Hepatitis PROPHYLAXIS and Hepatitis TREATMENT and Management

Hepatitis PROPHYLAXIS and Hepatitis TREATMENT and Management

Hepatitis PROPHYLAXIS

• Prevention is through immunizationHow to Manage Hay Fever at Home. Read more ... »

Hepatitis A prophylaxis

• Passive immunization with IG
• Active immunization with killed vaccines
• 1. Passive immunization is given before exposure or during early incubation period.
• 2. Post exposure prophylaxis – 0.02 ml/kg IgG is given after exposure as soon as possible. It is effective up to 2 weeks after exposure.
• 3. If a person is traveling to developing countries 0.02 ml/kg IgG is given.
• 4. For more than 3 months- 0.6 ml/kg is given ev­ery 4 months.
• 5. Vaccines of HAV are safe and effective and pro­tection lasts about 20 yrs.

Hepatitis B prophylaxis

• 1. Passive immunoprophylaxis with IgG – hepatitis BViruses General Introduction To VIRAL DISEASES Diagnosis Treatment with Causative Agents. Read more ... » immune globulin.
• 2. Active immunization with recombinant vaccine
• 3. For pre-exposure prophylaxis 3 intramuscular deltoid injections of hepatitis B vaccine are given at 0, 1 and 6 months. The injection is not given in the gluteal region. All the children up to the age of 18 yrs m ust be vaccinated.
• 4. All the persons at risk of exposure to blood must be vaccinated.
• To recombinant hepatitis B vaccines are:
• 1. Recombivax HB – 10 ~gm of HBsAg
• 2. Engerix B – 20 ~gm of HBsAg
• Protection after vaccination is for approximately 10 years.

Hepatitis D prophylaxis

• Hepatitis DHepatitis Types Causes Symptoms Diagnosis and Treatment. Read more ... » is prevented by vaccination with hepatitis . B vaccine.

Hepatitis C prophylaxis

• IG is ineffective.
• Hepatitis C is prevented by :
• 1. Screening of all blood donors.
• 2. Avoid contact with infected persons’ secretions and blood .
• . 3. Hepatitis C patients should not share tooth­brushes, nail clippers, razors.

Hepatitis E prophylaxis

• Recombinant vaccine is under trial.

Hepatitis PROPHYLAXIS and Hepatitis TREATMENTCARDIAC TAMPONADE Causes with Physical findings and Treatment. Read more ... » and ManagementChronic Renal Failure (CRF) Risk factors Causes Stage CRF Treatment. Read more ... »

PROGNOSIS of Hepatitis

• Hepatitis A patients recovers completely.
• In hepatitis B healthy adults recovery completely. In hepatitis B prognosis is bad if :
• · Patient is aged
• · Patient has ascites
• · Peripheral edema
• · Hepatic encephalopathyCirrhosis and COMPLICATIONS of CIRRHOSIS with Treatment. Read more ... »
• · Prolonged PT
• · Low serum albumin
• · Hypoglycemia
• · High serum bilirubin
• Such patients must be hospitalized. Hepatitis C is less severe than hepatitis B.
• In patients of hepatitis Band D mortality is higher than other types of hepatitis.

