chronic active virus hepatitis

Question 1

etiology

Answer 1

Viral Hepatitis B commonly associated with Viral Hep D.

Question 2

pathogenesis

Answer 2

Aggressive hepatitis
- ↓ metabolic activity, ↓ synthetic function, ↓detoxification functn
- Acute attack of virus → stay long time in organism (in DNA) → virus disturb funct of m‘brane → cell dystrophy (direct degradation & necrotic changes) → virus activated by DNA polymerase → replication of virus → affected cells secreting special Ag (liver specific lipoproteins) → organism produce Ab → delayed hypersensitivity → macrophages infiltrate into lobule → produce enz → cell affectd
- Later if hyperactivity of lymphocytes → affection of whole liver
- Cell damage is due to infiltration & autoAb causes necrotic changes → free spaces occupied by collagenic tissues → liver fibrosis → Imbalance btw parenchyma & fibrotic tissues → sclerosis

Question 3

clinical picture

Answer 3

• Dull pain, arthralgia, LOW, xanthomas, vasculitis, hyperpigmttn
• hepatomegaly, splenomegaly, Hypersplenism, red nose, club fingers (AV shunt)
• small liver syndrome, hemangioma (small red spots)
• Red lips, jaundice, spider nevi, palmar erythema, gynecomastia, raspberry tongue.
• Cytolysis, immunoinflmtory, Cholestasis, Hepatodepression, Hemorrhagic syndromes
• Mesenchymal inflammation – arthralgia, myalgia, enlarged lymph nodes, vasculitis, fever, dysproteinemia, ↓ albumins
• nausea, anorexia, urine dark and stools pale

Question 4

symptoms and signs

Answer 4

• 3-5 yrs after acute viral infection
• Hepatomegaly, jaundice
• Pain – boring, aching, intensive, increased after physical exertion
• Ascites, edema
• Fatigue, weakness, bad mood, dyspepsia
• hepatodepression, cytolysis, Hemorrhagic syndrome, mesenchymal inflmtn
• hypersplenism – pancytopenia
• hepatic signs – stars erythema
• progressive period (virus replicatn): nephritis, carditis, ↑AST & ALT, Liver failure, Death

Question 5

investigation

Answer 5

• Liver biopsy –bridging necrosis, infl infiltrate, fibrosis
• US – hepatomegaly & splenomegaly
• Lab: +ve serological test for respective virus, ↓prothrombin, ↓cholinesterase, ↓cholesterol, ↓fibrinogen, ↑toxins, ↑ALT, AST, conjugated bilirubin
• liver biochemistry – bilirubinuria and increased urinary urobilinogen. Increased AST and ALT
• Haematological tests – leucopenia with lymphocytosis.
• Viral markers: antibodies to HAV

Question 6

etiological diagnostics

Answer 6

Hep B immunological Dx (viral serological markers Abs to virus B, C, D)
- HBsAg & HBV DNA with HBE Ag found in serum
- HBs Ag – may be seen as ground glass, appearance in cytoplasm on H & E stain
- HBc Ag seen in hepatocytes by immunohistochem staining
- Hepatitis B – HbsAg, IgG anti-HBc, HBeAg, HBV DNA
- Hepatitis C – anti-HCV, HCV RNA
- Hepatitis D – anti-HDV, HDV RNA, HBsAg, IgG anti-HBc

Question 7

treatment

Answer 7

1. Diet No. 5 – no fatty food, spices, alcohol, rest, balanced diet
2. Etiological Tx
   Antiviral drugs - interferon, acyclotin, virocides, Lamivudine, Adeforvir, Dipivoxil, Interferogens, Exogenous interferons (interferon-α)
3. Pathogenetic Tx
   - Hepatoprotectors – Riboxin, acid glutaminic acid, Vipamic, Legalon, lipoic acid, phospholipids
   - Glucocorticoids
4. Symptomatic Tx
   - Diuretics – for ascites
   - Liver funct improvemt: vitamins B, C & PP
   - prednisolone, contra-cholerectics & cholekines

Question 8

prognosis

Answer 8

• prognosis is excellent with complete recovery.
• Prognosis is usually poor w liver cirrhosis development in last stages within 10 years after infection.
• complications associated w cirrhosis such as acsites, esophageal varices, encephalopathy
• Prognosis is worse if Hep B + D