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Chronic Hepatitis

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  • 1. Chronic Liver Diseases By Dr. Osman Bukhari
  • 2.
    • Chronic liver disease
    • 1 - Chronic hepatitis
    • 2-Liver cirrhosis
    • Chronic hepatitis
    • Def:- Hepatitis lasting 6month or more
    • Classification
    • a) According to a etiology
    • 1- Viral : HBV , HCV , HDV
    • 2- Autoimmune
    • 3-Drugs e.g. Methyl dopa, INH.
  • 3.
    • 4-Hereditary e.g. Alpha ATD, Wilson's
    • 5-Inflammatory bowel disease e.g UC
    • 6-Alcohol (rare)
    • b) Histological
    • 1-Chronic persistent hepatitis (CPH)
    • -Chronic inflammatory infiltrate
    • confined to portal tract
    • -Spotty necrosis
    • -Normal liver architecture
    • -Cirrhosis is rare
  • 4.
    • 2- Chronic active hepatitis (aggressive)
    • -Inflammatory infiltrate in portal tract &
    • parenchyma (piece meal necrosis)
    • -Distorted lobular architecture
    • -Septa linking portal tract & C.V
    • -Subsequent Cirrhosis can follow.
  • 5.  
  • 6.
    • Clinical features
    • -Depend on pathology & aetiology
    • -Mild illness with dyspepsia & variable
    • increase in liver enzymes without evidence
    • of chronic liver disease in CPH (DD,
    • Gilberts)
    • -Florid progressive liver disease with
    • evidence of chronic liver disease in CAH.
  • 7.
    • Chronic HBV hepatitis
    • -Due to cont. replication of the virus
    • -Age > 30 years & M > F
    • -A symptomatic, mild or severe disease
    • -Non specific symptoms + hepatomegly
    • -No jaundice or mild
    • -mod increase in bilirubin & transaminases,
    • mild increase in ALP & reversed Alb/ Glob
    • -+ve HBs Ag +_ HDV serology
  • 8.
    • - -ve Auto anti bodies
    • -Treatment indications are +ve HBs Ag, HBe Ag & HBV – DNA, Abnormal transaminases
    • & chronic hepatitis on liver biopsy
    • *No TR for decompunsated liver disease
    • *Aim of TR is to eliminate HBs Ag &
    • HBV- DNA with reduction of liver cell
    • necrosis
    • 1-Alpha- interferon
    • 5M units daily or 10M units 3times weekly
  • 9.
    • for 4-6 M
    • ـــــ Transient increase in transaminases & flu like illness for 6-8 M
    • ـــــ Rarely depression , cardiac & renal failure
    • ـــــ Response rate with sero conversion is
    • 25-40 %
    • 2-Famciclovir & Lamivudine PO
    • 3-Liver transplant for decompunsated liver disease
  • 10.
    • Chronic HCV hepatitis
    • -A symptomatic or few symptoms
    • - +ve HCV Abs & +ve PCR for HCV- RNA,
    • +ve liver biopsy & raised transaminases
    • for > 6/12
    • -Aim of TR : Elimination of HCV- RNA, to stop progression of liver disease & to prevent H.C.C.
    • ــــــ Alpha IF 3M units three times weekly for 12M
    • ـــــــ Ribavivin + Alpha IF
  • 11.
    • ـــــ Liver transplant for decompsated liver.
    • Chronic HDV hepatitis
    • -60 - 70 % ـــــ Cirrhosis
    • -Diagnosis by +ve HDV Abs in patients with
    • +ve HBs Ag, +ve HDV- RNA.
    • ـــــ Alpha IF 10M unit 3times weekly
  • 12.
    • Autoimmune hepatitis
    • -Female in 2 nd or 3 rd decade
    • -ass. autoimmune disease
    • -Remission & relapses
    • -Insidious onset. Acute in 25 %
    • -Fever, fatigue, anorexia, arthralgia, epistaxis,
    • & Amenorrhoea
    • -Mild to moderate jaundice or absent.
    • -Spider telangiectasia +H/S
    • -LFT varies with activity & severity
  • 13.
    • -Low serum alb. & marked hyper glob.
    • -Anti smooth muscle Ab (2/3), ANF (1/12) & AMA (2/3)
    • ــــــ Prednisolone 30mg/dl , tapering with
    • improvement of LFT & maintain on 10-15mg
    • for 2years & LFT become normal. Azathioprin
    • (1.2mg/kg) used as steroid sparing agent.
    • -Progress to liver Cirrhosis. H.C.C. is uncommon
    • -50% die with liver failure in 5 years
  • 14.
    • Drug induced chronic hepatitis
    • -Similar to autoimmune hepatitis with -ve serology.
    • -Improve withdrawal of drug.
    • Alcohol
    • Chronic alcohol consumption occasionally ـــــ chronic
    • hepatitis