Anti

Anti- Hcv antibodies:- by ELISA or RIA detected After 5-6* .week of infection .Hcv RNA : by PCR detected after 2weeks of infection* .other investigations : as H B V -3

Hepatitis D virus -: Hepatitis D Markers HDV RNA : by PCR* :Anti – HDV antibodies* .Igm denotes recent infection .IgG denotes previous infection .HBS Ag is positive * Hepatitis E virus -:Anti – HEV antibodies .IgM denotes recent infection .IgG denotes previous infection

-:Treatment Hepatitis A virus Rest in bed : is advised until the patient becomes symptom -1 free, the liver is no longer tender & serum bilirubin is less than .1.5 mgidl -:Diet -2 High carbohydrate & protein diet is given for regeneration to .occure Proteins should be restricted if manifestations of liver failure .appear Low fat diet is usually preferred if nausea is marked.Vitamins especially A, C, E, Antioxidant effect-: Symptomatic treatment -3 .Antiemetics E.G. domperidone for nausea & vomiting .cholestyramine for pruritis -:Treatment of complications -4 .E.G. steroids may be used in cholestatic hepatitis Hepatitis B virus Treatment in general is made as described for hepatitis A. ,interferon, adenine arabinoside Cartcosteroids & azathioprine alone & in combinations

.May have a role to improve the chronic active carriers The response occure in about 50% of patients. When the drug is .stopped, 50% of responding patients experience a relapse Hepatitis C virus .Only the general measures like that of VBH must be followed Immunoglobuline is not effective as immunotherapy. .Interferone may be useful in chronic active carriers Hepatitis D virus .No specific treatment for delta hepatitis -: Prevention & control Hepatitis A virus .Maintenance of good sanitary conditions -1 Passive immunization with pooled human gamma globulin-2 gives some protection for several monthes. Its recommended for military persons or persons going into areas where poor .sanitation exists Hepatitis B virus -:A) General measures Avoidance of contaminated instruments when cutting tissues -1 .or injecting medications Avoid transfusing blood that may contain HBV. Detect the -2 prescence of HBV in the blood of donors using RIA or ELISA .tests -:B) Specific measures seroprophylaxis using hepatitis B immunoglobulin that gives -1 :protection for 6-8 monthes. This immunoglobulin is applied for prevention of post – transfusion jaundice, in high risk* .individuals .personel who have accidentaly handeled infected blood* Neonates of HBS Ag – positive mothers: given 0.5 Ml, IM,* within 24 hours of birth, & at 3& 6 monthes, to reduce the .incidence of carriers & hepatoma later in life N.B. Immuno globulins must be virus – free or sterilized by .ultraviolet radiation -: Active immunization -2

Hepatitis B vaccine is highly immunological, giving effective neutralizing Abs in 96% of cases. The vaccine is given to -:special high risk groups personnel exposed to the risk of professional infection on * .providing laboratory, surgical, dental or other medical sevices .Medical & paramedical students on starting hospital training* Cases of lowered body resistance & immune response, when in* .Need of repeated blood transfusion N. B. vaccination is achieved in Egypt at 2nd , 4th & 6th monthes after birth. This, according to the international role, gives .protection for 10 years Hepatitis C virus Only the general measures like that of VBH must be followed. No available vaccine. Immunoglobulin is not effective either as immunotherapy or immunoprophylaxis, however its given to .workers of high risk Hepatitis D virus General measures & vaccination against HBV protect against .delta virus infection .N. B -:clinical picture of chonic hepatitis * -:Symptoms .may be asymptomatic ,Non – specific symptoms: as fatigue, food intolerance anorexia.Abdominal discomfort Hepatic manifestations: as pain in right hypochondrium .jaundice & features of liver failure which appear lately -:Signs .The liver is enlarged, firm & tender but later may be shrunken .The spleen is usually enlargedSigns of liver failure (e. g. jaundice, ascitis, oedema, &.encephalopathy )are late features .signs of portal hypertension are also late-

:Liver imaging-3 .e. g. Abdominal ultrasonography shows diffuse hepatomegaly -: Blood picture -4 .Leucopenia with relative lymphocytosis -: urine analysis -5 .Bilirubin & bile salts are present .Urobilinogen is variable .There may be slight protheinuria -: stool analysis -6 pale stools & may be features of steatorrhea .Decreased strcobilinogen -