Chronic Hepatitis Classification viral hepatitis Clinical features and Treatment

Chronic Hepatitis Classification viral hepatitis Clinical features and Treatment

Chronic Hepatitis

• Chronic hepatitis is a liver disorder with inflam­mation and necrosis persisting for more than 6 months.
• Chronic hepatitis may be mild, non-progressive, or severe, or may lead to cirrhosis.

Chronic hepatitis may be of three types:

• · Chronic viral hepatitis
• · Chronic drugClinical features and Diagnosis of Unstable Angina(UA) / NSTEMI with Cardiac Biomarkers in Angina. Read more ... »-induced hepatitis
• · Autoimmune chronic hepatitis.

Other presentations of chronic hepatitis may be

• · Wilson’s diseaseClinical features and Diagnosis of Unstable Angina(UA) / NSTEMI with Cardiac Biomarkers in Angina. Read more ... »
• · Alcoho’lic hepatitis.

Classification of Chronic Hepatitis Classification by extent of liver injury

• 1. Chronic persistent hepatitis
• 2. Chronic lobular hepatitis
• 3. Chronic active hepatitis.

Classification of Chronic hepatitis by Cause

• · Hepatitis BViruses General Introduction To VIRAL DISEASES Diagnosis Treatment with Causative Agents. Read more ... »
• · Hepatitis B plus D
• · Hepatitis C
• · Autoimmune hepatitis type I, II and III based on serology
• · Drug-associated chronic hepatitis
• · Cryptogenic chronic hepatitis.

Classification of Chronic hepatitis by Grade

• 1. Periportal necrosis
• a. Piecemeal necrosis or interface hepatitis
• b. Bridging necrosis
• 2. Intralobular necrosis
• 3. Portal inflammation
• 4. Fibrosis.

Chronic viral hepatitis generally follows:

• Viral hepatitis B
• Viral hepatitis C
• Viral hepatitis Band C with superimposed hepa­titis D.
• Hepatitis A and E are self-limited and do not progress to chronic hepatitis.

Chronic Hepatitis B

• Hepatitis B infectionHepatitis Types Causes Symptoms Diagnosis and Treatment. Read more ... » at birth may be silent but there
• is a 90% chance of chronic infection. •
• In young adults there is overt symptomatic acuteClinical features and Diagnosis of Unstable Angina(UA) / NSTEMI with Cardiac Biomarkers in Angina. Read more ... » hepatitis but progression to chronic hepatitis is rare.
• Chronic hepatitis may be asymptomatic, mild or se­vere.
• Chronic hepatitis B may progress to severe form, cir­rhosis, and liver failure in about a quarter of the cases.

Hepatitis B virus replication (HBV)

• Replicative phase is identified by the presence of se­rum markers – HBeAg (Hepatitis B e antigen) and HBV DNA, presence of intrahepatocyte antigens ­HBcAg (Hepatitis B core antigen) and liver injury.
• Non-replicative phase is characterized by absence of HBeAg and HBV DNA, and minimal liver injury.
• Chronic HBV infection at birth and in early childhood leads to hepatocellular carcinomaArbuda or Cancer Ayurvedic Review. Read more ... » in a majority of, cases.

Clinical features of Chronic hepatitis B

• · Asymptomatic infection
• · Deblitating disease
• · Progresses to end-stage hepatic failure
• · Onset may be insidious (slow), or chronic disease may follow acute hepatitis B.
• · FatigueFatigue diagnosis medicine and treatment. Read more ... »
• · Persistent or intermittent jaundiceCauses of jaundice with diagnosis and bio markers. Read more ... »
• · Malaise, anorexia, leading to slow hepatic dec­ompensation
• · Cirrhosis of liver – ascites, edema, bleeding gas­troesophageal varices, hepatic encephalopathyCirrhosis and COMPLICATIONS of CIRRHOSIS with Treatment. Read more ... », coagulopathy and hypersplenism.
• Extrahepatic manifestations – arthralgias, arthritis, purpuric lesions due to vasculitis, polyarteritisVasculitis Syndrome Causes Differential Diagnosis Symptoms and Treatment. Read more ... » nodosa.

Laboratory features

• · Amino transferase elevation may be from 100 to 1000 units.
• · ALT (Alanine amino transferase) is elevated more
• than AST (aspartate amino transferase).
• · In cirrhosis AST may be more than A LT.
• · Alkaline phosphatase may be normal.
• · Serum bilirubin may be moderately raised – 3 to 10 mg/dL.
• · Hypoalbuminemia may be present.
• · Prothrombin time increased.

