Abdul Waris Khan
Dept: Internal medicine
Subjective: a 55 years old male smoker presented to ER with
complains of right hypochondrical pain, fatigue, fever, and
weight loss and jaundice.
H/O of presenting i l lness: He has been having these complaints
for the past 1 month. He is a known case of IV drug abuser in
Objective: history taking and P.E
Evaluation: hepatitis, cirrhosis, l iver CA, cholecystitis.
Plan: CBC, LFTs, U&E
Elaboration: pain ki l lers and antibiotics
Learning goals: Hepatitis C
Hepatitis C is an infection caused by the hepatitis C virus
(HCV) that attacks the l iver and leads to inflammation.
Hepatitis C is a RNA virus.
ACUTE VS CHRONIC HEPATITIS
Acute l iver injury may present with non-specific symptoms of
fatigue and abnormal LFTs, or with jaundice and acute l iver
Chronic l iver injury is defined as hepatic injury, inflammation
and/or fibrosis occurring in the l iver for more than 6 months.
MODE OF TRANSMISSION
Blood and blood products
IV drug abuse
Ver tical transmission
Hepatitis B and C are also considered as
Sexually transmitted Diseases.
Hepatitis A can also be transmitted
through sexual activity.
Hepatitis A 2-4 Weeks.
Hepatitis B 4-20 Weeks.
Hepatitis C 2-26 Weeks.
Hepatitis D 6-9 Weeks.
Hepatitis E 3-8 Weeks.
Most acute infect ions are asymptomat ic, wi th about 10% of pat ients having
a mi ld f lu- l ike i l lness wi th jaundice and a r ise in serum aminot ransferases.
Most pat ients wi l l not be diagnosed unt i l they present , years later, wi th
evidence of abnormal t ransferase values at heal th checks or wi th chronic
l iver disease.
Loss of appet i te
Vomi t ing
Dark ur ine
Clay -colored bowel movements
Jaundice (yel low color in the skin or eyes)
This is frequently by exclusion in a high-risk individual with
negative markers for HAV, HBV and other viruses .
A drug cause for hepatitis should be excluded i f possible.
HCV RNA can be detected from 1 to 8 weeks af ter infection.
Anti -HCV tests are usually positive 8 weeks from infection.
Alpha Inter feron for 6-24 weeks has been used in acute cases
to prevent chronic disease.
85-90% of asymptomatic patients develop chronic l iver
Cirrhosis develops in about 20–30% within 10–30 years and
of these patients between 7% and 15% wi l l develop
Patients wi th chronic hepati tis C infection are usual ly
asymptomatic, the disease being discovered only fol lowing a
routine biochemical test when mi ld elevations in the
aminotransferases (usual ly ALT) are noticed.
The elevation in ALT may be minimal and fluctuating and some
patients have a persistently normal ALT, the disease being
detected by checking HCV antibodies (e.g. in blood donors).
Severe chronic hepati tis and even cirrhosis can be present wi th
only minimal elevation in aminotransferases, but progression is
very uncommon in those wi th a persistently normal ALT.
Fatigue is the commonest symptom wi th sometimes nausea,
anorexia and weight loss.
11 dif ferent genotypes and 50 dif ferent subtypes
Used to asses need for treatment and how long the treatment
regime should be.
Genotype 1 is most di f ficult to treat and needs 48 weeks to
Other needs 24 weeks to treat and respond wel l to inter feron
This is made by finding HCV antibody in the serum using third-generation
HCV RNA should be assayed using quantitative HCV-RNA PCR.
The viraemia is usually variable; less than 600 000 iu/mL
signi fies a greater l ikelihood of response to antiviral therapy.
Current treatment is combination therapy with pegylated
inter feron, which is inter feron with a polyethyleneglycol tai l
( α − 2 a 1 8 0 μ g /we e k o r α − 2 b 1 . 5 μ g/kg/week), and ribavirin
(1000–1200 mg/day for genotype 1, 800 mg/day for
genotype 2 or 3) in dai ly divided doses for 12 months for
1, and 6 months for other genotypes. Ef ficacy is also
determined by viral load, with HCV RNA > 600 000 iu/L less
l ikely to respond.
Ribavirin is usual ly wel l tolerated but side-ef fects include a
dose-related haemolysis, pruritus and nasal congestion.
Pregnancy should be avoided as ribavirin is teratogenic.
Kumar and Clark cl inical medicine 7th edition
Shor t textbook of medical diagnosis and management by M.