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)