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TerryZ
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A/C hepatitis - distinction
- acute < 6 mo
- chronic > 6 mo
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A/C hepatitis - causes
- ~inf: EtOH, drug-induced, AI, heredit
- A&E: oral-fecal (never chronic)
- B: parenteral/sexual (sex/perinatal)
- D: HBsAg
- C: parenteral (IVD) & transfusion
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Acute hepatitis - S/Sx
- range: asympt to fulminant LF
- jaundice: sclera
- urine: dark (conj bilirubin)
- pain: RUQ
- Const: N/V, F, malaise, flu-like
- Hep B: serum sickness-like dz
- Hep C: no acute illness
- Fulm LF: Hep B,D,E
- Enceph (asterixis,palm eryth)
- Hepatorenal synd.
- Bleeding diathesis
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Acute hepatitis - Dx
- //ALT&AST (400-5K IU, nl 10-40), L>S
- nl-slightly/Alkϕ, /TBili, PT?->
- PCR for HCV
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Acute hepatitis - Tx
- Tx: sxs
- HAV: spont resolv; tx sxs; vaccine
- HEV: spont resolv; tx sxs; NO vaccine
- Hosp: if A-LF (INR>1.5,enceph,bili>15)
- HBV: oral agents, nucleo[s|t]ides:
- lamivudine, adefovir, entecavir...
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Acute hepatitis - PPx
- Hep A vax: 0, 6mo
- Hep B vax: 0, 1, 6mo
- HBIG: post-exposure w/in 7 days + vax
- Hep C: NO vaccine
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Chronic hepatitis - facts
- Most asympt until advanced dz
- Mild /AST&ALT
- Only in Hep B,C,D
- Hep B Hep C
- After acute 1-10% >80%
- Cirrhosis w/ or w/o only w/
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Chronic hepatitis - S/Sx
- Asympt: some are chronic carriers)
- Jaundice: (1st sclera)
- Derm: spid ang,palm eryth,caput medus
- Other: HSM, ascites, asterixis, gynecom
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Chronic hepatitis - Dx
- Bx: liver (stages)
- AST/ALT: nml or < 3xULN
- Alkϕ: nml or slightly /
- HoAlb: MC in chronic
- Bili: /TBili & conj
- /PT: .
- Serum serologies: .
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Chronic hepatitis - Tx general
- Mon: PLT,/ALT/AST,/Bili,HoAlb,>PT/INR
- HCC: AFP/6mo;HepC if cirrh;~nl:CT/MRI
- Varices: scrn
- Mgmt: P, F (APAP-not bleed risk); EtOH
- Enceph: restrict protein
- Vax: Hep A & B, flu, pneumococcal
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HepC: interferon-α + ribvirin, unless:
- ~IVD,EtOH abuse x6mo
- Uncntl psych/depression Decomp liver dz(HoAlb,enceph,ascites) ~Contraception
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Chronic hepatitis, B - Tx
- HepB: interf-α (xCirrh)
- PO nucl (lami,adef,entec,telbiv,teno)
- If +HBcAb, PO ~vir b4 i-mod agents
- (chemo,RA meds,TNF blockers)
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Chronic hepatitis, C - Tx
- Interferon-α + ribvirin, unless:
- ~IVD,EtOH abuse x6mo
- Uncntl psych/depression
- Decomp liver dz(HoAlb,enceph,ascites) ~Contraception
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Hepatitis serologies
- A: IgM ~HAV IgG
- a-inf a-inf-life immun .
- B: HBsAg HBeAg HBsAb HBcAb VirLoad
- a/c activ repl in1-3m IgM/G >6wks
- 1wk-clr immun wndow chron
- C: HCVAb VirLoad
- months 1-2wk
- expos .
- D: HDVAb VirLoad
- superinf RNA
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Alcoholic hepatitis - labs
- AST: 2-7x, <400u/L, >ALT
- ALT: 2-7x, <400u/L
- AST/ALT: >1
- GGTP: not specific (/ all fatty liver dz)
- Bili: ?//
- PMN: >5500/μL
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