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SOEPEL: HEPATITIS-C 
Abdul Waris Khan 
Dept: Internal medicine
SOEPEL 
Subjective: a 55 years old male smoker presented to ER with 
complains of right hypochondrical pain, fatigue, feve...
 Objective: history taking and P.E 
 Evaluation: hepatitis, cirrhosis, l iver CA, cholecystitis. 
 Plan: CBC, LFTs, U&E...
DEFINITION 
 Hepatitis C is an infection caused by the hepatitis C virus 
(HCV) that attacks the l iver and leads to infl...
ACUTE VS CHRONIC HEPATITIS 
 Acute l iver injury may present with non-specific symptoms of 
fatigue and abnormal LFTs, or...
MODE OF TRANSMISSION 
 Blood and blood products 
 IV drug abuse 
 Sexual contact 
 Ver tical transmission
Hepatitis B and C are also considered as 
Sexually transmitted Diseases. 
Hepatitis A can also be transmitted 
through sex...
INCUBATION PERIOD 
 Hepatitis A 2-4 Weeks. 
 Hepatitis B 4-20 Weeks. 
 Hepatitis C 2-26 Weeks. 
 Hepatitis D 6-9 Weeks...
CLINICAL FEATURES 
 Most acute infect ions are asymptomat ic, wi th about 10% of pat ients having 
a mi ld f lu- l ike i ...
DIAGNOSIS 
 This is frequently by exclusion in a high-risk individual with 
negative markers for HAV, HBV and other virus...
TREATMENT 
 Alpha Inter feron for 6-24 weeks has been used in acute cases 
to prevent chronic disease.
COURSE 
 85-90% of asymptomatic patients develop chronic l iver 
disease. 
 Cirrhosis develops in about 20–30% within 10...
CHRONIC PHASE 
 Patients wi th chronic hepati tis C infection are usual ly 
asymptomatic, the disease being discovered on...
 11 dif ferent genotypes and 50 dif ferent subtypes 
 Used to asses need for treatment and how long the treatment 
regim...
DIAGNOSIS 
 This is made by finding HCV antibody in the serum using third-generation 
ELISA-3 tests. 
 HCV RNA should be...
TREATMENT 
 Current treatment is combination therapy with pegylated 
inter feron, which is inter feron with a polyethylen...
 Kumar and Clark cl inical medicine 7th edition 
 Emedicne.medscape.com 
 Shor t textbook of medical diagnosis and mana...
Hepatitis c
Hepatitis c
Hepatitis c
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Hepatitis c

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Hepatitis c

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Hepatitis c

  1. 1. SOEPEL: HEPATITIS-C Abdul Waris Khan Dept: Internal medicine
  2. 2. SOEPEL 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 the past.
  3. 3.  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
  4. 4. DEFINITION  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.
  5. 5. 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 fai lure.  Chronic l iver injury is defined as hepatic injury, inflammation and/or fibrosis occurring in the l iver for more than 6 months. 12/13/2014 6
  6. 6. MODE OF TRANSMISSION  Blood and blood products  IV drug abuse  Sexual contact  Ver tical transmission
  7. 7. Hepatitis B and C are also considered as Sexually transmitted Diseases. Hepatitis A can also be transmitted through sexual activity. 12/13/2014 8
  8. 8. INCUBATION PERIOD  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. 12/13/2014 9
  9. 9. CLINICAL FEATURES  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.  Fever  Fat igue  Loss of appet i te  Nausea  Vomi t ing  Abdominal pain  Dark ur ine  Clay -colored bowel movements  Joint pain  Jaundice (yel low color in the skin or eyes)
  10. 10. DIAGNOSIS  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.
  11. 11. TREATMENT  Alpha Inter feron for 6-24 weeks has been used in acute cases to prevent chronic disease.
  12. 12. COURSE  85-90% of asymptomatic patients develop chronic l iver disease.  Cirrhosis develops in about 20–30% within 10–30 years and of these patients between 7% and 15% wi l l develop hepatocellular carcinoma.
  13. 13. CHRONIC PHASE  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.
  14. 14.  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 treat.  Other needs 24 weeks to treat and respond wel l to inter feron based therapy. GENOTYPES
  15. 15. DIAGNOSIS  This is made by finding HCV antibody in the serum using third-generation ELISA-3 tests.  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.
  16. 16. TREATMENT  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 genotype  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.
  17. 17.  Kumar and Clark cl inical medicine 7th edition  Emedicne.medscape.com  Shor t textbook of medical diagnosis and management by M. Inam Danish  www.cdc.gov REFERENCES

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