00:01
Quickly here, hepatitis B.
00:03
Now, we’re getting to more chronic users.
00:05
And hepatitis B, obviously, there is going to be vaccination involved.
00:09
And in immunology and microbiology,
you’ve covered these topics further.
00:13
What I'm going to provide to you
is more of a clinical background
for each one of these viral hepatites.
00:20
400 million worldwide.
00:22
Obviously, need to know this quite a bit.
00:24
DNA virus with incubation.
00:26
You need to know that hepatitis B is a DNA virus.
00:30
Last time we talked anything about this,
at some point in time,
is that there is every possibility in chronicity.
00:38
Two major chronic viral hepatites
that are important for you and I,
for pathology and cancer will be hepatitis B,
which is a DNA virus
and hepatitis C which would be an RNA virus.
00:52
It’s important that you know
what kind of molecular goes on to cancers.
00:58
Transmission here, parental or sexual routes.
01:02
High risk of vertical transmission.
01:04
What does that mean to you?
You are thinking about a pregnant lady that is now giving birth;
and during delivery, there is every possibility
that through the vaginal canal
there might be vertical transmission
unfortunately to the newborn.
01:16
Think of this as being part of your torch. Hepatitis B.
01:20
Leading risk factor for liver cancer worldwide.
01:24
Also, keep in mind, hepatitis C –
and make sure that you know how to identify hepatitis B or C.
01:30
This is a DNA virus.
01:33
Only 5% of adult infection develop chronic hepatitis,
while the majority of perinatal infections are chronic.
01:41
So, there are two populations here.
01:43
Very rarely do adults go on to chronicity.
01:47
That would be more hepatitis C.
01:48
C in hepatitis C – C for chronicity.
01:54
However, could you move on to chronicity in hepatitis B?
Sure, you can, but a measly 5%.
02:00
Still important, though.
02:02
Now, if a childhood vertical transmission,
ohh, that’s a little bit – that’s difficult.
02:07
That's more challenging
and there's every possibility or likelihood
of a child going on to chronicity.
02:15
Clinical presentation of hepatitis B:
Symptomatic disease more severe than hepatitis A,
hence we’re going to elaborate on it further.
02:26
Jaundice rarely lasts greater than four weeks.
02:30
So, you’re thinking about –
if you find jaundice in a patient with hepatitis B,
you’re thinking about,
well, this must've been a timeline of approximately one month.
02:39
1% incidence of fulminant hepatitis.
02:42
Thank goodness.
02:46
Move on to extra hepatic manifestations of hepatitis B.
02:50
Here, you do want to pay attention to (inaudible).
02:52
Angioneurotic edema.
02:56
This is important.
02:57
30% of your patients –
this patient may come to you and may complain of –
‘doc, my tummy hurts.’
And also, you notice that there's blood in the urine.
03:11
And you find that upon serology,
you find an increase in ALT.
03:17
Wow, that's interesting.
03:18
The liver is involved and I'm finding abdominal pain
and I'm finding hematuria.
03:27
Should be thinking about polyarteritis nodosa.
03:29
30% of your patients with hepatitis B
might actually be suffering from polyarteritis nodosa.
03:35
These would be adults for the most part
and the two symptoms that I gave you –
hey, doc, my stomach hurts, the abdominal region.
03:42
Radiate to the back?
No, nothing like that.
03:44
And I'm finding hematuria.
03:46
So, you need to be –
make sure that you’re quite astute with paying attention
to your patient with such symptoms.
03:53
And when we you say polyarteritis nodosa,
obviously, this is a vasculitis.
03:57
The vascular system that is being affected here
would be the mesenteric blood vessel.
04:03
What does that vasculitis mean to you?
Inflammation, inflammation, inflammation of your blood vessel
until there's occlusion,
lack of blood supply to the abdominal region,
mesentery, anytime there's ischemia.
04:16
How is the patient feeling?
Pain. Pain. So, pain in the abdomen.
04:20
In addition, you have the renal blood vessels
might start undergoing microaneurysms
and may result in, as I told you, hematuria.
04:30
Keep that in mind.
04:31
Spend a second on polyarteritis nodosa
and its association with hepatitis B.
04:37
Also, association with MPGN (membranoproliferative glomerulonephritis).
04:43
So, what does this mean to you?
MPGN, what kind of symptoms?
Is it strictly nephritic, is it strictly nephrotic or is it both?
Both.
04:55
So, there might be hematuria and hypertension
and there might be also massive edema
and a greater than 3.5 grams of protein loss.
05:03
Allow for each one of these symptoms to give you
amazing information for a particular condition,
so that you can choose the correct answer.
05:12
Stick with me and I will get you there.
05:15
MPGN, nephritic, nephrotic,
type 1 much more common than type 2.
05:21
Now, we can move on.
05:23
Mononeuritis multiplex,
that’s interesting.
05:27
Mononeuritis multiplex, what does that mean?
One nerve that's being affected,
an inflammatory process in multiple, multiple organs.
05:35
Maybe it’s a radial nerve that’s affected, wrist drop.
05:39
Maybe it's the common peroneal nerve, foot drop.
05:42
Just as an example.
05:43
One nerve in which it may affect multiple systems
resulting in the sequelae that you would expect to see.
05:52
Important here as well, cryoglobulinemia.
05:55
This is more so found in hepatitis C.
I will tell you that right off the back.
05:59
If it’s any type of viral hepatitis that
you’re worried about with cryoglobulinemia,
what does that mean to you?
Allow the name to speak to you.
06:07
Cryo means cold.
06:09
Upon exposure to cold,
because of the immunoglobulins
that are involved in viral hepatites,
that upon exposure to cold,
the globulins will do what?
Oh, yes.
06:19
They will then precipitate. Right?
When they precipitate,
this is then referred to as being your cryoglobulinemia.
06:27
During cold conditions,
it then aggregates or precipitates.
06:31
Interesting.
06:32
So, two major cold issues that you want to know
for your boards and your wards.
06:36
When you're cold and you find that the fingers are now cyanotic –
that's Raynaud's –
or if you find cryoglobulinemia, cold.
06:46
And oftentimes,
whenever you think about
or you hear about a patient
in which there is ascending paralysis,
it's preceded by infection
and usually viral. Viral. Gilliam-Barre syndrome.