Viral hepatitis

Causes

Hep B:

HBsAg: first +; if + long time may be chronic; implies infection -infectivity.

Anti-HBs: + p clearance of Ag or vaccination; appears p windon period; if Ag neg then implies recovery, noninfectious

Anti-HBc: +in window; appears early; IgM = acute & in flares; IgG always present.

HBe-Ag: implies viral replication & infectivity; if + > 3 months may be chronic.

HBV dna: like HBe-Ag but more sensitive & precise.

Hepatitis C:

-Risk: Drugs (IVDA/intranasal cocaine), hemodialysis, transplant-92, needle stick, maternal-fetal transmission (5%), sex.

Blood products: cyro> 1987, PRBC>94, 1/10000-100000.

of 100 pt infected>85 chronic, 70 chronic active, 15 cirrohsis, hcc, 5 die.

No vaccine.

-acutely>asymptomatic: 60%

-syx>constitutional

-chronic: HCC 1- 4%

-extrahepatic: PAN, cryoglobulinemia, porphyria cutanatardica.

LFTs q3-6 months if all normal then q1year.

LFTs: do NOT indicate infectivity or chronicty.

Infectious: based on PCR

Tx: alpha interferon 50% respond in 1 year. May try ribavarin in conjuction if failed.

SE: fatigue, worsened hepatitis.

ribavirin- anemi

==Disposition ==

ADMIT CRITERIA

1) INR >2

2) Unable tol POs

3) Pain control

4) Bilirubin >30

5) Hypoglycemia

6) Significant comorbid illness/immunocomp

7) >50 years

Adapted from Stevens, Donaldson, Pani

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