Hepatitis

//Western Diagnosis// liver inflammation with hepatocellular necrosis

Etiology of acute viral hepatitis
1. HAV 2. HBV 3. HCV 4. HDV - only with HBV 5. HEV 6. HGV - transmitted by blood

Epidemiology
a. incubation 2-6 weeks b. fecal-oral spread: virus shed during incubation period c. often subclinical or unrecognized infections
 * HAV**

a. incubation 6-25 weeks b. parenteral spread i. usually contaminated blood products ii. shared needles of IV drug users iii. sexual contact iv. renal dialysis v. hospital personnel c. sexual contact d. closed institutions e. chronic HBV carriers are reservoir i. <0.5% population in North America ii. >10% population in Far East
 * HBV**

a. incubation 3-16 weeks b. blood-borne c. chronic, idiopathic, acute
 * HCV**

Signs & Symptoms
a. anorexia, malaise, N, V, fever b. distaste for cigarettes if smokes
 * prodromal phase**

a. 3-10 days after prodrome b. dark urine c. followed closely by jaundice d. systemic sx regress and patient feels better e. jaundice peaks within 1-2 weeks
 * icteric phase**

a. lasts 2-4 weeks 4. hepatomegaly and jaundice
 * recovery phase**

Laboratory
1. very high liver enzymes a. high in prodrome, peak before maximal jaundice, fall slowly in recovery phase a. IgM Ab early in disease and dec in several weeks b. IgG anti-HA in several weeks and persists for life a. HBsAg ---during incubation period ---1-6 weeks before clinical sxs ---disappears during recovery b. anti-HBs ---weeks or months later, after clinical recovery and persists for life c. HBcAg ---in liver cells, usually not looked for in serum ---anti-HBc at onset of clinical illness and persists for years or life a. blood-borne b. anti-HCV - several weeks after acute infection c. HCV-RNA
 * HAV**
 * HBV**
 * HCV**

Diagnosis
1. clinical 2. liver enzymes 3. antigen/antibody testing 4. difficult to diagnose in prodromal phase

Prognosis

 * HAV** rarely becomes chronic

a. mild persistent hepatitis b. chronic active hepatitis with eventual cirrhosis c. subclinical chronic carrier state - hepatocellular CA
 * HBV** chronic in 5-10% of cases

a. up to 80% of cases b. benign, mild chronic hepatitis c. 20% develop cirrhosis - hepatocellular CA usually only with cirrhosis
 * HCV** most likely to become chronic

Prophylaxis
1. isolation not important a. hygiene b. immune globulin ---household contacts ---travelers to endemic areas a. HBIG ---unsure if better clinically than standard IG ---accidental needlestick exposure to HBsAg + blood ---given within 24 hours and again 1 month later ---regular sexual contacts of those + ---given within 2 weeks of last contact b. HBV vaccination ---safe with no side effects ---postexposure vaccine after needlestick exposure to HBsAg + blood ---sexual contact with those + ---preexposure vaccine for pts and staff in hemodialysis units, health care personnel exposed to blood, dentists, those in institutions for mentally retarded, male homosexuals
 * HAV**
 * HBV**

Treatment
1. licorice 2. selenium 200-1000 mcg/day - any retrovirus 3. silymarin 150 mg TID 4. Vitamin C - 100mg IV 5. interferon with or without ribavirin

Caution - Use of Chai Hu (bupleurum) seems to have an interaction with interferon

Orthomolecular Treatment
-Catechins -SAMe