Chronic hepatitis B Treatment

• Progression of disease occurs in patients with active HBV replication.
• Patients with high level HBV replication are at risk of hepatocellular carcinoma.
• Antiviral therapy should be given to all patients of chronic hepatitis B. The drugs for chronic hepa­titis B are injectable interferon alpha IFNa, oral lamivudine, oral adefovir dipivoxil.
• Antiviral therapy should be given to patients with detectable· markers of HBV replication, in patients with incr~ased ALT twice the upper limit of nor­mal, all immunocompromised individuals, pa­tients of compensated or uncompensated disease. “,
• Dose of interferon - IFN 5 million units subcutaneous daily for 16 weeks or 10 million units 3 times a week.
• Dose of LamiAcute Myocardial Infarction (AMI) Causes PATHOPHYSIOLOGY and Etiology. Read more ... »vudine - Daily oral dose of 100 mg for 12 months.
• Dose of Adefovir - Oral daily dose of 10 mg for 48 weeks (1 year).

Chronic Hepatitis D

• Chronic hepatitis DHepatitis Types Causes Symptoms Diagnosis and Treatment. Read more ... » may follow acute infection with hepatitis B virus.
• HDV infection can increase the severity of acute hepa­titis B but progression to chronic hepatitis mayor may not occur.
• If HDV infection occurs in chronic hepatitis B then there is deterioration of liver function resulting in se­vere liver disease.
• The clinical featuresPulmonary Thromboembolism Pathophysiology Clinical Features with Treatment. Read more ... » of hepatitis D over hepatitis B are same as for chronic hepatitis B alone.
• In chronic hepatitis D, anti-LKM i.e. antibodies to liver­kidneyDiabetic Nephropathy and Renal complications of DM (Diabetes Mellitus). Read more ... » microsomes is an important serological fea­ture. This anti-LKM is called anti LKM3 (anti LKM1 is seen in patients with chronic hepatitis C and autoim­mune hepatitis).

Chronic Hepatitis D Treatment

• IFN-ex in high doses – 9 million units 3 times a week for 12 months.
• Liver transplantation.

. Chronic hepatitis C

• Acute hepatitis C virus infection may lead to chronic hepatitis C in more than half the cases.
• In chronic transfusion-associated hepatitis there is progression to cirrhosis in l/S^th of cases.
• Even in asymptomatic patients who go for blood do­nation, hepatitis C may be detected.
• The source of HCV infection may be percutaneous exposure in the past.
• ALT may be normal.
• In patients with normal ALT the disease may not be serious and may not progress to failure and cirrhosis.
• In chronic hepatitis C, progression to liver failure is common with old age, longer duration of infection, histological changes, alcoholic liver disease, chronic hepatitis B, HIVAIDS Acquired Immunodeficiency Syndrome Diagnosis Signs and Symptoms with Treatment. Read more ... » infection, a antitrypsin deficiency.
• Chronic hepatitis C may also convert to hepatocellu­lar carcinoma.

Clinical features

• · Fatigue
• · Jaundice – rarely
• · Sjogren’s syndromeMetabolic,Insulin Resistance Syndrome X Causes Symptoms. Read more ... »
• · Lichen planus
• · PorphyriaPorphyrias Inherited disorders Causes Classifications Diagnosis and Treatment. Read more ... » cutanea tarda.

Laboratory features

• · ALT may be raised
• · Autoantibodies in serum
• · Anti-LKM.

Chronic hepatitis C Treatment

• IFN ex subcutaneous – 3 times a week for 6 months.
• IFN ex plus Ribavirin daily.
• Pegylated IFNs – Long acting IFN bound to poly­ethylene glycol (PEG) – have a longer half life with once weekly dose.

Chronic Autoimmune Hepatitis

• It is a chronic hepatitis with continued hepatocellular necrosis with fibrosis progressing to cirrhosis and liver failure.
• Mortality is high.
• Clinical features are similar to chronic viral hepatitis. Onset may be insidious or abrupt.
• Common in young or middle-aged women.
• There is high titer of circulating ANA
• There is fatigue, malaise, anorexia, amenorrhoea, acne, arthralgias, jaundice, arthritis, colitis, pericardi­tis, anaemia, sicca syndrome, cirrhosis.
• Course is variable. There may be hepatocellular car­cinoma as a late complicationHyperglycemic Hyperosmolar State (HHS) Acute Complication Of DM. Read more ... ».

Laboratory features

• · Serum AST 100 to 1000 units
• · Serum bilirubin normal to 10 mgjdL
• · Prothrombin time prolonged
• · Hypergammaglobulinemia >2.5 gjdL
• · ANA positive
• · Smooth- muscle antibodies
• · Anti-LKM 1 antibody.

Autoimmune Hepatitis Treatment

• Glucocorticoid therapy Cyclosporine Tacrolimus.