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Diffrensial diagnosis of viral and alcoholic hepatitis

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Shivansh Malik

This document discusses the differential diagnosis of viral and alcoholic hepatitis. It outlines the clinical manifestations, modes of transmission, diagnostic tests, and treatment approaches for different types of viral hepatitis (A, B, C, D, E) and alcoholic hepatitis. Key diagnostic tests for viral hepatitis include serological studies, antigen testing, PCR for viral DNA levels, and liver function tests. Treatment depends on the specific type and severity, and may include antiviral medications, lactulose, frozen plasma, steroids, or liver transplantation in cases of fulminant hepatitis.

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By-SHIVANSH 8TH SEM GROUP 1 UNIVERSITY GEOMEDI DIFFERENTIAL DIAGNOSIS OF VIRAL & ALCOHOLIC HEPATITIS
INTRODUCTION Inflammatory Disease - Mostly asymptomatic. Acute and Chronic (6 MONTHS). Caused by- Hepatitis virus A,B,C,D,E -Heavy alcohol use, genetic, autoimmune,some other infections. Vaccination 3 Dose needed. Complication- Coinfection, Super infection, Fluminant hepatitis Liver cirrhosis, Liver failure.
CLINICAL MANIFESTATION Poor appetite Nausea & Vomiting Fatigue & Tiredness Right upper Quadrent pain Portal hypertension Jaundice Diarrhea Encephalopathy & Coagulopathy
Diffrensial diagnosis of viral and alcoholic hepatitis
VIRAL HEPATITS A & E Spread via Fecal oral Root. B & C via sexual or blood contamination. D Stands only with preexisting B. Precore mutant virus- in Europe & Russia.
Diagnosis for Viral Hepatitis Serological Study Antigen testing for HBsAg , HBcAg , HBeAg , HCV, HBxAg. PCR HBV/HCV DNA (>20000 IU/ml) LFT (Ratio of SGPT to SGOT >1 ) Ultra sonography- echo texture and span of liver. (Starry sky liver with increased span)
HBsAg+ IGM anti HBc+ HBsAg+ IgG anti HBc IgM anti HBc+ Anti HBsAg+ IgG anti HBcAg Acute Hapetitis B. Cronic Hepetitis B. Gap period. Vaccinated Remote Inf. Or Low level carrier
Diffrensial diagnosis of viral and alcoholic hepatitis
Fulminant Hepatitis IgM anti HBcAg + IgM anti HDV Ag IgG anti HBcAg + IgM anti HDV Ag Features- Encephalopathy Coagulopathy MELD score for transplantion (>17) (Bilirubin, PT, S. Creatinine) COINFECTION SUPERINFECTION/FULMINANT
Alcoholic Hepatitis 20 % cases of total , Male-160 gm/day , Female-20 gm/day . HCV, Genetics, Obesity. Macro vesicular fat deposition. Mallory hyaline bodies. Features-Right upper quadrant pain,nausea,vomiting,jaundice absent -Portal hypertension, splenomegaly, Caput medusa. -
Diagnosis for alcoholic Hepatitis SGOT (MOST SPECIFIC) 2-7 TIMES ELEVATED SAP (S.alkaline phosphate)Increased Ultrasonography (echo texture,portal reversal flow) PT Elevated MADDREYS/Discriminant score (>21 start treatment) {4.6*(pt above normal limit)+s.bilirubin} Glasgow Alcoholic hepatitis score (Age, wbc count, bilirubin, pt, BUN)
Treatment Hepatitis B if HBeAg+, PCR DNA = >20000IU/ml +SGPT*2 times - Tenofovir(300mg/day*48week) /Entecavir. Fulminant Hepatitis - Lactulose (NH3 binder) ,Rifaximine(bacteriostatic) - enema ,IV L.O.L.A(Ormithine and aspartate for urea formation -IV 10% glucose, Frozen plasma ( vitamin k not helpful) Alcoholic Hepatitis- PREDNISOLONE (3mg/day*4 week) -Naltrexone(deaddiction) -TNF A INHIBITOR
Diffrensial diagnosis of viral and alcoholic hepatitis

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Diffrensial diagnosis of viral and alcoholic hepatitis

  • 1. By-SHIVANSH 8TH SEM GROUP 1 UNIVERSITY GEOMEDI DIFFERENTIAL DIAGNOSIS OF VIRAL & ALCOHOLIC HEPATITIS
  • 2. INTRODUCTION Inflammatory Disease - Mostly asymptomatic. Acute and Chronic (6 MONTHS). Caused by- Hepatitis virus A,B,C,D,E -Heavy alcohol use, genetic, autoimmune,some other infections. Vaccination 3 Dose needed. Complication- Coinfection, Super infection, Fluminant hepatitis Liver cirrhosis, Liver failure.
  • 3. CLINICAL MANIFESTATION Poor appetite Nausea & Vomiting Fatigue & Tiredness Right upper Quadrent pain Portal hypertension Jaundice Diarrhea Encephalopathy & Coagulopathy
  • 5. VIRAL HEPATITS A & E Spread via Fecal oral Root. B & C via sexual or blood contamination. D Stands only with preexisting B. Precore mutant virus- in Europe & Russia.
  • 6. Diagnosis for Viral Hepatitis Serological Study Antigen testing for HBsAg , HBcAg , HBeAg , HCV, HBxAg. PCR HBV/HCV DNA (>20000 IU/ml) LFT (Ratio of SGPT to SGOT >1 ) Ultra sonography- echo texture and span of liver. (Starry sky liver with increased span)
  • 7. HBsAg+ IGM anti HBc+ HBsAg+ IgG anti HBc IgM anti HBc+ Anti HBsAg+ IgG anti HBcAg Acute Hapetitis B. Cronic Hepetitis B. Gap period. Vaccinated Remote Inf. Or Low level carrier
  • 9. Fulminant Hepatitis IgM anti HBcAg + IgM anti HDV Ag IgG anti HBcAg + IgM anti HDV Ag Features- Encephalopathy Coagulopathy MELD score for transplantion (>17) (Bilirubin, PT, S. Creatinine) COINFECTION SUPERINFECTION/FULMINANT
  • 10. Alcoholic Hepatitis 20 % cases of total , Male-160 gm/day , Female-20 gm/day . HCV, Genetics, Obesity. Macro vesicular fat deposition. Mallory hyaline bodies. Features-Right upper quadrant pain,nausea,vomiting,jaundice absent -Portal hypertension, splenomegaly, Caput medusa. -
  • 11. Diagnosis for alcoholic Hepatitis SGOT (MOST SPECIFIC) 2-7 TIMES ELEVATED SAP (S.alkaline phosphate)Increased Ultrasonography (echo texture,portal reversal flow) PT Elevated MADDREYS/Discriminant score (>21 start treatment) {4.6*(pt above normal limit)+s.bilirubin} Glasgow Alcoholic hepatitis score (Age, wbc count, bilirubin, pt, BUN)
  • 12. Treatment Hepatitis B if HBeAg+, PCR DNA = >20000IU/ml +SGPT*2 times - Tenofovir(300mg/day*48week) /Entecavir. Fulminant Hepatitis - Lactulose (NH3 binder) ,Rifaximine(bacteriostatic) - enema ,IV L.O.L.A(Ormithine and aspartate for urea formation -IV 10% glucose, Frozen plasma ( vitamin k not helpful) Alcoholic Hepatitis- PREDNISOLONE (3mg/day*4 week) -Naltrexone(deaddiction) -TNF A INHIBITOR