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