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Published on March 14, 2014

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PowerPoint Presentation: 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 1 HEPATITIS B DISEASE: HEPATITIS B DISEASE BY- DR.KAMLESH KUKREJA FINAL YEAR PG SCHOLAR 3/14/2014 2 DEPT. OF P.G STUDIES IN PANCHAKARMA H.O.D DR.SHALINI.C.ELI M.D.(AYU) PowerPoint Presentation: 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 3 PAPER CONTENTS: PAPER CONTENTS INTRODUCTION ANATOMY & PHYSIOLOGY OF LIVER CELL INJURY & ETIOLOGY VIRAL HEPATITIS HEPATITIS B- DEFINITION VIROLOGY & ETIOLOGY PATHOGENESIS CLINICAL & LABORATORY FEATURES COMPLICATIONS TREATMENT & PROPHYLAXIS AYURVEDIC VIEW RESEARCH WORKS DONE DISSCUSSION CONCLUSION 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 4 INTRODUCTION: INTRODUCTION 3/14/2014 Dept. of P.G Studies ln Panchakarm 5 PowerPoint Presentation: 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 6 Word Hepatitis= Greek Hepar + Itis (Liver) (Inflammation) Hepatitis(plural Hepatitides ) Implies Injury To Liver Characterized By Presence Of Inflammatory Cells In The Tissue Of Organ. Hepatitis Viruses Are Most Common Cause , One Caused By HBV Is Hepatitis B Disease Which May Be Self Limiting Or Can Progress To Chronicity . HBV Infection Occurs Throught The World. It Is Estimated That More Than 2 Billion People Have Been Infected,of Which 350 Million Have Chronic Hepatitis B Infection. Panchakarma A Unique Treatment Modality Of Ayurveda Can Help In Controlling Hepatitis B Disease ( Swatantra Kamala) ANATOMY: ANATOMY 3/14/2014 Dept. of P.G Studies ln Panchakarm 7 PowerPoint Presentation: 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 8 Liver- Wedge Shape Heaviest gland(1.4kg) Largest internal organ Located in Rt.Hypochondrium & a Epigastric region. Liver Rt.lobe (5/6) Lt.Lobe (1/6) inf.Quadrate lobe post.Caudate lobe Functional unit is called as lobule/ acinus . PHYSIOLOGY:  PHYSIOLOGY 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 9 PowerPoint Presentation: 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 10 Vital organ which performs vast number of functions- Metabolic- Carbohydrate, Lipid, Protein Storage- Protein,Vitamins,Minerals,Glycogen Secretion & Execretory – Bile Defensive- Kuffer’s cells Heamopoietic - stores vit.B12,Iron thrompopoietin CELL INJURY: CELL INJURY Defined As A Variety Of Stresses A Cell Encounters As A Result Of Changes In Its Internal And External Environment. Responses- Cellular Adaptations Subcellular Changes / Intracellular Accumulations Recover / Die 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 11 ETIOLOGY:  ETIOLOGY 1.Hypoxia & Ischaemia 2.Physical Agents 3.Chemical Agents 4.Microbial Agents 5.Immunologic Agents 6.Nutrional Derangements 7.Pshychological Factors 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 12 GENETIC ACQUIRED 2 TYPES PowerPoint Presentation: 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 13 Infectious Disease Are Consequence Of Interrelationship Between Disease Producing Properties Of Microorganism And Host Defence Capability Against Invading Microorganisms Determining Factors Mode Of Entry Physical Barrier Spread Of Infection Chemical Barrier Production Of Toxins Effective Drainage Virulence Of Org. Immune Defense Mechanism Product Of Organism. HOST- MICROORGANISM RELATIONSHIP INFECTIOUS AGENTS HOST VIRAL HEPATITIS: VIRAL HEPATITIS 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 14 PowerPoint Presentation: 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 15 Term Used To Describe Infection Of Liver Caused By Hepatotropic Viruses. Currently 5 Main Varieties- Hepatitis A Virus (HAV)- Feacally Spread & Self Limiting Dis. Hepatitis B Virus (HBV)- Parenterally Trans. May Become Chronic. Hepatitis C Virus (HCV)/ (NANB)- Transfusion, Chronic Hepatitis D Virus (HDV)- Superinfection With Hbv . Hepatitis E Virus (HEV)- Water Borne All These Human Hepatitis Viruses Are RNA Viruses