Hepatitis C: Difference between revisions

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==Background==
==Background==
*Bloodborne transmission
*NO acute phase
*>75% progress to chronic hepatitis C infection
*Disease course depends on comorbidities (e.g. alcohol use, HIV status, etc.)
*May progress to [[cirrhosis]], +/- [[hepatocellular carcinoma]]


==Clinical Features==
==Clinical Features==
*Asymptomatic during first few years
*Symptoms occur once [[cirrhosis]] has developed
*Malaise, [[weakness]] (from [[electrolyte derangements]])
*[[Abdominal pain]]
*[[Ascites]], [[SBP]] (fever, abdominal tenderness)
*[[Altered mental status]] due to [[hepatic encephalopathy]]
*[[liver disease induced coagulopathy|Coagulopathy]]
*[[GI bleed]]


==Differential Diagnosis==
==Differential Diagnosis==
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==Management==
==Management==
'''Complications of cirrhosis'''
*[[Ascites]]
*[[Esophageal varices]]
*[[Hepatic encephalopathy]]
*[[Spontaneous bacterial peritonitis]]
*[[Hepatorenal syndrome]]
*Portal hypertension
*[[Upper gastrointestinal bleed]]
*[[Hepatocellular carcinoma]]
'''Outpatient HCV treatment may include:'''
*[[Interferon-α]] or pegylated interferons
*[[Ribavirin]]
*Direct-acting antiviral agents (boceprevir, telaprevir, simeprevir, sofosbuvir, Harvoni, etc.)


==Disposition==
==Disposition==
*Often complex and should be based on presence/absence of acute complications
*If no complications present, discussion with patient's primary care provider or gastroenterologist recommended


==See Also==
==See Also==
*[[Cirrhosis]]
*[[Ascites]], [[SBP]]
*[[Hepatic encephalopathy]]
*[[Hepatorenal syndrome]]
*[[Upper gastrointestinal bleed]]


==External Links==
==External Links==

Revision as of 21:05, 29 September 2019

Background

  • Bloodborne transmission
  • NO acute phase
  • >75% progress to chronic hepatitis C infection
  • Disease course depends on comorbidities (e.g. alcohol use, HIV status, etc.)
  • May progress to cirrhosis, +/- hepatocellular carcinoma

Clinical Features

Differential Diagnosis

Causes of acute hepatitis

Evaluation

Interpreting Acute Hepatitis Panel Results

Anti-hepatitis A, IgM Hepatitis B surface antigen Anti-hepatitis B core, IgM Anti-hepatitis C Interpretation
Positive Negative Negative Negative Acute hepatitis A
Negative Positive Positive Negative Acute hepatitis B
Negative Positive Negative Negative Chronic hepatitis B infection
Negative Negative Positive Negative Acute hepatitis B; quantity of hepatitis B surface antigen is too low to detect
Negative Negative Negative Positive Acute or chronic hepatitis C; additional tests are required to make the determination

Management

Complications of cirrhosis

Outpatient HCV treatment may include:

  • Interferon-α or pegylated interferons
  • Ribavirin
  • Direct-acting antiviral agents (boceprevir, telaprevir, simeprevir, sofosbuvir, Harvoni, etc.)

Disposition

  • Often complex and should be based on presence/absence of acute complications
  • If no complications present, discussion with patient's primary care provider or gastroenterologist recommended

See Also

External Links

References

  1. Ostapowicz G, Fontana RJ, Schiodt FV, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med. 2002 Dec 17; 137(12): 947-54.