A 55-year-old male presented with complaints of right upper quadrant pain, fatigue, fever, and weight loss over the past month. He has a history of IV drug use. Laboratory tests showed elevated liver enzymes. The patient is diagnosed with hepatitis C based on his risk factors and lab results. Hepatitis C is a viral infection that attacks the liver, often transmitted through blood or drug use. It can lead to both acute and chronic liver inflammation and damage over many years.

2. SOEPEL: HEPATITIS-C
Abdul Waris Khan
Dept: Internal medicine

3. 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.

4.  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

5. 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.

6. 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

7. MODE OF TRANSMISSION
 Blood and blood products
 IV drug abuse
 Sexual contact
 Ver tical transmission

8. Hepatitis B and C are also considered as
Sexually transmitted Diseases.
Hepatitis A can also be transmitted
through sexual activity.
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9. 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

10. 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)

11. 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.

12. TREATMENT
 Alpha Inter feron for 6-24 weeks has been used in acute cases
to prevent chronic disease.

13. 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.

14. 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.

15.  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

16. 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.

17. 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.

20.  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