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