Hepatitis
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Introduction
- Diffuse inflammation of the liver that can be caused by infective agents, drugs, alcohol, autoimmune and toxins
Clinical features
Acute hepatitis (lasting for less than 6 months):
- Mild-to-moderate jaundice
- Vague right upper quadrant discomfort
- Fever with or without mild fever
- Hepatomegaly
Chronic hepatitis (lasting more than 6 months):
- General malaise/Fatigue
- Re-occurence of jaundice
Complications
- Liver failure
- Bleeding tendencies
- Cirrhosis/Liver cancer
Investigations
- Liver Function Tests
- Serologic markers of Hepatitis A, B, C, D and E
- Viral load
- Abdominal ultrasonography
- Prothrombin time
- HIV Screening
Treatment goals
- Provide supportive measures
- Prevent progression to chronic phase
Non-drug treatment
- High carbohydrate and normal protein diet
- Discontinuation of hepatotoxic medication
- Bed rest
Drug treatment
Chronic Hepatitis B
• Treatment is required in patients with viral load exceeding 2000 IU/ml for HBeAg negative or 20000 IU/ml for HBeAg positive status.
- Pegylated interferon alfa -2b: 180μg sc. weekly for 48 weeks
- Oral Tenofovir 300 mg daily
Chronic Hepatitis C
• Pegylated interferon alfa-2b: 180 microgram subcutaneously weekly for 48 weeks
Plus:
• Ribavirin:
- 400 mg orally twice daily for adults with body weight less than 65 kg
- 400 mg in the morning and 600 mg in the evening for adults weighing 65-85 kg;
- 600 mg twice daily for adults weighing over 85 kg
Or
Peg IFN + Ribavirin + Sofosbuvir for 12 weeks. (For all genotypes)
Hepatitis D
Treatment of HBV is effective for HDV
Notable adverse drug reactions, complications, and caution
- Interferon alpha 2b and Ribavirin reduce hematopoiesis
- Flu-like illness
- Leucopenia
- Psychiatric-like symptoms
- Development of early resistance if therapy exceeds one year