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Chronic Active Hepatitis


Presentation

  • Ten patients presented moderate anemia and six patients, leukopenia and thrombocytopenia. Eighteen patients presented hypergammaglobulinemia.[ncbi.nlm.nih.gov]
Abdominal Lymphadenopathy
  • Chronic active hepatitis should be included in the differential diagnosis of abdominal lymphadenopathy.[ncbi.nlm.nih.gov]
Pain
  • Narrative Medicine Nephrology Neurology Neuroscience and Psychiatry Notable Notes Nursing Nutrition Nutrition, Obesity, Exercise Obesity Obstetrics and Gynecology Occupational Health Oncology Ophthalmic Images Ophthalmology Orthopedics Otolaryngology Pain[jamanetwork.com]
  • Symptoms Nonspecific symptoms - eg, fatigue, anorexia, muscle pains, arthralgia, weight loss. Right hypochondrial pain (liver distension). Abdominal distension (ascites). Ankle swelling (fluid retention).[patient.info]
  • Symptoms of an acute infection may include loss of appetite, joint and muscle pain, low-grade fever, and possible stomach pain.[hepb.org]
  • Photo Credit Gracia Lam Personal Health A Little-Known Skin Disease That Can Disrupt People’s Sex Lives Patients deal with pain and itching and often encounter medical ignorance and mistreatment until affected tissues become irreparably scarred.[nytimes.com]
Fever
  • Abstract A 28-year-old man was admitted to our department with intermittent fever, hepatosplenomegaly and pancytopenia. Liver parameters and serum ferritin were markedly elevated.[ncbi.nlm.nih.gov]
  • Several randomized controlled studies established that corticosteroid not only prolong life but decrease the symptoms and signs of fatigue, loss of appetite and fever.[hepatitiscentral.com]
Weight Loss
  • A 27-year-old woman, para 0-1-2-1, presented at 36 weeks' gestation with a 2-week history of malaise, nausea, emesis, diarrhea, and an 18-lb weight loss.[ncbi.nlm.nih.gov]
  • The dog is usually sick by that point in time, and demonstrating the following clinical signs of CAH: vomiting, diarrhea, jaundice (yellow tinge to skin and whites of eyes), weight loss, and fluid accumulation in the abdomen (ascites).Genetic For more[dpca.org]
  • Symptoms can include: weakness weight loss blood clotting problems Fluid can sometimes collect in the abdomen. Jaundice (yellowing of the skin) only appears in people with advanced cirrhosis.[healthline.com]
  • Symptoms Nonspecific symptoms - eg, fatigue, anorexia, muscle pains, arthralgia, weight loss. Right hypochondrial pain (liver distension). Abdominal distension (ascites). Ankle swelling (fluid retention).[patient.info]
Malaise
  • A 56-year-old Saudi male was admitted with abnormal liver chemistry values and a 5-month history of lethargy, malaise, anorexia, and jaundice. Extensive investigations did not establish an etiological diagnosis.[ncbi.nlm.nih.gov]
  • Patients with IACAH most often present with insidious onset of malaise, anorexia, fever and fatigue. Approximately 75% of these patients are female with the most frequent ages of onset between 10-40 years.[hepatitiscentral.com]
  • Some patients have intermittent episodes of malaise, anorexia and jaundice. Occasionally increasing severity of the disease heralds the conversion of CPH to chronic active hepatitis.[gpnotebook.com]
Weight Gain
  • gain due to ascites Persistent jaundice Loss of appetite, weight loss , wasting Vomiting with blood in the vomit Bleeding from the nose, mouth, or rectum; or blood in the stool Hepatic encephalopathy (excessive sleepiness, mental confusion, and in advanced[emedicinehealth.com]
  • gain Vertebral compression Psychosis Brittle diabetes Uncontrolled hypertension TPMT thiopurine methyltransferase.[clevelandclinicmeded.com]
  • Side effects can be very distressing and sometimes serious; they include weight gain, skin problems, moon-shaped face, high blood pressure, diabetes, cataracts, mental disturbances, infections, and osteoporosis.[skylinefamilypractice.net]
Loss of Appetite
  • Several randomized controlled studies established that corticosteroid not only prolong life but decrease the symptoms and signs of fatigue, loss of appetite and fever.[hepatitiscentral.com]
  • Symptoms can include: fatigue muscle aches loss of appetite Most symptoms of chronic hepatitis C don’t appear until cirrhosis develops and the liver begins to fail.[healthline.com]
  • Symptoms of an acute infection may include loss of appetite, joint and muscle pain, low-grade fever, and possible stomach pain.[hepb.org]
Abdominal Pain
