepatocytes but never found in blood however antibody to it is seen in blood
  • HBV DNA
  • HBeAg  -  marker for replication/infectivity of virus
  • Pre - core mutant = HBeAg absent
- More severe
- Replication not detected routinely

ROUTE OF TRANSMISSION:
  • Most commonly - percutaneous route : sexual transmission
  • Blood transfusion
  • Vertical transmission - mother to baby
  • Accidental needle stick injury


SERUM MARKERS:

  • HBsAg - 
- first to appear 1 - 12 weeks of infection
- earliest serological evidence of hepatitis - B infection
- precedes SGPT increases = 2 - 6 weeks
- sequence of appearance

HBsAg positive → SGPT increases → jaundice → disappear in reverse direction
  • HBcAg - Never appears in blood
  • HBeAg - Replication/infectivity of virus
  • HBxAg - CD 95 inhibitor → inhibit extrinsic pathway of apoptosis
↓↓↓
trigger development of hepatocellar carcinoma (HBV>HCV)
  • PCR HBV DNA - Quantify the viral load
TREATMENT:
  • Tenofovir(DOC) / Entecavir
  • Pegylated interferon + Lamivudine

ANTIBODIES AGAINST HEPATITIS B:
  • Anti HBsAg - protective antibody
  • Anti HBcAg - 
- Ig M = Acute viral hepatitis and Ab present in Gap period/window period
- Ig G = Chronic hepatitis
  • Anti HBeAg - Replication rate reduce and infectivity reduces


NOTE: Jaundice will appear at last and is the first to disappear
HBeAg → anti HBs → ALT increases → jaundice (but first to disappear)



WORKUP:

  • LIVER FUNCTION TEST =
- S. Bilirubin increased (unconjugated)
- SGOT Increased (serum glutamic oxaloacetic transaminase)
- SGPT Increased ( serum glutamic pyruvic transaminase)
- S. alkaline phosphatase normal
= seen in hepatocellular jaundice


  • In obstructive jaundice:
- S. Bilirubin increased (conjugated)
- SGOT normal
- SGPT normal
S. Alkaline phosphatase increased

  • In hemolytic jaundice:
- S. Bilirubin increased (unconjugated)
- SGOT normal
- SGPT normal
- S. Alkaline phosphatase normal and splenomegaly can also be seen



  • USG- To check the echo texture and span to liver
  • if on USG report came - STARRY SKY LIVER and LIVER SPAN increases - seen in viral hepatitis







TREATMENT:
Acute hepatitis B
  • Bed rest
  • itopride/mosapride for nausea
  • IV fluids (10%dextrose or NS)
  • Monitoring



Chronic hepatitis B
  • HBeAg = Reactivity
  • PCR HBV DNA = >2 х 10 POWER OF 4 IU/ml + SGPT х 2times


Compensated cirrhosis patients
  • HBeAg = Reactivity
  • PCR HCV DNA = 2 х 10 POWER OF 3 IU/ml + SGPT RAISED
  • DOC - Tenofovir (300mg OD 48weeks) or Entecavir 



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