SKENARIO 3 PART 2 BLOK 9

Hepatitis A is a type of viral liver infection uncommon in England but widespread in other parts of the world such as Africa and India.

Initial symptoms of hepatitis A are similar to flu and include:

• low grade fever – usually no higher than 39.5C (103.1F)
• joint pain
• feeling and being sick

This may then be followed by symptoms related to the liver becoming infected, such as:

• yellowing of the skin and eyes (jaundice)
  passing very dark coloured urine and
• pale faeces (stools or ‘poo’)
• abdominal pain
• itchy skin

Symptoms usually clear up within two months, although occasionally last up to six months. Older adults tend to have more severe symptoms.

In most cases the liver will make a full recovery.

Treating hepatitis A

There is no cure for hepatitis A so treatment involves making a person feel as comfortable as possible until the infection clears up.

This involves:

• getting plenty of rest
• using paracetamol to relieve pain - always make sure you never exceed the recommended dose as this could further damage your liver
• taking a type of medication called an antiemetic to help with the symptoms of feeling sick (nausea) and being sick (vomiting)

What causes hepatitis A?

Hepatitis A is caused by the hepatitis A virus.

The virus is most commonly spread through what is known as the ‘faecal-oral’ route.  This is when you put something in your mouth that has been contaminated by the faeces (stools) of someone with hepatitis A.

Eating foods that have been contaminated with raw sewage such as shellfish can also lead you to become infected, as can drinking contaminated water.

Less commonly, hepatitis A can be spread through:

• sharing a needle with an infected person to inject drugs
• during sex; particularly anal sex

The condition can also spread through close personal contact in ‘closed environments’ such as student halls, boarding schools and army barracks.

Who is affected

Hepatitis A is widespread in parts of the world that are poor, over-crowded and have limited access to sanitation and clean water, such as:

• Africa
• India
• Pakistan
• some parts of the Middle East and South America

Hepatitis A is much less common in Western countries. There were only 367 reported cases of hepatitis A infection in England and Wales during 2010; it is unclear how many of these infections were actually caught abroad.

Hepatitis A is most common in young children but often goes undetected as it tends not to cause any symptoms in this age group.

Others with an increased risk of catching hepatitis A include:

• men who have sex with men
• people who regularly inject drugs
• sewage workers
• people who travel to and /or work in less developed countries

Vaccination may be recommended for high-risk groups.

Vaccination

There is an effective vaccine that protects against hepatitis A. Read more about the hepatitis A vaccine and who should have it.

Preventing the spread of infection

If you are diagnosed with hepatitis A it is important anyone you could have infected is tested for the condition.

An infection can often be prevented if it is treated within two weeks of a person becoming exposed to the hepatitis A virus.

Testing may be recommended for:

• people who live with you
• people you have recently prepared food for
• any person you have had sex with

It is also important to take some basic precautions in terms of hygiene such as washing your hands after going to the toilet and before preparing food.

Complications

In most people the infection will pass without causing any long-term problems. And once the infection passes you normally develop life-long immunity against the hepatitis A virus.

Complications tend to only occur in people with pre-existing liver disease and /or elderly people, with the most serious being liver failure (where the liver loses most or all of its functions).

Once liver failure has occurred, it is usually possible to sustain life for several years using medication. However, a liver transplant is currently the only option for curing liver failure.

Pemeriksaan Laboratorium

Pemeriksaan laboratorium diperlukan untuk memastikan diagnosis hepatitis karena penderita hepatitis sering tidak bergejala atau tidak gejala tidak khas.

Pemeriksaan untuk hepatitis akut :
- Enzim GOT, GPT
- Penanda Hepatitis A (Anti Hav IgM)
- Penanda Hepatitis B (HGsAg, Anti HBC IgM)
- Penanda Hepatitis C (Anti HCV, HCV RNA)
- Penanda Hepatitis E (Anti HEV IgM)

Pemeriksaan untuk hepatitis kronis :
- Enzim GOT,GPT
- Penanda Hepatitis B (HBsAg,HBe, Anti HBc, Anti HBe, HBV DNA)
- Penanda Hepatis C (Anti HCV,HCV RNA)

Penanda imunitas :
- Anti HAV
- Anti HBs

Treatment

As no specific treatment exists for hepatitis A, prevention is the most effective approach against the disease.

Therapy should be supportive and aimed at maintaining adequate nutritional balance (1 g/kg protein, 30-35 cal/kg). There is no good evidence that restriction of fats has any beneficial effect on the course of the disease. Eggs, milk and butter may actually help provide a correct caloric intake. Alcoholic beverages should not be consumed during acute hepatitis because of the direct hepatotoxic effect of alcohol. On the other hand, a modest consumption of alc

ohol during convalescence does not seem to be harmful.

Hospitalization is usually not required.

Adrenocortical steroids (corticosteroids) and IG are of no value in acute, uncomplicated hepatitis A, since they have no effect on the resolution of the underlying disease.

Antiviral agents have no beneficial clinical effect because a specific antiviral agent is not available and hepatic injury appears to be immunopathologically mediated. Patients who are taking oral contraceptives do not need to discontinue their use during the course of the

disease.

Referral to a liver transplant centre is appropriate for patients with fulminant hepatitis A, although the identification of patients requiring liver transplantation is difficult. A good proportion of patients (60%) with grade 4 encephalopathy will still survive without transplantation. Temporary auxiliary liver transplantation for subacute liver failure may be a way to promote native liver regeneration

sumber: 

http://www.nhs.uk/Conditions/hepatitis-a/Pages/Introduction.aspx

http://www.helmigs.com/healtharticles_content_hepatitis_id.php

http://www.who.int/csr/disease/hepatitis/HepatitisA_whocdscsredc2000_7.pdf

author: uray