Except HBV Which Is A DNA Virus. HEPATITIS B : HEPATITIS B 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 16 PowerPoint Presentation: 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 17 Infectious Disease Caused By HBV which Infects Liver and Causes Inflammation, Has A Longer Incubation Period Of 30 – 180 Days And It May Occur At Any Age. Transmission Through-1.Percutaneous ( Blood) 2.Non Percutaneous (Body Fluids) Same Way As HIV HBV Is Nearly 100 Times As Infectious As HIV HBV Is One Of Few Known Retroviral Viruses & Employ Reverse Transcription As Part Of Its Replication Process VIROLOGY: VIROLOGY FAMILY HEPADNA VIRUS GENOME DNA , ss / ds SEROTYPE& GENOTYPE 4 & 8 VIRAL PRACTICLE 3 TYPES- SMALL SPHERES 20nm HBsAG TUBULES 20X100 nm LARGE 42 nm DANE PARTICLES INTACT HBV. MORPHOLOGY DOUBLE SHELLED,ENVELOPED ANTIGENS HBsAG SURFACE HBcAG HBeAG CORE ANTIBODIES anti-HBs anti- HBc anti- HBe 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 18 (IMMUNO) PATHOGENESIS: (IMMUNO) PATHOGENESIS HBV Is Not Directly Cytopathic And The Fact That Patients With Defect In Cellular Immune Competence Are More Likely To Remain Chronically Infected Supports Immunopathogenesis . During HBV Infection Host Immune Response Is Responsible For Hepatocellular Damage & Viral Clearance. 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 19 PowerPoint Presentation: 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 20 The Adaptive Immune Response, particularly Virus Specific Cytotoxic T Lympocytes (CTLs),Contributes to nearly all of liver injury associated with HBV. By Killing Infected Cells And By Producing Antiviral Cytokines Capable Of Purging HBV From Viable Hepatocytes , CTLs Also Eliminate Virus. Formation Of Immune Complexs By Combination Of Ag- Ab Leads To Activation Of Complement System Result In Tissue Damage This Is Major Pathogenic Mechanism For Extrahepatic Manifestation. CLINICAL FEATURES: CLINICAL FEATURES Asypmtomatic Sypmtomatic ( fever,tiredness,nausea,jaundice,abd.pain ) Fulminant (massive hepatic necrosis) Persistent ( asypmtomatic carrier) Active/Progressive (Cirrhosis, HCC ) 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 21 Acute Chronic Hepatitis B infection: Possible outcomes: Hepatitis B infection: Possible outcomes Possible outcomes of infection: Subclinical or acute hepatitis with recovery and clearance (85%); 1% of those may develop fulminant hepatitis and death Healthy carriers (10%) Persistent infection (5%): 80% recover and 20% develop chronic hepatitis 20% of chronic hepatitis patients develop cirrhosis and 10% of those develop hepatocellular carcinoma LAB. INVESTIGATIONS: LAB. INVESTIGATIONS 1.TO ASSESS LIVER FUNCTION – LFT’s 2.TO DETECT HBV RELATED Ag- Ab - A BATTERY OF SEROLOGICAL TEST USED- HBsAg - GENERAL MARKER HBsAb - MARKS RECOVERY OR IMMUNITY anti- HBc IgM - ACUTE INFECTION anti- HBc IgG - PAST OR CHRONIC INFECTION HBeAg - ACTIVE REPLICATION anti- Hbe - NO LONGER REPLICATION HBV DNA- ACTIVE REPLICATION 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 23 HBV SEROLOGY: HBV SEROLOGY HBsAg HBcAb IgM HBcAb IgG HBsAb Acute HBV + + - - Resolved HBV - - + + Chronic HBV + - + - HBV vaccinated - - - + COMPLICATIONS: COMPLICATIONS FULMINANT HEPATITIS CHRONIC HEPATITIS CIRRHOSIS OF LIVER HEPATOCELLULAR CARCINOMA 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 25 TREATMENT: TREATMENT Treatment Can Be Done With- Alpha-interferon 2b (Original) 1.Interferon ( Immunomodulators ) Alpha-interferon 2a(Newer) 2.Antivirals- Lamivudine , Adefovir , Entecavir .. PROPYLAXIS/PREVENTION: PROPYLAXIS/PREVENTION Vaccination Hepatitis B Immunoglobulin ( HBIG ) Other measures - screening of blood donors, blood and body fluid precautions . Public Awareness- world hepatitis day 28 july ( THIS IS HEPATITIS) AYURVEDIC VIEW: AYURVEDIC VIEW 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 28 PowerPoint Presentation: 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 29 Yakrt - Derived From Root kr. With prefix ya & suffix tuk . ‘‘ samayamam karoti iti yakrt ’’ | Meaning one which controls is yakrt . Shonita ( rakta ) Koshtanga Mula of raktavaha srotas ETIOLOGY IN AYURVEDA: ETIOLOGY IN AYURVEDA Bhoota Visha Vayu Agni Samprahar 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 30 2 TYPES NIJA/ ABHYANTAR AGANTU/ BAHYA PowerPoint Presentation: Classification of diseases in modern texts based on anatomical/structural considerations. But we don’t find such classification in ayurvedic texts rather it is based on physiological/functional consideration. 