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14. Viral Hepatitis | USMLE Step 1 Pathology
Introduction:
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Viral hepatitis represents a group of infectious diseases characterized by inflammation of the liver caused by hepatotropic viruses. Understanding the pathogenesis, clinical manifestations, and management of viral hepatitis is paramount for medical practitioners, particularly for those preparing for the USMLE Step 1 examination.
Viral Etiology:
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Hepatitis A Virus (HAV): Transmitted primarily through the fecal-oral route, HAV infection typically results from contaminated food or water. It is characterized by acute hepatitis and does not lead to chronic infection.
Hepatitis B Virus (HBV): Transmitted through percutaneous or mucosal exposure to infected blood or bodily fluids, HBV can cause acute or chronic hepatitis. Chronic infection may lead to cirrhosis and hepatocellular carcinoma.
Hepatitis C Virus (HCV): Mainly transmitted through percutaneous exposure to infected blood, HCV often leads to chronic hepatitis, which can progress to cirrhosis and hepatocellular carcinoma.
Hepatitis D Virus (HDV): Requires HBV coinfection for replication, leading to more severe disease outcomes compared to HBV alone.
Hepatitis E Virus (HEV): Similar to HAV, HEV is transmitted through the fecal-oral route and typically causes acute hepatitis, particularly in developing countries.
Pathogenesis:
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Viral Entry and Replication: Hepatotropic viruses enter hepatocytes and replicate within the liver, triggering an inflammatory response.
Immune Response: Activation of the host immune system leads to hepatocellular injury, characterized by inflammation and necrosis.
Chronic Infection: In some cases, viral persistence and evasion of the immune response result in chronic hepatitis, leading to progressive liver damage.
Clinical Manifestations:
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Acute Hepatitis: Presents with symptoms such as jaundice, fatigue, abdominal pain, nausea, and elevated liver enzymes.
Chronic Hepatitis: Often asymptomatic but may manifest as fatigue, malaise, and signs of advanced liver disease in later stages.
Diagnostic Evaluation:
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Serologic Testing: Detection of viral antigens and antibodies in serum can help identify the causative virus and determine the stage of infection.
Liver Function Tests: Measurement of serum markers such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels can assess liver function and degree of hepatocellular injury.
Viral Load Testing: Quantification of viral RNA or DNA levels aids in monitoring disease progression and response to treatment.
Management:
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Prevention: Vaccination against HAV and HBV, implementation of infection control measures, and safe injection practices are crucial for preventing viral hepatitis transmission.
Treatment: Antiviral therapy, including nucleos(t)ide analogs for HBV and direct-acting antivirals for HCV, aims to suppress viral replication and reduce liver inflammation.
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