IM hepatitis

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Author:
TerryZ
ID:
249343
Filename:
IM hepatitis
Updated:
2013-11-28 08:04:14
Tags:
internal medicine IM hepatitis
Folders:
IM
Description:
Internal medicine - hepatitis
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  1. A/C hepatitis - distinction
    • acute < 6 mo
    • chronic > 6 mo
  2. A/C hepatitis - causes
    • ~inf: EtOH, drug-induced, AI, heredit
    • A&E: oral-fecal (never chronic)                
    • B: parenteral/sexual (sex/perinatal)                
    • D: HBsAg
    • C: parenteral (IVD) & transfusion
  3. Acute hepatitis - S/Sx
    • range: asympt to fulminant LF
    • jaundice: sclera
    • urine: dark (conj bilirubin)
    • pain: RUQ
    • Const: N/V, F, malaise, flu-like
    • Hep B: serum sickness-like dz
    • Hep C: no acute illness
    • Fulm LF: Hep B,D,E
    •              Enceph (asterixis,palm eryth)
    •              Hepatorenal synd.
    •              Bleeding diathesis
  4. Acute hepatitis - Dx
    • //ALT&AST (400-5K IU, nl 10-40), L>S
    • nl-slightly/Alkϕ, /TBili, PT?->
    • PCR for HCV
  5. Acute hepatitis - Tx
    • Tx: sxs
    • HAV: spont resolv; tx sxs; vaccine
    • HEV: spont resolv; tx sxs; NO vaccine
    • Hosp: if A-LF (INR>1.5,enceph,bili>15)
    • HBV: oral agents, nucleo[s|t]ides:
    •         lamivudine, adefovir, entecavir...
  6. Acute hepatitis - PPx
    • Hep A vax: 0, 6mo
    • Hep B vax: 0, 1, 6mo
    • HBIG: post-exposure w/in 7 days + vax
    • Hep C: NO vaccine
  7. Chronic hepatitis - facts
    • Most asympt until advanced dz
    • Mild /AST&ALT
    • Only in Hep B,C,D
    •                    Hep B         Hep C
    • After acute    1-10%       >80%
    • Cirrhosis      w/ or w/o    only w/
  8. Chronic hepatitis - S/Sx
    • Asympt: some are chronic carriers)
    • Jaundice: (1st sclera)
    • Derm: spid ang,palm eryth,caput medus
    • Other: HSM, ascites, asterixis, gynecom
  9. Chronic hepatitis - Dx
    • Bx: liver (stages)
    • AST/ALT: nml or < 3xULN
    • Alkϕ: nml or slightly /
    • HoAlb: MC in chronic
    • Bili: /TBili & conj
    • /PT: .
    • Serum serologies: .
  10. Chronic hepatitis - Tx general
    • Mon: PLT,/ALT/AST,/Bili,HoAlb,>PT/INR
    • HCC: AFP/6mo;HepC if cirrh;~nl:CT/MRI
    • Varices: scrn
    • Mgmt: P, F (APAP-not bleed risk); EtOH
    • Enceph: restrict protein
    • Vax: Hep A & B, flu, pneumococcal
  11. HepC: interferon-α + ribvirin, unless:
    •    ~IVD,EtOH abuse x6mo
    •    Uncntl psych/depression   Decomp liver dz(HoAlb,enceph,ascites)   ~Contraception
  12. Chronic hepatitis, B - Tx
    • HepB: interf-α (xCirrh)
    •    PO nucl (lami,adef,entec,telbiv,teno)
    •    If +HBcAb, PO ~vir b4 i-mod agents
    •           (chemo,RA meds,TNF blockers)
  13. Chronic hepatitis, C - Tx
    • Interferon-α + ribvirin, unless:
    • ~IVD,EtOH abuse x6mo
    • Uncntl psych/depression
    • Decomp liver dz(HoAlb,enceph,ascites)   ~Contraception
  14. Hepatitis serologies
    • A:   IgM   ~HAV     IgG
    •      a-inf a-inf-life  immun                   .
    • B: HBsAg  HBeAg  HBsAb HBcAb VirLoad
    •       a/c  activ repl in1-3m IgM/G  >6wks
    •     1wk-clr            immun wndow  chron
    • C:                                HCVAb VirLoad
    •                                    months  1-2wk
    •                                     expos           .
    • D:                                HDVAb VirLoad
    •                                    superinf   RNA
  15. Alcoholic hepatitis - labs
    • AST: 2-7x, <400u/L, >ALT
    • ALT: 2-7x, <400u/L
    • AST/ALT: >1
    • GGTP: not specific (/ all fatty liver dz)
    • Bili: ?//
    • PMN: >5500/μL

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