HEPATITIS VIRUS

Paramedic Lecture GI Emergencies

HEPATITIS
Involves any injury to hepatocytes associated with an inflammation or infection. Five viruses: A, B, C, D, and E Alcoholic hepatitis, arises from alcoholic cirrhosis, rather than an infectious agent. Factors that increase the risk of contracting hepatitis include: unsanitary living conditions, poor personal hygiene that invites oral-fecal transmission, exposure to blood borne pathogens, and chronic alcohol intake.
Paramedic Lecture GI Emergencies

HEPATITIS
Any of the viral pathogens, alcoholic exposure, or trauma can injure the hepatocytes, causing inflammation and, possibly, chronic liver disease. Whatever the cause, results are similar: enlargement and hypertrophy, fatty changes, loss of architecture, and appearance of lesions and spontaneous hemorrhages. Symptoms range from mild to liver failure and death.

Paramedic Lecture GI Emergencies

Hepatitis A
Hepatitis A is probably the best known. Commonly referred to as infectious hepatitis. Spreads by oral-fecal route. Disease is self-limiting. Lasting between 2-8 weeks. Low mortality rate.

Paramedic Lecture GI Emergencies

Hepatitis B
Hepatitis B known as Serum Hepatitis. Blood borne pathogen that can stay active in bodily fluids outside the body for days. 310 million carriers worldwide, HBV is an epidemic. Effects may be minimal, but can range to severe liver ischemia and necrosis.

Paramedic Lecture GI Emergencies

Treatment
Interferon - for HBeAg +ve carriers with chronic active hepatitis. Response rate is 30 to 40%.
- alpha-interferon 2b (original) - alpha-interferon 2a (newer, claims to be more efficacious and efficient)

Lamivudine - a nucleoside analogue reverse transcriptase inhibitor. Well tolerated, most patients will respond favorably. However, tendency to relapse on cessation of treatment. Another problem is the rapid emergence of drug resistance. Adefovir less likely to develop resistance than Lamivudine and may be used to treat Lamivudine resistance HBV. However more expensive and toxic. Entecavir most powerful antiviral known, similar to Adefovir Successful response to treatment will result in the disappearance of HBsAg, HBV-DNA, and seroconversion to HBeAg.
Paramedic Lecture GI Emergencies

Hepatitis C
Hepatitis C caused by the pathogen most commonly responsible for spreading hepatitis through blood transfusions. Marked by chronic and often debilitating damage to the liver.

Paramedic Lecture GI Emergencies

Treatment
Interferon - may be considered for patients with chronic active hepatitis. The response rate is around 50% but 50% of responders will relapse upon withdrawal of treatment. Ribavirin - there is less experience with ribavirin than interferon. However, recent studies suggest that a combination of interferon and ribavirin is more effective than interferon alone.

Paramedic Lecture GI Emergencies

Hepatitis D & E
Hepatitis D less common disorder because its pathogen is dormant until activated by HBV. Hepatitis E is a waterborne infection that has caused epidemics in Africa, Mexico, and other third-world nations. Mortality rate for pregnant women is high.

Paramedic Lecture GI Emergencies

Paramedic Lecture GI Emergencies

HEPATITIS
Commonly present with symptoms relative to the severity of their disease. Complain of URQ abdominal tenderness, not relieved by antacids, food, or positioning. May lose their appetite and become anorexic, usually losing weight. Decrease in bile production changes their stool to a clay color, and increased bilirubin retention causes jaundice, yellow coloring of the skin, and scleral icterus, yellowing of the white of the eyes.
Paramedic Lecture GI Emergencies

HEPATITIS
Other signs and symptoms include severe N/V, general malaise, photophobia, pharyngitis, and coughing. Exam will reveal a sick patient, possibly with a jaundiced appearance. Pain may present in URQ or the right shoulder. Fever may be secondary to infection or to tissue necrosis.

Paramedic Lecture GI Emergencies