Chronic Hepa Flashcards
are nonprogressive oronly slowly progressive type of chronic hepatitis.
Milder forms
Form of chronic hepatitis may be associated
with scarring and architectural reorganization, which, when
advanced, lead ultimately to cirrhosis.
severe forms
Classification of chronic hepatitis is based on
(1) its cause
(2) its histologic activity, or grade
(3) its degree of progression based
on level of fibrosis, or stage.
Type of Hepatitis which the Diagnositic Tests include HbsAg, IgG anti HBc, HbeAg, and HBV DNA
Chronic Hepatitis B
Type of Hepatitis which the Diagnositic Tests include Anti-HCV and HCV RNA.
Chronic Hepatitis C
Diagnostic Test for Autoimmune hepatitis
ANA, anti-LKM1 +/- hyperglobulinemia
A histologic assessment of necroinflammatory activity, isbased on examination of the liver biopsy.
Grade
An assessment of
important histologic features includes
- the degree of periportal necrosis and the disruption of the limiting plate of periportal
hepatocytes by inflammatory cells (so-called piecemeal necrosis orinterface hepatitis) - the degree of confluent necrosis that links or forms bridges between vascular structures—between portal tract andportal tract or even more important bridges between portal tract andcentral vein—referred to as bridging necrosis
- the degree of
hepatocyte degeneration and focal necrosis within the lobule
-the degree of portal inflammation
When
fibrosis is so extensive that fibrous septa surround parenchymal
nodules and alter the normal architecture of the liver lobule, the
histologic lesion is defined as
cirrhosis
self-limited and do not cause chronic hepatitis
hepatitis A
and E
The likelihood of chronicity after acute hepatitis B varies as a function of
age
is more common than HBeAg-reactive chronic hepatitis B in Mediterranean and European
countries and in Asia
HBeAg-negative chronic hepatitis B
is a common symptom in Chronic Hepatitis B
Fatigue
is a common feature in severe or advanced cases of Chronic Hep B
persistent or intermittent jaundice
reminiscent of acute
hepatitis
- Intermittent deepening of jaundice
- recurrence of malaise and anorexia
- worsening fatigue,
are associated with tissue deposition of circulating hepatitis B antigen–antibody immune complexes and similar to those seen during the
prodromal phase of acute hepatitis B
Extrahepatic
complications of chronic hepatitis B
was the first approved therapy (1992) for chronic hepatitis B.
Although it is no longer used to treat hepatitis B,
IFN-α
The first of the nucleoside analogues to be approved (in 1998) for hepatitis B that inhibits reverse
transcriptase activity of both HIV and HBV and is an effective agent
for chronic hepatitis B
dideoxynucleoside lamivudine
it is less potent than lamivudine or any of the newer antiviral agents.
ADEFOVIR DIPIVOXIL
was shown to be effective in the
treatment of hepatitis C, this more convenient IFN preparation was evaluated in the treatment of chronic hepatitis B.
PEGYLATED IFN/ PEG IFN
an oral cyclopentyl guanosine analogue polymerase inhibitor, appears to be the most potent of the HBV antivirals and is just as well tolerated as lamivudine.
Entecavir
a cytosine analogue, is similar in efficacy to entecavir but slightly less potent in suppressing HBV
DNA
Telbivudine
an acyclic nucleotide analogue
and potent antiretroviral agent used to treat HIV infection, is similar to adefovir but more potent in
suppressing HBV DNA and inducing HBeAg responses; it is highly active against both wild-type and lamivudine-resistant HBV and active in patients whose response to adefovir is slow and/or limited.
Tenofovir disoproxil fumarate (TDF)
a second-generation tenofovir, is a prodrug of tenofovir that requires activation to tenofovir in hepatocytes. This targeted delivery to hepatocytes
allows a lower dose to suffice and reduces systemic exposure by 90%, thereby minimizing TDF-associated proximal tubular renal injury, its associated phosphate wasting, and the potential
consequent loss of bone mineral density.
Tenofovir alafenamide (TAF)
a fluorinated cytosine analogue very similar to
lamivudine in structure, efficacy, and resistance profile, offers no
advantage over lamivudine
emtricitabine
approved for the treatment of HIV infection and is an
appealing combination therapy for hepatitis B, especially for
lamivudine-resistant disease
emtricitabine +
tenofovir
Recommendation Treatment
- HBeAg-reactive
- liver disease is mild and inactive
No tx, monitor
Recommendation Treatment
- HBeAg-reactive
- Chronic Hepatitis
Treat
Recommendation Treatment
- HBeAg-reactive
- Cirrhosis compensated
Tx w/ oral agents, not PEG IFN
Recommendation Treatment
- HBeAg-reactive
- Cirrhosis decompensated
- detectable
- Tx w/ oral agents, not PEG IFN
- Refer to liver transplant
Recommendation Treatment
- HBeAg-reactive
- Cirrhosis decompensated
- undetectable
- observe
- refer for liver transplant
Recommendation Treatment
- HBeAg- negative
- liver diseases is mild and inactive
Tx not necessary
Recommendation Treatment
- HBeAg- negative
- Chronic hepatitis
No tx except for major risk factors
Recommendation Treatment
- HBeAg- negative
- Chronic hepatitis
- > 2xULN ALT
Tx
Recommendation Treatment
- HBeAg- negative
- Cirrhosis compensated
Tx w/ oral agents, not PEG IFN
Recommendation Treatment
- HBeAg- negative
- Cirrhosis decompensated
- detectable
- Tx w/ oral agents, not PEG IFN
- Refer to liver transplant
Recommendation Treatment
- HBeAg- negative
- Cirrhosis decompensated
- undetectable
- observe
- refer for liver transplant