  • However, those that do have symptoms may experience: fatigue, loss of appetite, muscle and joint pains. nausea, abdominal pain, vomiting... What is the hepatitis C virus? Hepatitis means inflammation of the liver.[medicinenet.com]
  • Acute infection may cause nonspecific symptoms, such as fatigue, poor appetite, nausea, vomiting, abdominal pain, low-grade fever, jaundice, and dark urine; and clinical signs, such as hepatomegaly and splenomegaly.[aafp.org]
  • Symptoms of acute hepatitis B, if they appear, can include: Fever Fatigue Loss of appetite Nausea Vomiting Abdominal pain Dark urine Clay-colored bowel movements Joint pain Jaundice (yellow color in the skin or the eyes) How soon after exposure to hepatitis[cdc.gov]
  • pain (38%) Pallor (26%) See Clinical Presentation for more detail.[emedicine.medscape.com]
Tachycardia
  • Therefore, it should be kept in mind that fever and tachycardia may occur during the first and second weeks of INF therapy and patients with high risk for cardiac disease should be monitored closely in this period of treatment.[ncbi.nlm.nih.gov]
Liver Tenderness
  • It starts with acute symptoms in 30% of the cases with jaundice, fever, malaise, liver tenderness, like an acute viral hepatitis.[meddean.luc.edu]
  • Clinical signs include liver tenderness, hepatomegaly, and splenomegaly. Acute HBV infection typically lasts two to four months.[aafp.org]
Kayser-Fleischer Ring
  • Abstract Kayser-Fleischer ring is considered an important diagnostic sign of Wilson's disease. We report a 9 year old boy with autoimmune chronic active hepatitis who exhibited Kayser-Fleischer like ring.[ncbi.nlm.nih.gov]
Arthralgia
  • In addition, these patients may have arthralgia, oligomenorrhea, fluctuating jaundice and cushingoid appearance with striae, hirsutism and acne.[hepatitiscentral.com]
  • There may also be non-specific symptoms like fatigue, malaise, nausea, abdominal discomfort, itching, and arthralgia’s particularly in the small joints. B.[clinicaladvisor.com]
  • Symptoms Nonspecific symptoms - eg, fatigue, anorexia, muscle pains, arthralgia, weight loss. Right hypochondrial pain (liver distension). Abdominal distension (ascites). Ankle swelling (fluid retention).[patient.info]
  • Symptoms of cryoglobulinemia include fatigue, myalgias, arthralgias, neuropathy, glomerulonephritis, and rashes (urticaria, purpura, leukocytoclastic vasculitis); asymptomatic cryoglobulinemia is more common.[merckmanuals.com]
Hirsutism
  • In addition, these patients may have arthralgia, oligomenorrhea, fluctuating jaundice and cushingoid appearance with striae, hirsutism and acne.[hepatitiscentral.com]
  • Hirsutism. Investigation of chronic hepatitis Urinalysis : bilirubin and urobilinogen. Blood tests: FBC (associated anaemia, thrombocytopenia, raised MCV with alcohol abuse), clotting studies (clotting impairment with hepatic dysfunction).[patient.info]
  • Common symptoms include the following: Fatigue Upper abdominal discomfort Mild pruritus Anorexia Myalgia Diarrhea Cushingoid features Arthralgias Skin rashes (including acne) Edema Hirsutism Amenorrhea Chest pain from pleuritis Weight loss and intense[emedicine.medscape.com]
Pruritus
  • Pruritus (cholestasis). Breast swelling (gynaecomastia), testicular atrophy, loss of libido and amenorrhoea due to endocrine dysfunction. Confusion and drowsiness (encephalopathy).[patient.info]
  • […] symptoms of AIH are: feeling more tired than normal or becoming tired easily feeling generally unwell mild joint or muscle pains, usually these are worse in the morning low appetite (not feeling hungry) and weight loss feeling sick (nausea) itching (pruritus[britishlivertrust.org.uk]
  • Signs of chronic liver disease (eg, splenomegaly, spider nevi, palmar erythema) Complications of cirrhosis (eg, portal hypertension, ascites, encephalopathy) A few patients with chronic hepatitis develop manifestations of cholestasis (eg, jaundice, pruritus[merckmanuals.com]
Amenorrhea
  • In autoimmune hepatitis, especially in young women, manifestations may involve virtually any body system and can include acne, amenorrhea, arthralgia, ulcerative colitis, pulmonary fibrosis, thyroiditis, nephritis, and hemolytic anemia.[merckmanuals.com]
  • Common symptoms include the following: Fatigue Upper abdominal discomfort Mild pruritus Anorexia Myalgia Diarrhea Cushingoid features Arthralgias Skin rashes (including acne) Edema Hirsutism Amenorrhea Chest pain from pleuritis Weight loss and intense[emedicine.medscape.com]

