CHRONIC HEPATITIS Flashcards
Chronic hepatitis
chronic inflammation of the liver of more than 6
months duration, with persistently elevated liver function tests.
Chronic hepatitis can progress to………
Liver cirrhosis
Portal hypertension with upper
gastrointestinal bleeding
Hepatic encephalopathy
Hepatocellular
carcinoma
Long-term monitoring for patients with chronic hepatitis B
Disease activity Hepatocellular
carcinoma screening Six-monthly Hepatitis B viral DNA quantification
LFTs
Abdominal ultrasound Alpha fetoprotein
Causes of chronic hepatitis
Hepatitis B virus (HBV)
Hepatitis C virus (HCV)
Hepatitis E virus (genotype 3)
Symptoms of chronic hepatitis
Recurrent fever
Arthralgia
Malaise
Jaundice
Lethargy
Signs of stigmata of chronic liver disease
Palmar erythema
Clubbing
Dupuytren’s contracture
Parotid enlargement
Gynaecomastia
Testicular atrophy
Spider naevi
Signs of decompensated liver disease
Jaundice
Ascites
Encephalopathy
Peripheral oedema
Purpura/skin bruising
Peripheral edema in decompensated liver disease is due to
Hypoalbuminemia
Manifestations of coagulopathy in decompensated chronic liver disease
Purpura or skin bruising
Investigations in chronic hepatitis
FBC
LFTs
INR
HIV
Baseline alpha-feto-protein
Abdominal ultrasound scan
Chronic Hepatitis B screen
Chronic Hepatitis C screen
Parameters in chronic hepatitis B screen
Hepatitis B surface Antigen (HBsAg)
HBc IgG
Hepatitis-B-e-antigen (HBeAg) & Anti-HBe
Hepatitis B Viral Load
Parameters in chronic hepatitis C screen
Hepatitis C Virus (HCV) antibody testing
HCV RNA
HCV genotyping
Treatment objectives in chronic hepatitis
To prevent disease progression and complications
To prevent hepatic encephalopathy
To prevent disease progression and complications
To prevent hepatic encephalopathy
Non-pharmacological management of chronic hepatitis
Prevention of transmission to partners
Lifestyle/dietary advice
Spouse/household screening
Ways of preventing transmission of hepatitis to partner
Protected sex
Not sharing of toothbrushes and sharps, blades, needles, body piercings,
tattoos, cultural scarification practices, circumcisions etc.
First line management of chronic active hepatitis B
Pegylated Interferon alfa-2a, subcutaneous,
Or
Tenofovir, oral,
Or
Entecavir, oral,
Second line management of chronic active hepatitis B
Lamivudine, oral,
First line for management of decompensated liver cirrhosis/ Fulminant Liver failure from
Chronic Hepatitis B
Tenofovir, oral,
Or
Entecavir, oral,
Second line for management of decompensated liver cirrhosis/ Fulminant Liver failure from
Chronic Hepatitis B
Lamivudine
First line management for patients with Chronic Hepatitis B undergoing chemotherapy or
immunosuppressive treatment
Tenofovir, oral,
Or
Entecavir, oral,
Second line management for patients with Chronic Hepatitis B undergoing chemotherapy or
immunosuppressive treatment
Lamivudine, oral
Four main actions done in post-exposure management of healthcare workers after
occupational exposure to Hepatitis B infection
- Post-exposure testing
- Post-exposure prophylaxis
- Post-vaccination Anti-Hbs
Post exposure testing involves
- Testing the surce patient
- Measuring healthcare worker Anti-Hbs
Post-exposure prophylaxis of Hepatitis B involves
- Hepatitis B immunoglobulin (HBIG)- 0.06ml/Kg
- HBV vaccination
Post-exposure management of healthcare workers after
occupational exposure to Hepatitis B infection - for a Documented Responder (> 3 Doses Received)
No action required
Post-exposure management of healthcare workers after occupational exposure to Hepatitis B infection
- Documented
Non- Responder (After > 6 Doses)
If post exposure test of source patient is positive;
a. Hepatitis B Immunoglobulin (0.06 ml/kg IM) twice, one month apart
If post exposure test of source patient is negative;
no action is required
Post-exposure management of healthcare workers after occupational exposure to Hepatitis B infection when Response Unknown (After >3 Doses)
- If post-exposure testing of source patient is positive or unknown and HCW
Anti-HBs is <10 MIU/ml;
a. Give HBIG 0.06ml/Kg once
b. Revaccinate patient c. Post-Vaccination Anti-HBs testing - If post-exposure testing of source patient is negative and HCW Anti-HBs is <10 MIU/ml;
a. Revaccinate patient
b. Post-Vaccination Anti-HBs testing - If HCW
Anti-HBs is >10 MIU/ml
No action is required
Post-exposure management of healthcare workers after occupational exposure to Hepatitis B infection- in an unvaccinated/
incompletely vaccinated health care worker
- If post-exposure testing of source patient is positive or unknown;
a. HBIG 0.06ml/kg once
b. Complete vaccination
c. Post-Vaccination Anti-HBs testing - If post-exposure testing of source patient is negative;
a. Complete vaccination
b. Post-Vaccination Anti-HBs testing
When should Post-Vaccination Anti-HBs be performed
1-2 months after last dose of HBV vaccination
series but ~ 4-6 months after HBIG to avoid detection of passively administered
Anti-HBs.
What does Documented Responder mean
Person with Anti-HBs > 10 MIU/ml after 3 or more HBV vaccination
doses
What does documented non-responder mean
Person with Anti-HBs < 10 MIU/ml after 6 or more HBV vaccination
doses
These group of healthcare workers should undergo HBsAg screening as soon as possible after exposure
and follow up testing ~ 6 months later (HBsAg + Anti-HBc) when they sustain exposure to a source patient who is HBsAg-positive/ unknown
HBsAg status
- Those who have Anti-Hbs < 10 MIU/ml
- unvaccinated or incomplete vaccination
First line treatment for chronic hepatitis C infections
Pegylated Interferon alfa-2a, subcutaneous,
Or
Pegylated Interferon alfa-2b, subcutaneous,
And
Ribavirin, oral,
