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

  Always discuss pain with your medical provider, particularly when pain is constant, severe or interferes with your quality of life. Call your medical provider if you have severe or chronic stomach pain. [hepmag.com]

  A biliary colic will present with a colicky RUQ pain yet without fever, leucocytosis, or jaundice. Cholecystitis will present with RUQ pain and fever yet jaundice will be absent. [teachmesurgery.com]

  These include sudden symptoms like: high fever for more than 24 hours chills nausea vomiting back pain pain below the shoulder blades dull pain or cramps in the upper right side sharp or dull pain in the middle of the stomach low blood pressure confusion [healthline.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]

  A biliary colic will present with a colicky RUQ pain yet without fever, leucocytosis, or jaundice. Cholecystitis will present with RUQ pain and fever yet jaundice will be absent. [teachmesurgery.com]

  RUQ pain and jaundice (neither sensitive nor specific) Symptoms Fever/chills Nausea/vomiting Abdominal pain Physical Exam RUQ tenderness to palpation Peritoneal signs are variable Jaundice Frank sepsis (fever, tachycardia, hypotension, tachypnea) is [coreem.net]

• 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]

  Appetite loss: Be sure to discuss this with your health care provider. If you are experiencing significant weight loss, you may be referred to a nutritionist or dietitian. [hepmag.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]

  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]

  It starts with acute symptoms in 30% of the cases with jaundice, fever, malaise, liver tenderness, like an acute viral hepatitis. [meddean.luc.edu]

  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]

• Weight Gain

  Try products designed to promote weight gain, such as nutritional supplements, canned formulas, protein powders, instant breakfast drinks, power bars and high-calorie puddings. [hepmag.com]

  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]

• Abdominal Pain

  […] stools Darkened urine Fever Jaundice (yellowing of the skin and eyes) Nausea Pain below the shoulder blade Right upper quadrant or middle abdominal pain that is sharp, crampy or dull Vomiting Diagnosis Making a diagnosis of cholangitis as quickly as [verywellhealth.com]

  Presentation 50-70% of patients present with classic Charcot's triad of jaundice, fever and right upper quadrant pain. In elderly patients, the abdominal pain may be poorly localised. [patient.info]

  You can also take an over-the-counter pain reliever, such as ibuprofen (Advil), to help with any abdominal pain you have. See a doctor if your symptoms are severe or seem to be getting worse. [healthline.com]

  […] and jaundice (neither sensitive nor specific) Symptoms Fever/chills Nausea/vomiting Abdominal pain Physical Exam RUQ tenderness to palpation Peritoneal signs are variable Jaundice Frank sepsis (fever, tachycardia, hypotension, tachypnea) is a common [coreem.net]

  These medications can also lead to nausea, diarrhea, constipation, abdominal pain, high blood pressure, elevated cholesterol, joint pain, diabetes, and gingivitis. [rarediseases.org]

• Loss of Appetite

  They include consumption of large amounts of alcohol, loss of appetite, nausea, and vomiting. [merckmanuals.com]

  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]

• 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]

• Diplopia

  The diplopia, which was diagnosed as abducent nerve paralysis, improved rapidly and reversed at about 6 weeks after discontinuation of interferon and during infusion of hydrocortisone. [ncbi.nlm.nih.gov]

• Blepharoptosis

  We report the case of a 53-year-old female patient, who developed bilateral blepharoptosis, limb weakness, dysphagia, and dyspnea several days after human natural interferon-beta (IFN-beta) treatment for chronic active hepatitis C. [ncbi.nlm.nih.gov]

• Cotton Wool Spots

  Fifteen patients (42%) were found to have retinopathy with cotton wool spot formation and splinter haemorrhages. [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]

  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]

• Pruritus

  Pruritus (cholestasis). Breast swelling (gynaecomastia), testicular atrophy, loss of libido and amenorrhoea due to endocrine dysfunction. Confusion and drowsiness (encephalopathy). [patient.info]

  In early stages, unspecific manifestations such as fever, fatigue, pruritus, malaise, abdominal pain, and weight loss are reported, however about 40-50% of patients may be asymptomatic at time of diagnosis. [orpha.net]

  The patient may also complain of pruritus (itching), as a result of bile accumulation, and pale stool with dark urine, from the obstructive jaundice. [teachmesurgery.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]

• 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]

  [18] Jaundice can occur as well, but much later in the disease process and is typically a sign of advanced disease.[18] Chronic hepatitis interferes with hormonal functions of the liver which can result in acne, hirsutism (abnormal hair growth), and amenorrhea [en.wikipedia.org]

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]

Abstract Few alternative treatments are available for those patients with autoimmune chronic active hepatitis who fail to respond to the conventional treatment of corticosteroids. [ncbi.nlm.nih.gov]

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]

Treatment and prognosis Treatment involves appropriate antibiotic therapy and biliary tree decompression (usually either via ERCP or PTC). Mortality rates are between 50-90% for severe acute cholangitis 5,6. [radiopaedia.org]

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]

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]

Epidemiology References:[1][2][3][4] Epidemiological data refers to the US, unless otherwise specified. Etiology Virus Transmission The frequency and patterns of transmission vary worldwide. [amboss.com]

Summary Epidemiology The prevalence of PSC in Europe ranges from 1/446,000-1/6,170. A male preponderance is observed with a male to female ratio of approximately 2:1. [orpha.net]

El-Serag HB ; Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology. 2012 May142(6):1264-1273.e1. doi: 10.1053/j.gastro.2011.12.061. [patient.info]

Pathophysiology <ul><li>A scending bacterial infection association with partial or complete obstruction of bile ducts. [slideshare.net]

Mortality rate 5-10% Hepatobiliary Tract Anatomy Pathophysiology Bile duct develops an obstruction Obstruction may be incomplete (more common) or complete Causes: Gallstones (most common), malignancy, benign stricture, iatrogenic (i.e. [coreem.net]

For related pathophysiology, please see the Cholelithiasis and Cholecystitis and Biliary Colic articles. [emedicine.medscape.com]

References:[5][6][7][8] Pathophysiology Acute infection Hepatocytes infected by the hepatitis B virus express viral peptides on their surfaces → lymphocytes recognize HBV-derived peptides and become activated (CD8+ cytotoxic T cells) → lymphocytes attack [amboss.com]

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]

Prevention In some cases, preventing cholangitis might not be possible. However, as most cases are caused by gallstones blocking the bile ducts, preventing gallstones may help. [verywellhealth.com]