Gall Stones

Abdominal Pain?gallstones?signs & Symptoms? http://ehealthcom.blogspot.com/2010/12/abdominal-pain-is-it-gallstones-what.html

Gall stones Cholecystectomy  http://ehealthcom.blogspot.com/2010/12/cholecystectomy.html

Cholecystectomy  http://ehealthcom.blogspot.com/2010/12/cholecystectomy.html

Hepatitis B? What are the treatments?

The disease caused by Hepatitis virus can be acute, chronic inactive or chronic active. The treatment differs according to the state of the disease.

If you have acute hepatitis B virus infection, then specific treatment is given for the disease. Some people become very anxious when they are not given any treatment, but they have to understand that it is the best treatment for the disease. Let me explain why.

Like in many other viral diseases, hepatitis B infection is also a disease caused by a virus. In many of the viral diseases we can’t do much to destroy the virus. There are several drugs that have been shown results, but the best way is to let the body fight against it by it self. So all we have to do is give our bodies the optimum condition to fight, so it does not have to spend energy on other things. That’s why the treatment for acute illness is rest and symptomatic treatment. So the body finally develops immunity against the virus and become resistant.

On the other hand the people who develop chronic illness are the once who were unable to fight against the virus successfully. So the virus persists in their bodies causing continuous damage to the liver finally causing cirrhosis and hepatocellular carcinoma. Therefore, such patients are given medications like interferon to kill the virus.

Hepatitis – Treatments

If Hepatitis is due to an infectious cause, the treatment varies according to the infecting viral agent.

Hepatitis A 

Usually there is no specific treatment carried out for hepatitis A. Corticosteroids, rest and dietary measures have no proven effectiveness in relieving the disease. The disease persist for several weeks and wears off on its own. 

Even though hospital admission is not requires, because the patient can recover on its own, many physicians tends to keep the patient under observation even after recovery. This is because that some people often develop another attack of hepatitis in rare instances.

If the patient develops fulminant hepatitis, it can be so severe enough to cause death.

Hepatitis B

The disease could be acute or chronic.

Acute Hepatitis – 

The treatments are often symptomatic, but antiviral therapy is started for symptomatic patients, but the efficacy of the treatment is still unknown.

Some specialist thinks that HBeAg positive patients should be treated with neucleoside analogues for 12 months. 

Chronic Heptitis –

These patients are treated with following antivirals.

• ·         Interferon

• ·         Lamivudin – Monotherapy is not recommended.

• ·         Adefovir – More effective than LAmivudin.

                                 Reduces HBV DNA more quickly
                                 Less virus resistance

• ·         Entacavir

• ·         Tenofovir  - Effective against lamivudin resisitant viruses.

In general C Hepatitis is treated with pegylated interferon or tenofovir

Hepatitis D

The patients are treated with pegylated alpha-29 interferon for 12 months duration, but the response id very poor. Lamivudin and adefovir are also not effective.

Hepatitis C

They are usually given a combination of pegylated interferon and ribavirin. The efficiency of the treatment will depend on the viral load.

References:

Kumar and Clark’s Clinical Medicine 7^th Edition

Is Hepatitis C virus transmitted by Sexual intercourse?

Hepatitis C virus is known to transmit through blood and blood products.  The high prevalence of the disease among patients who take intramuscular vaccination supports this finding.

There is a high prevalence of the disease in Egypt as a result of parenteral antimonial treatment.  Therefore, more contact with needles, greater the chance of getting the disease. 

Surprisingly the disease prevalence among homosexual and bisexual people and prostitutes is lower than that of intravenous drug users, indicating the lesser chance of acquiring the disease by unprotected sex. 

References:

Kumar and Clark’s Clinical Medicine 7^th Edition

Hepatitis B Active Immunization (Vaccine)

As Hepatitis B infection can cause severe liver disease including cirrhosis, hepato-cellular carcinoma and chronic liver disease, all at risk personnel should have protection against it.

Hepatitis B virus is transmitted through blood, blood products and body fluids. Therefore people who regularly get contact with these should be vaccinated against the virus. They are,

• Health care personnel
• Emergency and rescue service personnel
• Embalmers
• Morticians
• Children

This is done by giving active immunization. The vaccine is produced by integrating the hepatitis B surface antigen gene in to yeast. It is given in 3 doses. The second is given 1 month after the first dose and the second 6 months after. It is given to the deltoid muscle. It is capable of producing a short term protection in over 90% f the people.

The vaccine may not produce enough antibodies in,

• People older than 50 years of age
• Severely ill patients
• Immunocompromised people like HIV/ AIDS

So these people should be given larger doses more frequently.

The antibody levels should be checked in all the risk groups at 7-9 months after the initial dose.

The antibody levels slowly declines over time, so a booster dose to increase the antibody levels should be given 3-5 years after the initial dose.

There are some mild side effects that can occur rarely. There include fever, rash and soreness over the injection site.

References:

Kumar and Clark’s Clinical Medicine 7^th Edition