Today is Sunday ..my busiest day in the week contrary to others. Many times I am also thinking to take a rest day in the week but till now could not decide the day.
I started my clinic sharp at 9 am..already more than twenty patients are in the waiting room ..oh I have to hurry as I have to sit in another hospital OPD for two hours after 12 pm.
At number 9 one 10 years old boy came with his father. His weight was written as 30 kg and the temperature was 100 degrees these are rFahrenheitecorded before entering into my clinic by my staff)
I started taking history. Fever and vomiting on and off for the last seven days and yellowish discoloration of urine and eyes are the most important point I catch from history other related queries were not suggestive.
Now I started my clinical examination. The boy was febrile and dehydrated, icterus was significant.
After Abdominal examination, I almost came to a conclusion. The liver was enlarged by two-finger and was tender.
So the diagnosis is almost clear It is probably a case of Acute viral hepatitis.
There is five hepatitis viruses that can cause acute inflammation of the liver which is called Acute viral hepatitis. Out of these five most common is hepatitis A (HAV) followed by hepatitis B(HAB), then hepatitis C (HAC), hepatitis, and hepatitis E(HAE)
Besides hepatitis virus there is some other virus also like Ebteinber virus can also cause acute viral hepatitis.
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Hepatitis A is the most common cause of acute viral hepatitis. It is usually transmitted from contaminated water or food. So its prevalence is more commonly seen in people living in poor socioeconomic conditions. Hepatitis A is an RNA virus and its infection gives lifelong immunity. Children below five years are usually asymptomatic and childhood infection gives life-long immunity.
Symptoms of viral hepatitis
The incubation period of the hepatitis A virus is one to two weeks. Common presenting symptoms are fatigue, nausea or vomiting, fever, abdominal pain, light-colored stool, yellow sclera, etc.
Most of the cases of viral hepatitis caused by hepatitis A are cured automatically within two to three weeks. Only .1to1percent people develop extensive necrosis of the liver causing hepatic encephalopathy. If it occurs then the mortality increases to 70 to 80 percent.
How to diagnose?
As the liver is inflamed so the liver function is also disturbed. The enzymes produced by the liver are released into the blood, so the liver enzymes like SGPT, SGOT are elevated.
Most important is the detection of Hepatitis A IgM antibodies in the blood.It indicates a recent infection as this marker disappears from blood within 6 months after infection.
IgG antibody against hepatitis A is also detected but it remains lifelong once infected. So if IgM is not detected only IgG is detected then it is not acute viral hepatitis rather it is chronic hepatitis.
How to treat viral hepatitis?
As already mentioned Hepatitis A infection gets resolved within two to three weeks. So no specific treatment is needed RestRest, adequate fluid to correct dehydration, paracetamol for fever are usually sufficient.No antiviral drugs needed.
But in a very small proportion of patients who may have liver necrosis leading to hepatic encephalopathy require immediate hospitalization.
Hepatitis A virus
Hepatitis B infection is really dangerous. It can cause fulminant liver failure. Hepatitis B is a circular, double-stranded DNA virus.
Hepatitis B infection is seen usually in Asia, Latin America, Africa, and Sothern Europe.
Contaminated needle sharing, Blood transfusion, multiple sexual partners are the most common risk factor for Hepatitis B infection. In Asia, perinatal transfusion from the hepatitis B carrier(HBsAg)mother is an important route of transmission.
Hepatitis B presents clinically as an acute and chronic infection. In an Acute infection, the person may have mild or no symptoms at all may remain as the carrier or the person may develop severe fulminant hepatitis.
The incubation period of Hepatitis B is usually 2 to 6 months.
Symptoms are almost similar to other viral hepatitis in an acute stage like fever, nausea, vomiting, jaundice, etc.
Fulminant hepatitis is started with pathologic mental status changes within 2 to 8 weeks after initial symptoms.
Hepatitis B can lead to cirrhosis of the liver and hepatocellular carcinoma at any later age.
Hepatis B serface antigen,Hepatitis B e antegen are the markers used to diagnose hepatitis B .
Interferon(TNFalpha2) and Lamivudine are used to treat hepatitis B infection
Lamivudine monotherapy for one year gives promising results.
Immunoglobulins are used for infants born with hepatitis B-positive mothers. It is given with hepatitis B vaccine but in a different site. The dose is 0.5 ml intramuscularly.
]Fortunately, Vaccines are now available for both Hepatitis A and Hepatitis B and are very effective.
Hepatitis B virus
Hepatitis D virus
It is also called Delta agent. The interesting fact about it is that it cant infect humans alone as it lacks a protein to bind.it needs Hepatitis virus to infect because it uses hepatitis B protein for binding. So any person who is already getting an infection with hepatitis B then only hepatitis D can infect or sometimes there may be superinfection to a hepatitis B carrier. Once infected it can cause severe and chronic hepatitis.
Hepatitis E virus
In 1978 this virus was discovered in Kashmir in India when more than 50000 cases were diagnosed. It is also a single-stranded RNA virus. It is also transmitted by contaminant water or food like HAV. Clinical presentations are also almost the same with HAV but it causes more severe hepatitis. The mortality rate is also high particularly if it infects a pregnant mother particularly in the 3rd trimester then both maternal, as well as changes of dying the baby inside the womb, is much higher.
Hepatitis C virus
Another RNA virus. Blood transfusion, needle stick injuries are the most common route of transfusion of this virus. But it causes more severe viral hepatitis.
So all these things came to my mind before I came to a conclusion.
I analyzed my case and considering all these points I diagnosed my case as Acute viral hepatitis caused by the Hepatitis A virus.