Clinical presentation:
- Jaundice, fatigue, wt loss, hepatosplenomegaly, dark urine, ↑ conjugated bilirubin, ↑ ALT:AST, ↑ALP
- Most acute hepatitis: hep A or B, (hep C is rarely causing acute)
- Hep B,C,D: sex, blood, perinatal + can progress to chronic
- Hep A,E: food and water + mild\don’t progress to chronic
- Travellers should be vaccinated against Hep A
- Hep E is worst in pregnancy
- Increased prothrombin time is associated w\ increased mortality (↑ risk of fulminant hepatic failure and death)
- 10% of pts w\ acute hep B -> chronic
- 80% of pts w\ acute hep C -> chronic
Hep B tests:
- First one to appear after acquiring hep B infection? Surface Ag
- Correlated w\ active viral replication? E- antigen (= high DNA polymerase activity)
- As long as surface Ag is present -> pt can still transmit the ds
- Which pts will benefit the most from treatment? One w\ high E-antigen
- What indicates that pregnant women will transmit the ds to her child? E- antigen
- What indicates chronic hep B infec? Surface Ag for > 6 mo
Treatment:
Hep B: one of the following: interferon, adefovir, lamivudine, telbivudine, entecavir, tenofovir
Hep C: combination of: interferon + ribavirin + either telaprevir or boceptrevir
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References:
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