CLINICAL APPROACH TO CHRONIC HEPATITIS • DEFINITION • CAUSES • DIFFERENCES AMONG HEPATITIS A,B,C • COMPLICATIONS DEFINITION • A syndrome that is defined clinically by evidence of liver disease with inflammation and necrosis for at least 6 consecutive months, most commonly with hepatitis B, C, and D CAUSES The most common causes of chronic hepatitis are • Viral infections, such as hepatitis B and C • Alcohol use • Chronic exposure to other drugs or toxins, and • Autoimmune hepatitis Less common causes include inherited metabolic disorders like • Hemochromatosis • Wilson disease • α1-antitrypsin deficiency DIFFERENCES AMONG HEPATITIS A,B,C • HEPATITIS A, called “infectious hepatitis,” is easily spread by the fecal/oral route. • HAV causes a short-lived, acute hepatitis that is not followed by chronic liver disease. • Immunoglobulin G (IgG) antibodies to HAV remain positive for life. • To determine whether the hepatitis is acute, one must look for IgM antibodies in the serum. • Vaccine available •HEPATITIS B, called “serum hepatitis,” is contracted by • Contact with blood or other bodily secretions from an infected individual, usually through a break in the skin, • Sexual contact • Perinatal transmission • Use of a contaminated needle in IV drug users • Accidental needlestick in health-care workers • Transmission through blood transfusions is less common when blood donors are volunteers and are screened for hepatitis B surface antigen (HBsAg). • HBV may cause chronic disease and cirrhosis AND predisposes to HCC (hepatoma) • CHRONIC CARRIER STATE IN 6% OF THOSE INFECTED • A carrier state occurs when infected patients demonstrate persistent HBsAg without clinically evident disease and are able to transmit the disease. •HEPATITIS C is the form of hepatitis most commonly contracted from blood transfusion. • Currently, there are more than 170 million people infected with HCV worldwide. • In addition to the known sources of risk and exposure, at least one third of all infected patients have no known exposures for this potentially debilitating illness. • CHRONIC IN 85% OF THOSE INFECTED • NO VACCINE AVAILABLE • HCV infection is the most common viral cause of chronic liver disease and increases the patient’s risk for developing hepatoma (HCC). RISK FACTORS FOR ACQUISITION OF HCV • Intravenous drug use • Sharing of straws to snort cocaine • Hemodialysis • Tattooing and piercing • Sexual transmission is rare • Vertical transmission from mother to child is uncommon (may occur when the mother has high viral titers or is HIV positive)
