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]] | |||
*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:''' | |||
*Interferons or pegylated interferons | |||
*[[Ribavarin]] | |||
*Direct-acting anti-viral 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 22:22, 28 September 2016
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
- 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
- Coagulopathy
- GI bleed
Differential Diagnosis
Causes of acute hepatitis
- Acetaminophen toxicity (most common cause of acute liver failure in the US[1])
- Viral hepatitis
- Toxoplasmosis
- Acute alcoholic hepatitis
- Toxins
- Ischemic hepatitis
- Autoimmune hepatitis
- Wilson's disease
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
- Ascites
- Esophageal varices
- Hepatic encephalopathy
- Spontaneous bacterial peritonitis
- Hepatorenal syndrome
- Portal hypertension
- Upper gastrointestinal bleed
- Hepatocellular carcinoma
Outpatient HCV treatment may include:
- Interferons or pegylated interferons
- Ribavarin
- Direct-acting anti-viral 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
- ↑ 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.