Friends today I am discussing about Hepatitis. Hepatitis Hepatitis is the inflammation of the liver. The most common cause for hepatitis is viruses. Other causes may include excessive alcohol use, certain medications, toxins, other infections, and autoimmune diseases. Types of Hepatitis Hepatitis is mainly of five types that are caused by a virus, A, B, C, D, and E. These can be commonly determined by a laboratory test. Hepatitis types A, C, D, and E is caused by viruses that have a core of ribonucleic acid (RNA). While virus responsible for hepatitis B has a DNA core. Causes of Hepatitis • Hepatitis A and E are mainly spread by contaminated food and water. Hepatitis A is also called infectious hepatitis as it is very highly contagious disease, but it is rarely fatal. • Hepatitis B spreads through sexually transmission, but may also be passed from mother to baby during pregnancy or childbirth. Hepatitis B is also called as viral hepatitis. It can be severe and often leads to liver cirrhosis. Hepatitis B may commonly transmit through transfusions of contaminated blood. • Both hepatitis B and hepatitis C are commonly spread through infected blood like during sharing of the needle by intravenous drug users. Complications of Hepatitis C can lead to chronic hepatitis, cirrhosis, or liver failure. • Hepatitis D can only infect people already infected with hepatitis B. Hepatitis D is the most serious and also the rarest form of viral hepatitis. Many cases of hepatitis D are fatal, and most chronic cases lead to cirrhosis. • Hepatitis E often occurs in epidemics that can be linked to poor hygiene and contaminated water. Pregnant women can be at risk due to infection by Hepatitis E. The disease has been reported almost exclusively in developing countries. Symptoms of hepatitis Many people with hepatitis experience either mild symptoms or none at all. Symptoms may not occur until liver damage occurs. Acute hepatitis - The initial phase of hepatitis is called the acute phase. The symptoms may include: • Diarrhea • Fatigue • Loss of appetite • Mild fever and flu-like symptoms • Muscle or joint aches • Nausea & Vomiting • Pain in abdominal • Unexplained Weight loss. Chronic hepatitis-- The acute phase is not usually dangerous, but it may develop into the fulminant type of hepatitis which is a very serious stage and can lead to death. As the patient gets worse, these symptoms may follow: • Portal Circulation problems • Dark urine • Dizziness & Drowsiness (only toxic/drug-induced hepatitis) • Enlarged spleen (only alcoholic hepatitis) • Headache • Hives with or without Itching of skin • Clay-colored stool, which may contain pus • Yellow skin, whites of eyes, tongue (jaundice). Complications of Hepatitis Fibrosis - One of the most common complications of chronic hepatitis is fibrosis, which is a type of scarring of the liver. Due to constant inflammation, the liver is damaged and creates the scar tissue to repair itself. Cirrhosis of the liver - Extensive fibrosis is called cirrhosis. There are many causes for Liver cirrhosis, but alcoholic hepatitis and Hepatitis C is the common. Cancer of the Liver - One of the complications of cirrhosis is liver cancer, which are usually two types. First is hepatocellular carcinoma, where liver cells are affected. The other type is cholangiolar carcinoma, which affects the bile ducts. Liver Failure - Liver failure is a serious, but uncommon, complication of hepatitis. In this condition, function of the liver stopped and this leads to the body shutting down, and eventually, death. Glomerulonephritis - Glomerulonephritis is a kidney disorder caused by inflammation of nephrons and is seen in chronic hepatitis B and hepatitis C infections. Cryoglobulinemia - Seen in chronic hepatitis B and hepatitis C infection, cryoglobulinemia is an uncommon disease caused by an abnormal cluster of a kind of protein that blocks small blood vessels leading to circulation problems. Hepatic Encephalopathy - Severe loss of liver function, such as liver failure, can lead to inflammation in the brain called encephalopathy. This causes mental problems, like confusion, and can lead to coma. Portal Hypertension - One of the liver's important jobs is to filter blood. When this portal system is blocked due to liver cirrhosis and other problems, blood can't return to the liver from the digestive system and pressure increases. This is called portal hypertension and it is a serious complication and can be fatal. Porphyria - Porphyria is a group of diseases caused by problems processing important chemicals in the body called porphyrins. One type, called porphyria cutanea tara, leads to blistering of the hands and face and is a rare complication of chronic hepatitis C infection. Viral Co-Infection - A challenging complication of hepatitis is the possibility of having two viral infections at the same time. A common with co-infection with hepatitis is the human