cirrhosis
DESCRIPTION
TRANSCRIPT
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CHRONIC HEPATITIS
Hepatic inflammation and necrosis continue for at least 6 months
Classification: cause, grade, stage
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By Cause
Hepatitis B
Hepatitis B and D
Hepatitis C
Autoimmune Hepatitis
Drug-associated chronic hepatitis
Cryptogenic hepatitis
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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
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Table 300-2
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Table 300-2
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Chronic Viral Hepatitis
Hepatitis A and E – no chronic forms
Hepatitis B
Hepatitis C
Hepatitis B with superimposed Hepatitis D
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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
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Survival Rates
5 Years
Mild 97%
Moderate-severe 86%
Cirrhosis 55%
15 Years
Mild 77%
Moderate-severe 66%
Cirrhosis 40%
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CHB: Clinical features
Broad: asymptomatic debilitating end stage hepatic failure
Fatigue, anorexia
Jaundice (persistent, intermittent)
Ascites, edema
Bleeding varices, encephalopathy, coagulopathy, hypersplenism
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CHB: Laboratory Features
Elevated bilirubin levels
Elevated ALT/AST
Alk Phos – marginally elevated
Hypoalbuminemia
Prolongation of Prothrombin time
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Lab: hepatitis B markers
HBsAg
Anti HBs
HBeAg: viral replication, infectivity, liver injury
AntiHBe
HBVDNA viral load
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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
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Cirrhosis
Past: irreversible
Present: reversible, Chronic Hep C, hemochromatosis
Pathology: hepatic fibrosis architectural distortion with formatiion of regenarative nodules; decrease in hepatocellular mass/function; alteration of blood flow
Survival rate: < 50% in 5 years
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Clinical Features
Portal HPN: ascites, variceal bleeding
Loss of hepatocellular: decrease in hepatocellular mass/function, alteration of blood flow
Survival rate: <50 % in 5 years
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Alcoholic Cirrhosis
Types: CLD, Fatty Liver, Alcoholic hepatitis, alcoholic cirrhosis
Micronodular type - <3mm
Clinical Features:
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Clinical features
RUQ discomfort
Fever
Nausea & vomiting
Anorexia
Malaise
Ascites
Edema
GI bleeding
Hepatomegaly
Splenomegaly
Jaundice
Palmar erythema
Spider nevi
Parotid enlargement
Gynecomastia
Testicular atrophy
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Laboratory Investigations
Anemia
Thrombocytopenia
Elevated bilirubin
Prolonged prothrombin time
Elevated AST, ALT
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Therapy
Abstinence
Supportive treatment of complications
Steroids
TNF antagonist, Pentoxifylline
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Post Necrotic Cirrhosis
Hep B+ CHB 5% Cirrhosis 25%
Hep C+ CHC 80% Cirrhosis 20- 30%
Clinical Features
Labs: Hep B markers, HBVDNA
HCVRNA, genotype
Rx:Interferons, Nucleoside analogues
Interferons, Ribavirin
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Clinical features
RUQ discomfort
Fever
Nausea & vomiting
Anorexia
Malaise
Ascites
Edema
GI bleeding
Hepatomegaly
Splenomegaly
Jaundice
Palmar erythema
Spider nevi
Parotid enlargement
Gynecomastia
Testicular atrophy