| Author | 9 Posts |
nadiabarati
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43 male comes with fatigue. His HBS Ag is positive and HBeAg is positive, high HBV DNA, AST=60, ALT=120
icteric sclera and mild hepatomegaly, biopsy shows mild inflammation.
answer is: lamivudine or INF.
I'm wondering what point in the scenario guides us toward CHRONIC hepatitis. There is no menton about duration. when we treat and when we DO NOT treat chronic hepatitis B??
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| star1
Forum Guru
Topics: 93
Posts: 827
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Nadia is this not acute hepatitis B infection? why you are thinking this as chronic?
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| nadiabarati
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that's why I'm posting it here. Because in the explanations UW says it's chronic and put the patient on lamivudine or INF.
There is another Q in UW about a patient who has come with the complaint of fatigue for 1 month. HCV RNA is positive, ALT=600, biopsy shows moderate inflammation...
and the answer is : INF and ribivirin because it's chronic HCV with high ALT and moderate inflammation!
I'm wondering how it concludes it's CHRONIC. Please someone save my life!! Coz my hepatology score is not good and still don't understand these questions!
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| yasmeen
Forum Guru
Topics: 70
Posts: 942
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WHY R U CONFUSED ITS CHRONIC ACTIVE HEPATITIS.
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| ssrpk
Forum Fanatic
Topics: 154
Posts: 2,819
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chronicity can only be determined by the presence of IgG anitobodies, as none of IgG's are mentioned therefore it cannot be determined
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life is guud
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| doyoudig
Forum Guru
Topics: 144
Posts: 613
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no you can know if it is chronic or acute here as ssrpk mentioned already. In addition Surface Ab have to be present > 6 mo bfore we call it chronic Hep
The reason why you give Lamuvidine and/or Interferon is b/c the ALT/AST are elevated rite know -- so is is suffereing from acute episode of chronic hep
that how I understood it, so pls anyone correct me if wrong
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| doyoudig
Forum Guru
Topics: 144
Posts: 613
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nadiabarati
UW can be quite confusing sometimes b/c the info is scattered . You need to make sure that you read the all explanation carefully and relate it to the cases info. I made those mistakes in the beggining and now trying to be more carefull about it
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| doyoudig
Forum Guru
Topics: 144
Posts: 613
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here is some info that I collecetd from UW hope this eill be of help to ya
Indications for Rx of Chronic Active Hepatitis B or C to Limit Progression of Liver Disease
ts with Hep B
--With Persistently ↑ ALT levels of 2 X the Upper Limit + Detectable Serum HBsAg, HBeAg, and HBV DNA => Interferon and/or Lumividine
Hep C
-- With Persistently ↑ ALT levels of 2 X the Upper Limit + Detectable Serum HCV RNA
=> Interferon & Ribavirin
* The degree of elevation of serum ALT is important in deciding the treatment since it is one of the most important predictors of response to both interferon and lamivudine
* Lamivudine has a convenient route of administration (oral) and has fewer side effects than Interferon.
Interferon treatment is particularly not successful in Young children and
Immunocompromised Pts. (Interferon SE -- Depression)
* Studies have shown that patients with chronic hepatitis C who show persistently normal liver enzymes on multiple occasions have minimal histological abnormalities, therefore they do not need to be treated with interferon or antiviral drugs at this stage.
So: No Rx Just Yearly Follow Up
Hepatitis B
HBsAg:
It is the first virological marker detected in the serum after inoculation and it precedes the elevation of serum aminotransferases and onset of clinical symptoms. It remains detectable during the entire symptomatic phase of acute hepatitis B.
Anti HBsAg:
It appears in the serum after the disappearance of HBsAg and remains detectable for lifetime thereafter. However, there is a time lag between the disappearance of HBsAg and appearance of Anti HBsAg in the serum, which is called 'the window' period. Anti HBsAg is the protective antibody therefore the patients with anti HBsAg are protected from the reinfection with hepatitis B.
HBcAg:
It is not detectable in the plasma as it is normally sequestrated within the HBsAg coat.
Anti HBcAg:
It appears in the serum shortly after the appearance of HBsAg and remains detectable for a long time even after the patient recovers. IgM fraction is indicative of an acute phase of disease whereas the IgG fraction is indicative of recovery from the disease. IgM anti HBcAg is present in the ‘window period’ and thus is a very important tool for diagnosis during this period when both HBsAg and Anti HBsAg are undetectable. Thus IgM anti HBcAg is the most specific marker for diagnosis of acute hepatitis B.
HBeAg and anti HBeAg:
The antigen is detectable shortly after the appearance of HBs Ag, it indicates active viral replication and is associated with presence of HBV DNA. It's presence in the serum is indicative of a high degree of infectivity. HBeAg disappears shortly after peak elevations of aminotransferase and before the disappearance of HBsAg, and is followed by anti-HBeAg.
Anti HBeAg is suggestive of cessation of active viral replication and low infectivity.
* Anti HBcAg and HBsAg is the best screening of the acute hepatitis, as it won’t miss the window period when only HBcAg will be positive
Sum:
A. Acute hepatitis B ---> HbsAg, HbcAb-IgM
*Why Core?? so that you do not miss any Pt in the Window Period w/ Acute Hep B Infection)
B. Chronic hepatitis B. --> HbsAg > 6mo
C. Vaccination with hepatitis B. --> HbsAb
D. Past hepatitis B. --> HbsAb, HbcAb-IgG
*Anti HBcAg is present only in a person naturally immunized by a previous hepatitis B infection and not in those immunized through vaccination because the vaccine does not contain the core antigen of HBV therefore no antibodies are made against it.
E. Recovery phase of hepatitis B --> HbsAb, HbeAb, HbcAb IgG
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| ssrpk
Forum Fanatic
Topics: 154
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excellent review my friend ... keep it up
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