Hepatitis

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

Hepatitis 3Hepatitis 5

Treatment:

Hep B: one of the following: interferon, adefovir, lamivudine, telbivudine, entecavir, tenofovir

Hep C: combination of: interferon + ribavirin + either telaprevir or boceptrevir

Hepatitis 6

 


Download the PDF version: here


References:

  • Master the boards
  • Step up to medicine

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