Chronic Hepatitis

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Chronic Hepatitis

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

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