Workup

  • HBV DNA 2000 copies/mL along with an elevated alanine aminotransferase (ALT) suggests further workup and possible therapy is needed. Viral copies/mL above 10,000 suggest ongoing hepatitis with greater risk for carcinoma.[library.med.utah.edu]
  • See Workup for more detail.[emedicine.medscape.com]
Restrictive Pulmonary Function
  • These cases shared common clinical features: fever, dry cough, dyspnoea, hypoxaemia, diffuse infiltrates both on chest radiography and chest computed tomography, restrictive pulmonary functional impairment, and alveolitis on examination of transbronchial[ncbi.nlm.nih.gov]
Hepatocellular Carcinoma
  • The five of six patients that progressed to hepatocellular carcinoma were associated with cirrhosis. No patients who returned to normal ALT values developed hepatocellular carcinoma during the period of observation.[ncbi.nlm.nih.gov]

Treatment

  • There is no constant and regular change in circulating levels of these cytokines under IFN treatment with respect to treatment response.[ncbi.nlm.nih.gov]

Prognosis

  • Such patients have a poor prognosis and frequently require liver transplantation. We report a patient with autoimmune hepatitis who failed treatment with corticosteroids and azathioprine.[ncbi.nlm.nih.gov]
  • (c) Corticosterioids may be given. (4) Prognosis. The prognosis varies. When the disease is caused by drugs , signs and symptoms of this type of hepatitis may become less severe. With adequate therapy, the patient usually lives several years. 7-11.[armymedical.tpub.com]
  • Soloway RD, Summerskill WHJ, Baggenstoss AH, Geall MG, Gitnick GL, Elveback LR, Schoenfield LJ: Clinical, biochemical and histological remission of severe chronic active liver disease: A controlled study of treatments and early prognosis.[link.springer.com]

Etiology

  • Extensive investigations did not establish an etiological diagnosis. Liver histology confirmed the clinically apparent aggressive hepatitis with fibrosis but gave no clue to its etiology.[ncbi.nlm.nih.gov]
  • However, it is unequivocally heterogenous with regard to etiology.[hepatitiscentral.com]

Epidemiology

  • To present three patients in whom long-term exposure to the drug resulted in chronic active hepatitis; and to review the epidemiology, clinical immunology, histopathology, pathogenetic features and treatment of previously reported cases.[ncbi.nlm.nih.gov]
  • Reference [ CR ] [ PM ] [ EČ ][ 2 ][ GS ] Alter, M.J. (1997) Epidemiology of hepatitis C.[scindeks.ceon.rs]
  • Epidemiological multicentric study on prevalence of hepatitis in hospitalised immigrants in Italy during 2002. Ann Ig. 2005;17:11-8. [ Links ] 16. Senturker Guldas N, Abacioglu YH.[scielo.br]
  • "Epidemiology and the initial presentation of autoimmune hepatitis in Sweden: a nationwide study". Scand J Gastroenterol. vol. 43. 2008. pp. 1232. Abe, M, Onji, M, Kawai-Ninomiya, K.[clinicaladvisor.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology The proposed pathogenesis of autoimmune hepatitis involves the combination of genetic predisposition and environmental triggers. The genetic predisposition may relate to several defects in immunologic control of autoreactivity.[emedicine.medscape.com]
  • This approach is different than the other systems for which categories and scorings were created on the basis of the authors' knowledge (assumptions) of pathophysiology, which then underwent subsequent testing for reproducibility.[nature.com]

Prevention

  • IFN-alpha gave a sustained response in only a small proportion of patients, but worsening of compensated cirrhosis was prevented and development of hepatocellular carcinoma was inhibited, increasing the survival rate.[ncbi.nlm.nih.gov]
  • It is important to identify hepatitis, but it is of greater importance to know the measures which can be taken to prevent the spread of this disease. MD0581 7-6[armymedical.tpub.com]

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