immunodeficiency virus (HIV). Other common co-infections are with the hepatotropic viruses, named A through E. This type of Co-infections can be fatal. Diagnosis • Complete blood count • Liver function Test • Laboratory test to identify virus in blood • Bleeding time • Clotting time • Imaging- Ultrasonography, CT- scan, MRI • Liver biopsy Homoeopathy in the treatment of Hepatitis and other liver problem Homeopathy provides a very effective and safe treatment for Hepatitis and other liver disorders. It relieves the discoloration of the skin, mucous membrane, and sclera. These medicines strengthen the liver and metabolic system. The aim of homeopathy is not only to treat Hepatitis infection but It works by treating the underlying cause and not just the symptoms. The treatment is gentle and the relief obtained is usually long term. There are many homoeopathic medicines that have the potential to cure Jaundice. Out of them, few are – Andrographis Paniculata - Useful in resistant jaundice. Useful in Hepatitis B and C. It is found useful when Chelidonium Majus does not help. Arsenic Album - Where hepatitis results from bad food or food poisoning, Arsenic Album is the best Homeopathic medicine. There is burning pain in the liver which gets better with warm drinks. Aurum Metallicum - Very effective for jaundice during pregnancy. Distension of epigastrium with increased thirst and appetite, followed by burning sensation and hot eructations. Carduuas Marianus - Carduus Marianus is a very effective remedy for liver cirrhosis with general edema. There is engorged and laterally swollen liver, which gets worse from pressure. Jaundice. Carica Papaya - Hepatomegaly and splenomegaly associated with fever, dyspepsia and indigestion. Constipation is marked feature of this remedy. Intolerance to milk even small amount may lead to pain. Chelidonium - Chelidonium is very effective in treating an enlarged liver with tenderness. Hepatomegaly with bilious complications. Dull, throbbing pain in the region of the liver is also best treated with Chelidonium. Jaundice due to hepatic and gallbladder obstruction. Pain aggravation on eating. Marked desire for hot food and drinks Chionanthus - Chionanthus is very effective in chronic cases of jaundice, which recur every summer. The symptoms include an enlarged liver, constipation, clay-coloured stools and very yellow skin. Crotalus Horridus - Crotalus Horridus is used to treat jaundice cases where the entire body has gone yellow. Pain in the liver, coldness, Constant nausea and vomiting. Jaundice with haemorrhagic manifestations. Atonic dyspepsia. Complications arise from a blood transfusion. Lachesis - Lachesis is very effective for liver complaints largely among alcoholics. In cases where the liver region is very sensitive and a person can’t bear anything around the waist, Lachesis is one of the most effective Homeopathic medicines for fatty liver. Sensitiveness of right hypochondrium, hazards of blood transfusion. Lycopodium - Hepatitis, the atrophic form of nutmeg liver. Shooting pain across lower abdomen from right to left. Excessive flatulence. Bread aggravates. The desire for sweet and warm things. Natrum Sulpuricum - Natrum Sulphuricum is one of the great Homeopathic medicines for liver problems like jaundice where the symptoms include a liver region that is sensitive, tender and sore to the touch. Vomiting bile is another indicator. Nux Vomica - Hepatitis associated with constipation. Liver enlarged with stitches and soreness. Alcoholic liver. Phosphorus - Acute hepatitis. Fatty degeneration of liver, cirrhosis, and jaundice associated with the pancreatic disease. Suppuration with hectic night sweats, enlargement, and marked soreness. Podophyllum - Chronic relapsing hepatitis. History of repeated jaundice. Pain in right hypochondrium. Not well since the first attack of hepatitis. Irritable temperament with suicidal tendency.

A 22 year old female married for 2.5 months presented to ER with fever since 8 days low to moderate grade, intermittent.and yellowish discolouration of sclera and skin since 3/4 days and altered sensorium since 1 day. On examination: Vitals normal Pallor + Icterus +++ Rest GPE wnl Patient deeply comatosed E1V1M1 No neck rigidity no kernigs. Planter b\l flexor Liver just palpable ( span 11.5 cm) On enquiring her husband and mother, there is history of ayurvedic medicine intake for a month bt that too 2 months back for lump in left breast which seems to be a lipomatous 0.5*0.5 cm swelling. Lmp was 1.5 mnth back. History if rats in house is there. No major prev illness Husband told that she developed rashes on day 1 and 2 and as per description were maculopapular but no scars are seen now. LMP 1.5 month back UPT negative. Leptospira igM sent, hbsag hcv awaited. Reat reports attached. Started ceftriaxone , doxycycline, ppi, emset, ivf, lactulose, rt feed. Kindly give your valuable opinion for further plan.

