As I've told you, what our focus would be here
with Hepatitides of viral type
will be diagnosis.
You’ll notice that the symptoms
are taking place on the X axis.
We have months after infection.
I want you to begin approximately
two months here.
So, approximately 2 to 4 months,
the patient is having symptoms.
What kind of symptoms this would be?
For the most part, jaundice.
Remember anything beyond four weeks
of hepatitis B,
You usually wouldn't find your jaundice.
As the gray shaded box is illustrating.
What is viral hepatitis?
Which transaminases are
elevated more so?
I want you to focus on the red line
here and see where it has peaked?
ALT should be your focus when
dealing with Viral Hepatitis.
Next, we'll take a look at the others,
we have green,
which is the green which is the IgG.
And we have IgM.
At this point,
I want you to focus on IgM.
You know that IgM is the first immunoglobulin
to appear anytime there is infection
Immediate, if that helps you-IgM.
Eventually, that IgM is replaced by
what kind of immunoglobulin?
That would be IgG.
in terms of switching and such
these discussions take place in immunology
I’m just giving a quick review here.
So that you can quickly give a diagnosis
of a patient with hepatitis B.
There are different kinds of hepatitis B
surface antigen, E antigens, and DNA.
And those all play a role
in for the most part in descending order.
The Hepatitis surface antigen shows up a little bit later.
E antigen shows up quite early
And the HBV DNA
will show up extremely early.
You will notice that we have the yellow line.
and the gold line which is your anti-hepatitis (HBe)
And then you have your anti-hepatitis B surface antigen
And that then shows up at the very end
and that is your blue curve.
Your focus here, should be in that gray shaded area.
In which you are able to quickly
diagnose your patient with hepatitis B.
Interpretation of your table here.
This is once again for your hepatitis B specifically.
That’s your topic for the entire table.
and on the top are the different types
of components of Hepatitis B
depending on what's going
on in your patient.
Let's begin with the interpretation
at the far end of the table,
And your focus would be acute infection
or perhaps, reactivation.
So which one of these markers are you
going to find? Early, acute.
Hepatitis B surface antigen I told you,
shows up quite early
in the symptomatic period.
Negative. That shows up later on.
In order for this table to
make perfect sense,
I recommend that you take a look back
at the graph that we've just discussed.
So that you have a visualization,
As to the journey
or the time course of hepatitis B.
And you also have a table
in which it speaks to
And then listen to me,
so that we can all reinforce
And at some point in time,
I'll come back to you, very quickly.
We have anti-hepatitis B core IgM.
IgM is the first immunoglobulin
to show up thus, positive and acute.
And we have hepatitis B-E antigen
this DNA if all possible,
you'll find this very early early early.
This represents acute.
Let's go on to prior infection
If you're thinking about prior infection,
what kind of immunoglobulin
should you be jumping to
You will notice here
that Anti-HBc IgG is possible.
That’s where your focus
should be in,
prior infection. Why why why?
Anytime there is prior infection,
the type of immunoglobulin
that all you then are going to have chronically,
will be IgG.
Obviously anti-HBs would be positive.
HBE may or may not be found
but your focus here should be on IgG.
What about vaccination with immunity?
Well, with immunity and vaccination,
we still might find anti-HBs way down the line.
That that represents vaccination.
Let's do chronic HBV,
this is a carrier patient; carrier.
So, what is the patient now carrying?
It will be HBs as you can expect.
What kind of immunoglobulin
It would be IgG.
Hepatitis B and carrier
you will notice, you have anti-HBe
Here the viral account for HBV DNA
will less than 20,000 but
not as high as you find in an acute,
it is still present, why?
Your patient is state of chronic carrier state.
Your patient is in a state
of chronic carrier state.
Next, we have e Anti-positive
chronic hepatitis B
In this thing here
is dangerous, dangerous.
You find a couple things here.
Your focus should be once again IgG,
hepatitis B surface antigen
same on which you found earlier
with chronic carriers.
Here there is going to be e Antigen present
but this is difficult.
For the patient and for you
because you have a great number
of HBV DNA.
Active? Extremely. Chronic?
e Antigen not good in terms of
whether or not the patient is able
to pass it on to,
his or her partner.
And finally, we have e Antigen
negative, chronic Hepatitis B,
anything that you find here,
is the fact that you have anti HBV DNA
At this point is e Antigen negative.
In terms of viral count it will still
be greater than 20,000.
Interpretation is where your focus
will be at first,
then you take a look at the various
markers, we interpet as such,
and then go back and take
a look at the graph
so that you will be able
to understand the timeline.