Hepatitis C: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Asymptomatic during first few years | *Asymptomatic during first few years | ||
*Symptoms occur once cirrhosis has developed | *Symptoms occur once [[cirrhosis]] has developed | ||
*Malaise, weakness (from electrolyte derangements) | *Malaise, [[weakness]] (from [[electrolyte derangements]]) | ||
*[[Abdominal pain]] | *[[Abdominal pain]] | ||
*[[Ascites]], [[SBP]] (fever, abdominal tenderness) | *[[Ascites]], [[SBP]] (fever, abdominal tenderness) | ||
*[[Altered mental status]] due to [[hepatic encephalopathy]] | *[[Altered mental status]] due to [[hepatic encephalopathy]] | ||
*Coagulopathy | *[[liver disease induced coagulopathy|Coagulopathy]] | ||
*[[GI bleed]] | *[[GI bleed]] | ||
| Line 25: | Line 25: | ||
'''Complications of cirrhosis''' | '''Complications of cirrhosis''' | ||
*[[Ascites]] | *[[Ascites]] | ||
*Esophageal varices | *[[Esophageal varices]] | ||
*[[Hepatic encephalopathy]] | *[[Hepatic encephalopathy]] | ||
*[[Spontaneous bacterial peritonitis]] | *[[Spontaneous bacterial peritonitis]] | ||
Revision as of 21:05, 29 September 2019
Background
- Bloodborne transmission
- NO acute phase
- >75% progress to chronic hepatitis C infection
- Disease course depends on comorbidities (e.g. alcohol use, HIV status, etc.)
- May progress to cirrhosis, +/- hepatocellular carcinoma
Clinical Features
- Asymptomatic during first few years
- Symptoms occur once cirrhosis has developed
- Malaise, weakness (from electrolyte derangements)
- Abdominal pain
- Ascites, SBP (fever, abdominal tenderness)
- Altered mental status due to hepatic encephalopathy
- Coagulopathy
- GI bleed
Differential Diagnosis
Causes of acute hepatitis
- Acetaminophen toxicity (most common cause of acute liver failure in the US[1])
- Viral hepatitis
- Toxoplasmosis
- Acute alcoholic hepatitis
- Toxins
- Ischemic hepatitis
- Autoimmune hepatitis
- Wilson's disease
Evaluation
Interpreting Acute Hepatitis Panel Results
| Anti-hepatitis A, IgM | Hepatitis B surface antigen | Anti-hepatitis B core, IgM | Anti-hepatitis C | Interpretation |
|---|---|---|---|---|
| Positive | Negative | Negative | Negative | Acute hepatitis A |
| Negative | Positive | Positive | Negative | Acute hepatitis B |
| Negative | Positive | Negative | Negative | Chronic hepatitis B infection |
| Negative | Negative | Positive | Negative | Acute hepatitis B; quantity of hepatitis B surface antigen is too low to detect |
| Negative | Negative | Negative | Positive | Acute or chronic hepatitis C; additional tests are required to make the determination |
Management
Complications of cirrhosis
- Ascites
- Esophageal varices
- Hepatic encephalopathy
- Spontaneous bacterial peritonitis
- Hepatorenal syndrome
- Portal hypertension
- Upper gastrointestinal bleed
- Hepatocellular carcinoma
Outpatient HCV treatment may include:
- Interferon-α or pegylated interferons
- Ribavirin
- Direct-acting antiviral agents (boceprevir, telaprevir, simeprevir, sofosbuvir, Harvoni, etc.)
Disposition
- Often complex and should be based on presence/absence of acute complications
- If no complications present, discussion with patient's primary care provider or gastroenterologist recommended
See Also
External Links
References
- ↑ Ostapowicz G, Fontana RJ, Schiodt FV, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med. 2002 Dec 17; 137(12): 947-54.