Hepatitis B

Hepatitis B

1. a viral infection of the liver

   • anatomy of the liver
     • hepatobiliary system
   • physiology of the liver
     • Blood reservoir
       • recieves dual blood supply from portal vein and hepatic artery
     • metabolism
       • Glucose regulation - fatty acid synthesis - transamination
     • detoxification
       • removal of ammonia and drugs
     • storage site
       • Vitamen A-Vitamen B12-Iron
   • Diagnosis and lab investigations
     • serology
   • signs and symptoms
     • mainly jaundice
       • types
         • Pre-hepatic
           • +++ RBC's destruction
             • +++ unconjugated bilirubin
               • casues
                 • hemolytic anemia
                 • thalassemia
                 • physiological jaundice
                 • dark urine - normal stool
         • hepatic
           • Liver disease
             • ++ conjugated and unconjugated bilirubin
               • causes
                 • hepatitis
                 • alcoholic liver disease
                 • liver cancer
               • ++ AST-ALT /dark urine/ clay stool
         • post-hepatic
           • decrease flow of bile (obstruction)
             • +++ conjugated bilirubin
               • casues
                 • gallstones
                 • tumor head of pancreas
                 • bile duct cancer
               • +++ ALP/dark urine/clay stool
   • treatment
     • antiviral drugs
       • adefovir
       • lamivudin
       • entacavir
       • pegylated Interferon
   • epidemiology
     • A
       • Developing countries with poor sanitary conditions and hygienic practices
     • B
       • Western Pacific Region and the WHO African Region
     • C
       • Eastern Mediterranean and European Regions
     • D
       • Mediterranean, Middle East, Pakistan, Central and Northern Asia, Japan
     • E
       • Resource-poor areas with frequent water contamination-Areas with safe drinking water supplies
   • General charecteristics of viruses
     • DNA
       • enveloped
         • HepaDNA
           • Hepatitis B
             • disease course
               • Acute infection
                 • 90% resolution
                 • 1% fulminant hepatitis
                 • 9% becomes chronic
                   • resolution
                   • Asymptomatic carrier
                   • chronic persistent hepatitis
                   • chronic active hepatitis
       • naked capsid
     • RNA
       • +
         • enveloped
           • Flavi
             • hep C
         • naked capsid
           • pico
             • Hep A
           • Calici
             • Hep E
       • -
       • +/-
       • + via DNA
   • physiology of extrahepatic biliary system

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