Hepatitis Clinical manifestation, Jaundice

Bilirubin. Jaundice is the clinical manifestation of hyperbilirubinaemia. A raised level of uncongugated bilirubin occurs when there is excessive breakdown of red blood cells, for example in haemolytic anaemia, or where the ability of the liver to conjugate bilirubin is compromised, for example in cirrhosis. A raised blood level of congugated bilirubin occurs in various liver and bile duct conditions. It is particularly high if the flow of bile is blocked, for example by a gallstone in the common bile duct or by a tumour in the pancreas. It can also be raised with hepatitis, liver injury or long-term alcohol abuse. 

The major clinical manifestation of AAT deficiency is emphysema, which tends to occur at an earlier age and can occur in the absence of smoking. It is estimated that 1% of emphysema is related to AAT deficiency. In neonates, AAT deficiency is often associated with hepatitis in one study, almost one third of infants with prolonged jaundice were found to be AAT deficient. About 20% of AAT deficient infants develop hepatitis, with up to 25% 1-year mortality. In those who survive the first year, however, evidence of liver injury diminishes and usually resolves by age 12. At age 18, none of 183 individuals with AAT deficiency had clinical evidence of liver disease, none had elevated procollagen III peptide, and less than 20% had elevated liver-associated enzymes. These findings suggest that AAT may have minimal effects on pathogenesis of liver disease in adults." ... 

Usually hepatitis is caused by a viral infection, mostly hepatitis virus type A and B however, hepatitis C, D, E and other viruses such as CMV, Epstein Barr, herpes, and AIDS-HIV may also be involved. The clinical manifestations depend on the insult with jaundice, nausea, vomiting, and pyrexia commonly seen. 

Rifampicin toxicity is becoming of greater importance in the treatment of leprosy. Several studies have recently been reported in which rifampicin was used in combination with Isoprodian, a combination of dapsone, isoniazid and prothionamide. The commonest adverse effects observed on this combination are gastrointestinal disturbances and mild hepatitis, manifested either as abnormalities in biochemical parameters or clinically by jaundice. One case of exfoliative dermatitis was reported from a trial carried out in South India (35 ). 

Water retention due to sodium chloride (salt) is a common manifestation that leads to weight gain. Edema is also found in patients with cardiac heart failure, renal insufficiency, liver cirrhosis, and hypo-proteinemia. When large doses are used to treat neoplastic diseases, compounds with 17-alkyl substitutions can cause cholestatic hepatitis at high doses, jaundice is the most common clinical feature with accumulation of bile in the bile capillaries. Jaundice usually develops after 2-5 months of therapy. It can be detected by increases in plasma aspartate aminotransferase and alkaline phosphatase. 

Hepatitis A is caused by a 27-nm RNA picornavirus. It has four capsid proteins (VP 1-4), but only one serotype has been identified. The virus is not cytopathic to hepatoctyes, but causes liver injury by stimulating both cellular and humoral immune responses. Hepatitis A occurs in sporadic and epidemic forms, with an incubation period of 15 to 50 days. The clinical course of acute hepatitis A is usually that of a mild fiulike iUness that lasts for a few days to a few weeks. There is no chronic form of hepatitis A, but cholestasis (manifested by several weeks of jaundice and pruritus) may occur in some adults. Although a rare occurence, relapse in up to 5% of patients has been known to happen 1 to 3 months after the acute illness. It resembles the acute illness and is associated with viremia, hut recovery always ensues. 

The clinical course of HBV infection and the associated clinical features cannot be differentiated from other types of viral hepatitis based on symptoms. The duration of incubation is highly dependent on age and can vary between 6 and 24 weeks. Infants do not develop any symptoms and children between the ages of 1 and 5 years are asymptomatic in 85% to 95% of the cases. Symptomatic infections vary in severity and include fever, anorexia, nausea, vomiting, jaundice, dark urine, clay-colored or pale stools, and abdominal pain. Extrahepatic manifestations of HBV infection rarely occur and may include skin rash, arthralgias, and arthritis. Hepatic failure occurs rarely, with a case fatality rate of 0.4%. °... 

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