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Chronic hep b

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Chronic hep b

  1. 1. CHRONIC HEPATITIS <ul><li>Hepatic inflammation and necrosis continue for at least 6 months </li></ul><ul><li>Classification: cause, grade, stage </li></ul>
  2. 2. By Cause <ul><li>Hepatitis B </li></ul><ul><li>Hepatitis B and D </li></ul><ul><li>Hepatitis C </li></ul><ul><li>Autoimmune Hepatitis </li></ul><ul><li>Drug-associated chronic hepatitis </li></ul><ul><li>Cryptogenic hepatitis </li></ul>
  3. 3. By Grade <ul><li>Piecemeal necrosis – periportal necrosis and disruption of the limiting plate </li></ul><ul><li>Bridging necrosis –confluent necrosis that forms bridges between portal tracts and central vein </li></ul><ul><li>Degree of hepatocyte degeneration </li></ul><ul><li>Portal inflammation </li></ul><ul><li>Scoring Indices: HAI, METAVIR </li></ul>
  4. 4. Table 300-2
  5. 5. Table 300-2
  6. 6. Chronic Viral Hepatitis <ul><li>Hepatitis A and E – no chronic forms </li></ul><ul><li>Hepatitis B </li></ul><ul><li>Hepatitis C </li></ul><ul><li>Hepatitis B with superimposed Hepatitis D </li></ul>
  7. 7. Chronic Hepatitis B <ul><li>Likelihood of chronicity varies with age </li></ul><ul><li>Infection at birth: clinically silent but 90% chance of chronic infection </li></ul><ul><li>In adults: acute infection associated with clinical symptoms but risk of chronicity is 1% </li></ul><ul><li>Liver injury: absent (carriers), mild , moderate, severe </li></ul>
  8. 8. Survival Rates <ul><li>5 Years </li></ul><ul><li>Mild 97% </li></ul><ul><li>Moderate-severe 86% </li></ul><ul><li>Cirrhosis 55% </li></ul><ul><li>15 Years </li></ul><ul><li>Mild 77% </li></ul><ul><li>Moderate-severe 66% </li></ul><ul><li>Cirrhosis 40% </li></ul>
  9. 9. CHB: Clinical features <ul><li>Broad: asymptomatic  debilitating  end stage hepatic failure </li></ul><ul><li>Fatigue, anorexia </li></ul><ul><li>Jaundice (persistent, intermittent) </li></ul><ul><li>Ascites, edema </li></ul><ul><li>Bleeding varices, encephalopathy, coagulopathy, hypersplenism </li></ul>
  10. 10. CHB: Laboratory Features <ul><li>Elevated bilirubin levels </li></ul><ul><li>Elevated ALT/AST </li></ul><ul><li>Alk Phos – marginally elevated </li></ul><ul><li>Hypoalbuminemia </li></ul><ul><li>Prolongation of Prothrombin time </li></ul>
  11. 11. Lab: hepatitis B markers <ul><li>HBsAg </li></ul><ul><li>Anti HBs </li></ul><ul><li>HBeAg: viral replication, infectivity, liver injury </li></ul><ul><li>AntiHBe </li></ul><ul><li>HBVDNA viral load </li></ul>
  12. 12. Clinical Forms of Hep B <ul><li>HBeAg + CHB: ALT & HBVDNA elevated </li></ul><ul><li>HBeAg – CHB: ALT & HBVDNA elevated (pre-core mutants </li></ul><ul><li>Hepatitis B carrier: ALT normal; HBVDNA low or undetectable </li></ul>

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