Vinnytsya National Pirogov Memorial Medical University
Department of Children Infectious Diseases
“Approved”
at sub-faculty meeting
“__”_____2012, protocol №_____
Head of Department
prof. _______I.I. Nezgoda
Study Guide for practical work of students
Topic: “Enteral Viral hepatitis A, E and paranteral Viral hepatitis B, C
and others”
Course V
English-speaking Students’
Medical Faculty
Duration of the class-180min.
Composed by assoc. prof., phD O.S. Onofriychuk
Vynnytsa
2012
I. The theme urgency
Viral hepatitis is the most widespread infectious diseases of child's age. The
most common hepatitis viruses is type A. The hepatitis A virus (HAV) is the
commonest cause of viral hepatitis, responsible for up to 40% of cases worldwide.
It is spread by contaminated food. Vaccines is available against hepatitis A.
Hepatitis B, or serum hepatitis, is a highly contagious disease spread by
blood products or in body fluids. It often culminates in liver failure, and is also
associated with liver cancer, although only 10% of those infected suffer chronic
liver damage. Hepatitis C is mostly seen in people in need frequent transfusions,
75% of infected with hepatitis C will go on to develop chronic liver infections.
Vaccines are available against hepatitis B.
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Primary aims of the study
Student must know:
Etiology and properties of causing factors of illness
Epidemiology (source of infection, ways of transmission, age-old receptivity
and morbidity).
Pathogenesis of disease, pathomorphologic changes in the staggered organs.
Classification of the illness.
Clinical symptoms of pre-icteric, icteric and postichteric period of viral
hepatitis
Methods of laboratory research.
Treatment of viral hepatitis
Consequences and complications of viral hepatitis
Measures of prophylaxis of viral hepatitis
Student must be able:
To follow the basic rules of work near a bed sick with viral hepatitis.
To take anamnesis with the estimation of epidemiology information
To examine a patient and reveal the basic clinical signs of illness.
To represent information of anamnesis and objective inspection in a hospital
chart and formulate the preliminary diagnosis.
To write the plan of examination.
To write a clinical diagnosis (form of disease, type, severity, course of
disease).
To prescribe treatment taking into account age, severity of illness.
To write out a prescription.
To organize disease measures in the hearth of infection (to find out the
source of infection, fill an urgent report in SES, to set a quarantine, to define
the circle of contact persons, conduct them bacteriological inspection).
10.To write epicrisis with the estimation of flow of illness, results of inspection,
efficiency of treatment, prognosis, by recommendations for a subsequent
supervision or treatment depending on the form of viral hepatitis.
III. Educational aims of the study
- forming the deontology presentations, skills of conduct with the patients
- to develop deontology presentations, be able to carry out deontology
approach to the patient
- to develop the presentations of influence of ecological and socio-economic
factors on the state of health
- to develop sense of responsibility for a timeliness and loyalty of professional
actions
- to lay hands on ability to set psychological contact with a patient and his
family
IV. Control materials for the preliminary and final stage for the
lesson
Tests and tasks
1. A 6-year-old boy has been diagnosed as having mild form of viral hepatitis A.
What is the most important in treatment?
A. Regimen and diet
B. Hepatoprotectors
C. Antiviral medications
D. Corucosteroides
E. Infusion therapy
2. 4-year-old child. Complaints are fever Т- 39оС, abdominal pains, vomiting. The
5th day: dark urine, skin and mucous are jaundiced. Tongue is covered with white
coating. Liver is enlarged + 3,5 cm. Faeces are pale. Bilirubin 127 (mk/mol/L),
direct - 86, indirect - 41. ALT - 1,8 mmol/L/h, prothrombine index – 78 %. What’s
the primary diagnosis.
A. Viral hepatitis
B. Obstructive jaundice
C. Toxic hepatitis
D. Haemolytic anaemia Minkovski-Shoffar
E. Leptospyrosis
3. 5 -year-old child. Complaints: Т - 38,7о С, vomiting, abdominal pain. 3rd day of
the disease: malaise, skin and mucosa are without pathology. Tongue has white
coating. Pharynx is clear. Abdomen is soft. Liver is enlarged + 2,5 cm. Faeces and
urine are with normal colour. Child got in touch with person sick with viral
hepatitis A and Scarlet fever 2 weeks ago. What examination do you prefer to
found out the right diagnosis?
A. Blood on aminotranspherases
B. Smear from pharynx on haemolytic streptococcus
C. Urine analysis on bile pigments and urobilin
D. Blood on paired serums
E. Blood on bilirubin and fractions
4. At the eldest group of the kinder garden in Kyev was a case of viral hepatitis A.
16 children didn’t have hepatitis A before. What do you prefer to use to prevent the
viral hepatitis?
A. Immunoglobulin
B. Vaccination
C. Interferon
D. Remantadin
5. Should the patient with mild form of hepatitis A be hospitalized?
A. Yes
B. No
6. A 3-month-old baby has been admitted with a low-grade fever, motor anxiety,
anorexia, jaundice, hepatosplenomegaly, dark urine, discolored stool occurs. The
baby had blood transfusion 2 month ago. What is the most probable diagnosis?