A 45 year old female presented to OPD with complaints of generalised weakness, tremors in hand *History* She also adds that she had history of heat coming out from palms and soles *Vitals* BP 126/97 PR 112/min *Physical Examination* Conjunctival icterus is present *Investigations* HBsAg, HCV is negative *Management* 1) The probable cause of Jaundice? Is it the inflammation of GB? Should we get her checked for Hep A and Hep E? 2) Can propranolol along with Carbimazole be given for a jaundice patient on UDCA? I have started her on following - Tab Neomercazole 10 TDS PPI + Prokinetic Usibon 300 BD Liv 52 DS BD Ciplar LA 20 BD Seder OM at bedtime Syp Lactulose 10ml at bedtime Syp Vit D 60k daily for 5 days Give your valuable suggestions on this case

WORLD'S FIRST HUMAN CASE OF RAT DISEASE FOUND IN HONG KONG. September 28, 2018. A Hong Kong man has developed the WORLD'S FIRST EVER HUMAN CASE OF the RAT VERSION of the HEPATITIS E VIRUS, according to new research from one of the city's leading universities. There had PREVIOUSLY been NO EVIDENCE the disease could jump from rats to humans, the University of Hong Kong said Friday, WARNING the DISCOVERY HAD "MAJOR PUBLIC HEALTH SIGNIFICANCE". "This study CONCLUSIVELY PROVES for the first time in the world that RAT HEV CAN INFECT HUMANS TO CAUSE CLINICAL INFECTION," the university added. RAT HEPATITIS E VIRUS IS VERY DISTANTLY RELATED TO HUMAN HEPATITIS E VIRUS VARIANTS, HKU said. The DISEASE was FOUND IN A 56-YEAR-OLD MAN who persistently produced abnormal liver function tests FOLLOWING A LIVER TRANSPLANT. He COULD have CONTRACTED the ILLNESS THROUGH FOOD INFECTED BY RAT DROPPINGS, researchers said, according to details of the findings reported in the South China Morning Post. The man lived in a housing estate where there were SIGNS OF RAT INFESTATION OUTSIDE HIS HOME. HE IS NOW RECOVERING after being treated for the virus, the SCMP added. The HUMAN version of HEPATITIS E is a liver disease that AFFECTS 20 MILLION PEOPLE GLOBALLY EACH YEAR, according to the World Health Organisation. It is usually SPREAD THROUGH CONTAMINATED DRINKING WATER. SYMPTOMS include fever, vomiting and jaundice, and in rare cases liver failure. Rodent problems in Hong Kong have escalated in recent months because of a sustained spell of hot and humid weather. HONG KONG has been hit hard by disease OUTBREAKS IN THE PAST. In 2003, almost 300 people died from SARS—severe acute respiratory syndrome. The BUBONIC PLAGUE, carried by rats, swept through mainland China and Hong Kong in the late 19th century killing thousands. $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ The presence of the rat version of hepatitis E in a human is of "major public health significance", researchers say. ________________________________ AFP 09:34, UK, Friday 28 September 2018. ________________________________ IMAGE : 1 Credit: CC0 Public Domain. ________________________________ IMAGE : 2 There were signs of a rat infestation outside the patient's home. File pic. ***************************×**************************

Case Challenge of the day: A previously healthy 50 y/o male presented with a 2-week history of malaise, anorexia and worsening abdominal pain, which progressed to nausea, vomiting and scleral icterus. He initially attributed his symptoms to an influenza-like syndrome; however, he became alarmed when he developed dark urine and generalized jaundice. The patient had no known personal or family history of liver disease. No history of any medications. He denied any changes in his diet or use of alcohol, tobacco or illicit drugs, but endorsed drinking 4–5 energy drinks daily for 3 weeks prior to presentation. . He did get a tattoo in his 20s, but denied any transfusions of blood products or high-risk sexual behavior. On physical examination, the patient had normal vital signs, scleral icterus and jaundice. Abdominal examination was remarkable for right upper quadrant (RUQ) tenderness, but there was no ascites, asterixis, spider angiomata or other signs of chronic liver disease. Laboratory studies revealed normal renal function. Rest you can see in the image. What do you think is the diagnosis and management of this case? Reference: www.ncbi.nlm.nih.gov