ACUTE HEPATITIS

1
Jain Management of acute hepatitis

• ACUTE HEPATITIS
• Definition A systemic infection predominantly
  affecting liver, with clinical, biochemical
  histological features of acute / recent onset
  hepatic necroinflammation, and usual resolution
  (Mostly in lt 4 months)
• Clinical profile
• Typical presentation well recognized
• Extrahepatic manifestations up to 25
• Unusual course / Sequalae
• Cholestatic hepatitis
• Liver failure acute subacute
• Subacute hepatitis (?)
• Chronicity persistence of viremia
• gt 24 wks, with / without necro-inflammation

2
Jain Management of acute hepatitis

• Cholestatic viral hepatitis
• Prolonged Cholestatic phase
• Criteria Varied - Most Accepted (Schiff 1992)
• Peak S Bil gt10mg, For gt 2 wks
• Bilirubin Elevation usually lasts gt 12 wks
• Clinical Cholestasis /- , ? ? ALP
• Histologic Cholestasis may be seen without
  clinical cholestasis
• 36 Cholestatic Hepatitis due to HBV (BHU)

3
Jain Management of acute hepatitis

• Hepatic failure nomenclatures - 1
• Several terms proposed, based on temporal
  progression of disease to development of
  encephalopathy
• Trey Davidson 1970 FHF lt 8wks
• Kings College 1986 LOHF 9-26 wks
• Beaujon 1986 Fulminant lt 2 wks
• Sub Fulminant 2-12wks
• O Grady 1993 Hyper Acute lt 7 day
• Acute lt 8-28 days
• Sub Acute 29-72 days
• Tandon 1999 Acute lt 4 wks
• (IASL) Hyper acute lt 10 days
• Fulminant 10-30 days
• Sub Acute 5-24 wks
• Overlap in Prognosis in Different Groups

4
Jain Management of acute hepatitis

• Acute hepatic failure
• Absence H/O pre-existing liver Disease
• Rapid development of hepatic dysfunction
• (Jaundice, Coagulopathy), often reversible,
• Encephalopathy within 4 wks (8 wks) of onset
• Tandon et al (IASL) 1999 4 wks
• Trey and Davidson 1970 8 wks (Fulminant)
• Subacute hepatic failure (Tandon IASL 1999)
• Persistence of acute hepatitis with
• Progressive Liver Dysfunction
• Ascites / Encephalopathy at 5th to 24th wks
• Absence of pre-existing liver disease
• Exclusion Criterias IHBRD ( on US), Varices gt
  Gr.I/CLD on histology, ALD, CRF, KF Ring/
  ?Ceruloplasmin

5
Jain Management of acute hepatitis

• Subacute hepatitis
• Boyer in early 70s for Severe Viral Hepatitis
  (often with Ascites BHN)
• With Introduction of SAHF SAH Sparingly used
• Recent reports from Japan India redescribed it
  for Acute Hepatitis cases with
• Persistent elevation of bilirubin, or
• Progressive rise of bilirubin after 6 weeks

6
Jain Management of acute hepatitis

• Investigations
• Haemogram
• Biochemical LFT, Transaminases, Prothrombin
  time
• BUN, Glucose, S.Creatinine (when indicated)
• Virologic HBs Ag, IgM Anti HBc
• IgM Anti HDV, if deterioration optional

7
Jain Management of acute hepatitis

• Management of AVH-B
• SUPPORTIVE
• Hepatoprotectives - No Role / Debatable
• Antiviral Therapy - No Role
• Spontaneous Recovery in Adults 95-99
• Lamivudine in Ac Hep B Needs Evaluation
• Risk involved Benefit obtained
• Family counseling

8
Jain Management of acute hepatitis

• Follow up
• Biochemical Tests (ALT,Bil, ALP, PT, etc)
• Every 2 weeks
• Earlier if Clinical Deterioration / Severe
  Forms
• AVH with Clinical Biochemical Resolution
• - HBs Ag at 6m?Negative No Action
• - Positive FU, HBe Ag, Liver Biopsy
• Features of Necro inflammation at 26 wks
• - HBs Ag, HBe Ag, HBVDNA
• - Liver Biopsy