A. Viral hepatits B
B. Hemolytic anemia
C. Viral hepatitis A
D. Atresia of biliferous tructs
E. Conjugation jaundice
7. 2-year-old. Complaints: malaise, appetite loss. 5th day – dark urine, pale stool.
6th - jaundice of skin and sclera, Т - 37,4о С, repeated vomiting. Liver enlarged + 7
cm, lien +2,5 cm. Heart sounds are muted, bradycardia. Child not active. Sleeping
disturbances. Bilirubin - 220 mmol/L, direct - 176. Prothrombine - 60%. ALT - 6,4
IU. Found НВS Ag. In age 1,5 years child have had pneumonia, have got treatment
in the hospital. What is the primary diagnosis:
A. Viral hepatitis В
B. Haemolytic anaemia
C. Viral hepatitis А
D. Toxic hepatitis
E. Obstructive jaundice
8. 4-year-old child. Complaints are fever Т- 39оС, abdominal pains, vomiting. The
5th day: dark urine, skin and mucous are jaundiced. Tongue is covered with white
coating. Liver is enlarged + 3,5 cm. Faeces are pale. Bilirubin 127 (mk/mol/L),
direct - 86, indirect - 41. ALT - 1,8 mmol/L/h, prothrombine index – 78 %. What’s
the primary diagnosis.
A. Viral hepatitis
B. Obstructive jaundice
C. Toxic hepatitis
D. Haemolytic anaemia Minkovski-Shoffar
E. Leptospyrosis
9. 10-month old child on the 5th day of the disease have got vomiting, denied
meals, became anxious, doesn’t recognize parent, have got seizures, haemorrhagic
rash, the jaundice appeared, the liver size became smaller, liver is soft on
palpation. Т- 37,5 - 39,9°С. What caused the worsening?
A. Liver coma
B. Encephalitis
C. Meningitis
D. Spasmophilia
E. Acute intestinal infection
10.The possible ways of transmission of viral hepatitis B?
a. Fecal-oral
b. Transmissive
c. Air-borne
d. Parenteral
e. Water
f. mother to child transmission
Task 1
A six-year child is ill over 5 days. Among the symptoms are: lost of appetite;
nausea, discomfort in the right subcostal region, dark colour of urine.
Physical Examination: The child has jaundice of the skin and scleras. The
hepar enlarge (+3 cm from the costal arch).
The findings of the biochemical analyses of the blood are as follows:
total bilirubinum – 68,9 mkmol/l, direct bilirubinum – 50,8 mkmol/l, indirect
bilirubinum – 18,1 mkmol/l;
PT index – 90%;
ALT 2,25 mkmol/l, AST 1,5 mkmol/l;
Thymol test 7 un.;
Choleric pigment is founded in the urine;
Anti-HAV IgM are determined in the blood.
Questions:
1.What is your primary diagnosis?
2.Estimate the date of the laboratory findings?
Task 2
An eight-year child is ill for five days. He has jaundice of the skin and
scleras, recurrent vomiting, the temperature rises up 38,30 C. The stools are
acholic, the urine is dark.
Physical Examination: the child is flaccid, adynamic. He is vomiting. Hepar
+4 cm is from the costal arch, tenderness of the hepar with painful palpation.
The findings of the biochemical analyses of the blood are as follows:
total bilirubinum – 208,3 mkmol/l, direct bilirubinum – 185,1 mkmol/l,
underect bilirubinum – 23,2 mkmol/l;
PT index – 40%;
ALT 4,00 mkmol/l, AST 2,5 mkmol/l;
Sublimate test 1,5ml;
The findings of the IFA are as follows: HBsAg (+)
Questions:
1.What is your primary diagnosis?
2.Estimate the date of the laboratory findings?
Task 3
A five-year child has complaints of malaise, lost of appetite, temperature
0
37,2 C. Hepar +1,5 cm is from the costal arch.
The findings of the biochemical analyses of the blood are as follows:
total bilirubinum – 30 mkmol/l, direct bilirubinum – 25 mkmol/l, indirect
bilirubinum – 5 mkmol/l;
Thymol test 6 un.;
Sublimate test 2,2 ml.;
Anti-HAV IgM are determined in the blood.
Questions:
1.What is your primary diagnosis?
2.Estimate the date of the laboratory findings?
Task 4
A thirteen-year child has malaise, lost of appetite, pain in the right subcostal
region. He has jaundice of the skin and scleras.
The findings of the biochemical analyses of the blood are as follows:
total bilirubinum – 62 mkmol/l, direct bilirubinum – 44 mkmol/l, indirect
bilirubinum – 18 mkmol/l;
ALT 2,6 mkmol/l, AST 1,2 mkmol/l;
PT index – 85%;
The findings of the IFA are as follows: Anti-HCV IgM (+)
Questions:
1.What is your primary diagnosis?
2.Estimate the date of the laboratory findings?
V. Literature
1. Mikhailova A.M., Minkov I.P., Savchuk A.I. Infection diseases in children.Odessa, 2003.- 236 p.
2. Nelson Textbook of Pediatrics. / Edited by Richard E. Behrman, Robert,
M.Kliegman, Ann M. Arvin.; senior editor, Waldo E. Nelson. – 1996.
3. Kuznetsov S.V., Olchovskaya O.N., Tatarkina A.N. Selected lectures in
children’s infectious diseases.- Kharkiv, 2006.- 164 p.