Ι Α ΚΑΛΙΑ Θ ΩΡΗΣΙΚΩΝ ΜΑΘΗΜΑΣΩΝ ΠΑΘΟΛΟΓΙΑ ΙΙ 1 ΑΘΗ Ε Η Α Α Χ ΗΦ ΩΝ
Η 2
Η Η Η Η Η K Ω Η SGOT-AST SGPT-ALT ( ω ό ) Χ Η Χ Η ALP GT Χ Θ Η Η Θ Η Η
ALT (SGPT) and AST (SGOT) Enzymes found in Hepatocytes Released when liver cells damaged SGPT (ALT) is specific for liver injury AST (SGOT) is also found in skeletal and cardiac muscle
Ε 6 Φ Γ Η χ 1 mg/dl ω > 2.5mg/dl 85%
Ε 7 Η Η
9 Ε χ Η (Indirect bilirubin)
10 Ά χ acid) (glucuronic (glycuronyltransferase). Η Η (direct bilirubin)..
11 Ά χ Η Η...
12
Χ 13 Φ. Η ( ). Ό
Χ 14 Ε (. ). Η
15 ηγο Η ό ο / / ω χ ό /χ ό χ χ ό ω ω ω χ ό χ
16
17
18
Η ΔΕ 19 H Η. Φ χ ( )
Copyrights apply
21 Σ ) ω Epstein-Barr CD Ε (
22 (<6 ) wilson
23 Ε -
24 Ε Η Η ( LT AST) 20 ALP - -
25 Δ DNA ) : (
26
27 Ε Χ Χ ( Η ALT AST > 6 B C )
28 ( Ε Η C +/_- (INF) Ε )
29 Η ) ( Η Η C Η E n) (
30
Clinical and Epidemiologic Features of Viral Hepatitis Feature HAV HBV HCV HDV HEV Incubation (days) 15-45 mean 30 30-180 mean 60-90 15-160 mean 50 30-180 mean 60-90 14-60 mean 40 Onset Acute Insidious or acute Insidious Insidious or acute Acute Age preference Children young adults Young adults (sexual and percutaneous) babies toddlers Any age but more common in adults Any age (similar to HBV) Young adults (2040 years) Transmission Fecal-oral +++ Percutaneous Unusual +++ +++ +++ +++ Perinatal +++ a + Sexual ++ a ++ Clinical Severity Mild Occasionally severe Moderate Occasionally severe Mild Fulminant 0.1% 0.1-1% 0.1% 5-20%b 1-2%e Progression to chronicity None Occasional (1-10%) (90% of neonates) Common (50-70% chronic hepatitis; 80-90% chronic infection) Commond None Carrier None 0.1-30%c 1.5-3.2% Variable None Cancer None + (neonatal infection) + Prognosis Excellent Worse with age debility Moderate Acute good Chronic poor Good Prophylaxis IG Inactivated vaccine HBIG Recombinant vaccine None HBV vaccine (none for HBV carriers) Unknown Therapy None Interferon Lamivudine Interferon plus ribavirin Interferon None None a Primarily with HIV coinfection and high-level viremia in index case; risk approximately 5%. b Up to 5% in acute HBV/HDV coinfection; up to 20% in HDV superinfection of chronic HBV infection. c Varies considerably throughout the world and in subpopulations within countries; see text. d In acute HBV/HDV coinfection the frequency of chronicity is the same as that for HBV; in HDV superinfection chronicity is invariable. e 10-20% in pregnant women. f Common in Mediterranean countries rare in North America and western Europe.
32 3 Γ
33 Θ Η
Χ 34 C) ( > 6
Χ 35 Η 5-10% Θ INF/ HDV HDV ( Η )
Χ 36 Η 20% Θ C 75% INF/
37 Θ Δ
ΚΙΡΡΩ Η ΣΟΤ ΗΠΑΣΟ Γ θδε ηϋθβ θω β κ κλγϊθκ Πκ θ Ϊ δ η θγ θθβ δεκτ σκ ΠΑΘΟΛΟΓΟΑΝΑΣΟΜΙΚΗ ΔΙΑΓΝΩ Η
40
Φ ΓΓΕ 41 Η 2 ) ( ) ( :75-80% ( 40% )
Φ ΓΓΕ 42 Η 2 ( ) :75-80%
Φ ΓΓΕ 43 Η ( :20-25% 2 )
Η Ε Ω Ε 44 Ε Ό ->
45
46 Φ Wilson 1- ) (BC D) - (
47 Δ ) (
48
49 Δ libido ( Δ ) Ε ) ( ( Ca) ) (
Δ 50 Ε Δ
Ε 51 Η
Ε 52 Φ Ά ) ω (
53 Θ - - Δ ( ( - - ) ) ( ) -
Η 54-30-45% Θ - -
55
Χ 56 Ύ χ Χ Χ : : 20-30 %. ( )
Χ 57 (1/3)
58 30. -
59 Δ - - Άζγκ ιδκτ κχκθ λκ λ σ ε λκ βη κ Murphy Ν Ϋη κδ θκλ ι Murphy ( ) Ε ΔΕ
60 Δ Θ
61