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 31 PowerPoint Presentation: 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 32 HUMAN BODY PURUSHA CELL TISSUE ORGAN.. ANATOMICAL/ STRUCTURAL LIVER SROTOMAYA PHYSIOLOGICAL/FUNCTIONAL RAKTAVAHA SROTAS YAKRT HEPATOCYTE DISEASE/ROGA KAMALA: KAMALA “ Kayam malayate iti kamala”|| “ Kutsita mala yasmin roge sa kamala”|| “ Kamam lati hanti iti kamala” || 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 33 PowerPoint Presentation: 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 34 PowerPoint Presentation: Kamala roga Hepatitis. Swatantra kamala Viral hepatitis Chikitsa 1.Nidana Parivarjana 2.Shodhana 3.Shamana 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 35 NIDANA PARIVARJANA: NIDANA PARIVARJANA Avoid Raktavaha srotas dushti hetus . Vidahinya anapanani snigdhoshna dravani cha | raktavahini dushyanti bhajtam cha aatapanalu || cha.vi.5/14 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 36 SHAMANA: SHAMANA Raktapitta Hari Kriya - Rasa - Madhura , Tikta , Kashaya Guna - Sita , Ruksha , Guru Dravya - Katuki,Musta,Nimba,Patola,Guduchi,Haridra,Bhumyamalki , Pippali .. Loha,Mandur,Makshik Bhasma 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 37 SHODHANA: SHODHANA Snehana Ghrita ( Haridra ) Swedana Mrudu Virechana Mrudu ( Trivrut / Danti ) Some Conditions Shodhana Nasya With Jeemootaka Phala . 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 38 RESEARCH WORKS: RESEARCH WORKS 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 39 PowerPoint Presentation: 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 40 1976 - Dr Ashok Vaidya -Therapeutic effect of Luffa echinata(Roxb) on viral hepatitis. 2003-Dr Prashant Doshi – Management of heptocellular B virus induced jaundiceW.S.R to virechana and nasya.AMV,Hubli,RGUHS. 2009 – Dr Sachin Ganeshwadi - Pathological study of Serum Bilirubin in Infective Hepatitis (Kamala) with respect to Devdali ( Luffa achinata ) Nasya 2010-Dr Smina - A Comparitive Clinical Study of virechana yogas in Koshtashakashrita Kamala W.S.R. to Infective Hepatitis. DISCUSSION: DISCUSSION 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 41 PowerPoint Presentation: 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 42 In ayurveda treatment is based on vitiated doshas not on name of disease. In HBV Infection Pitta is vitiated so line on treatment is based on it. Hence Virechana as Shodhana would be beneficial in HBV Infection. Some Stage Shodhana Nasya can be given. CONCLUSION: CONCLUSION 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 43 PowerPoint Presentation: Hepatitis B Can Be Considered As Vyadhi Of Raktavaha Vaha Srotas In Which Nidana - HBV ( Agantu-bhoota ) Rupa - Koshtashaka Ashrita Kamala Samprapti - Vitiation Of Pitta Chikitsa - Virechana & Some Stage Nasya 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 44 PowerPoint Presentation: 3/14/2014 DEPT. OF P.G STUDIES IN PANCHAKARMA 45 Hepatitis B disease can be considered as Swatantra kamala caused by agantuja hetu ( bhoota - Chakrapani ‘ Savisha krimi Pischadayah ’) Management of Hepatitis B can be done based on line of treatment explained for Raktavaha Srotas Vikaras , specifically of Kamala roga . Virechana & Nasya can be used as Shodhana karma in Hepatitis B. PowerPoint Presentation: Dhanyavad …. 3/14/2014 Dept. of P.G Studies ln Panchakarma 46

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