COMPLICATIONS AND SEQUELAE of Hepatitis

• In hepatitis A there may be a relapse after weeks or months.
• In hepatitis A there may be cholestatic hepatitis. But hepatitis A is self-limited.
• In hepatitis B there may be a serum sickness like syndromeMetabolic,Insulin Resistance Syndrome X Causes Symptoms. Read more ... » with arthralgia high feverHow to Manage Hay Fever at Home. Read more ... », rash, an­gioedema, proteinuria, hematuriaDIAGNOSIS and Investigations OF SECONDARY HYPERTENSION. Read more ... ». ALT and AST are elevated. Serum HBsAg is positive.
• In hepatitis C there may be porphyriaPorphyrias Inherited disorders Causes Classifications Diagnosis and Treatment. Read more ... » cutanea and lichen planus.
• Most serious complicationHyperglycemic Hyperosmolar State (HHS) Acute Complication Of DM. Read more ... » of viral hepatitis is fulmi­nant hepatitis or massive hepatic necrosis. It is seen in hepatitis B, D and E, Most common in hepatitis B and rarest in hepatitis E.
• Fulminant hepatitis is common in pregnancy.
• In fulminant hepatitis there is encephalopathy, con­fusion, disorientation, somnolence, ascites, edema, cerebral edema, GI bleeding, sepsisSepsis (Septic Shock) Definition Diagnosis and Pathophysiology. Read more ... », respiratory fail­ure, altered consciousness, small liver, increased PT, increased bilirubin level, (but SGOT, SGPT may fall), cardiovascular collapseCardiac Arrest Causes Symptoms Features and Management. Read more ... », renalDiabetic Nephropathy and Renal complications of DM (Diabetes Mellitus). Read more ... » failure and death. When patients go into deep coma, mortality is very high.
• Liver transplant may be life saving in fulminant hepa­titis.
• 10% of patients remain positive for HBsAg for more than 6 months after acuteCARDIAC TAMPONADE Causes with Physical findings and Treatment. Read more ... » hepatitis B. 50% of these become HBsAg negative in some years.
• Acute hepatitis B leads to chronicChronic Hepatitis Classification viral hepatitis Clinical features and Treatment. Read more ... » hepatitis and there is persistent anorexia, weight loss, fatigueFatigue diagnosis medicine and treatment. Read more ... », hepatome­galy, bridging hepatic necrosis, high bilirubin and SGPT levels more than 6 months and upto 1 year.
• Rare complications are pancreatitis, myocarditisMYOCARDITIS Physical Examination Symptoms Clinical Manifestations Diagnosis. Read more ... », aplastic anaemiaAplastic Anaemia Causes Symptomes Diagnosis And Treatment. Read more ... », transverse myelitis, peripheral neu­ropathy, hepatocellular carcinoma.
• Hepatitis Band C is common in HIVAIDS Acquired Immunodeficiency Syndrome Diagnosis Signs and Symptoms with Treatment. Read more ... » patients.

Hepatitis TREATMENT

Treatment of Acute Attack of Hepatitis

• In hepatitis B, if patient was healthy before acute hepatitis, recovery occurs in 99% persons.
• No antiviral therapy required.
• Some physicians like to give in acute hepatitis B, Lamivudine 100 mg/day oral.
• In hepatitis C recovery usually does not occur and it progresses to chronic hepatitisChronic Hepatitis Classification viral hepatitis Clinical features and Treatment. Read more ... ».
• In such cases antiviral therapy with interferon alpha 5 million units subcutaneous daily for 4 weeks then 3 times a week for another 20 weeks· results in nearly 100% response.
• For chronic hepatitis CChronic Hepatitis Classification viral hepatitis Clinical features and Treatment. Read more ... » long acting pegylated in­terferon plus Ribavirin is given.
• Patients with chronic hepatitis C are rare.
• In health workers who get hepatitis C due to contaminated needles therapy should be started immediately.
• Most patients of acute hepatitis do not require hospital admission. Physical activity should be restricted.
• High calorie diet is given especially in the morn­ing.
• If patient has vomitingNausea and Vomiting. Read more ... », IV fluids are given for severe itching (pruritus), Cholestyramine the bile salt binding resin is given.
• Steroids (glucocorticocoid) should not be given. Isolation of patient is not required except if :
• 1. Patients have fecal incontinence
• 2. Severe bleeding in hepatitis Band
• 3. Hepatitis C patients with bleeding.
• Gloves should be used by all those handling stools of hepatitis patients.
• Gloves should be used for people handling blood and body fluids of hepatitis Band C patients.
• Hands should be washed thoroughly when nurs­ing hepatitis patients.
• Patients’ are discharged from hospital when:
• 1. There is symptomatic relief
• 2. Serum aminotransferase (AST and ALT) falls down ‘\
• 3. Serum bilirubin falls down
• 4. Prothrombin time returns to normal.

MANAGEMENT OF FULMINANT HEPATITIS

• 1. Maintain fluid balance
• 2. Support of circulation
• 3. Support of respiration
• 4. Control of bleeding
• 5. Treat hypoglycemia
• 6. Management of comatose patient
• 7. Diet – protein restriction, plenty of carbohydrates
• 8. Oral lactulose or neomycin
• 9. Therapies like sterOid, exchange transfusion,
• plasmapharesis are not effective.
• 10. Liver assist devices are under trial
• 11. Intensive care management
• 12. Liver transplantation gives excellent results.

Complementary & Alternative Hepatitis Therapies

• No medicalDizziness cause diagnosis treatment. Read more ... » evidence exists for using herbal or alternative therapy in HCV/cirrhosis/HCC
• Milk thistle (silymarin) generally safe and may reduce ALT but does not eradicate virus nor improve outcomes; avoid while on IFN.
• Rate of HCC tripled in patients on herbal therapy compared to IFN therapy