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Chronic Active Hepatitis B

Chronic Active Type Hepatitis B Virus


Presentation

  • MATERIALS AND METHODS: Thirty patients with chronic active hepatitis B were included in our present study.[ncbi.nlm.nih.gov]
Fever
  • 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]
  • If you have symptoms such as jaundice, fatigue or fever or have been exposed to hepatitis B, don’t delay: make an appointment to see a liver specialist who is experienced in diagnosing and treating the virus.[cpmc.org]
  • 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]
  • Serum sickness-like syndrome can develop during the prodromal (preicteric) period ; : rash, polyarthritis, fever Subclinical hepatitis (70% of cases) Symptomatic hepatitis (30% of cases; see also acute viral hepatitis ) Fever, skin rash, arthralgias,[amboss.com]
Fatigue
  • People with symptoms most commonly complain of fatigue. Fatigue worsens throughout the day and may even be debilitating.[drugs.com]
  • If you have symptoms such as jaundice, fatigue or fever or have been exposed to hepatitis B, don’t delay: make an appointment to see a liver specialist who is experienced in diagnosing and treating the virus.[cpmc.org]
  • 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]
  • Many people have no symptoms, but some have vague symptoms, such as a general feeling of illness, poor appetite, and fatigue. Chronic hepatitis can result in cirrhosis with portal hypertension and liver failure.[merckmanuals.com]
  • […] spontaneously recover most neonates progress to chronic infection worse prognosis with coinfection with hepatitis D or hepatitis C infection Presentation Symptoms acute hepatitis anorexia nausea right upper quadrant pain chronic hepatitis many are asymptomatic fatigue[medbullets.com]
Malaise
  • Transient side effects of malaise and influenza like symptoms occurred in all patients and resolved rapidly after treatment.[ncbi.nlm.nih.gov]
  • Snapshot A 35-year-old presents to the emergency department due to abdominal pain and malaise. He also reports "yellow-ing" of his skin. Medical history is noncontributory.[medbullets.com]
  • 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]
  • Symptoms of chronic hepatitis often include a vague feeling of illness (malaise), poor appetite, and fatigue. Sometimes affected people also have a low-grade fever and some discomfort in the upper abdomen. Jaundice is rare.[merckmanuals.com]
  • These symptoms abate with the onset of jaundice, although anorexia, malaise, and weakness can persist.[clevelandclinicmeded.com]
Intermittent Fever
  • 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]
Loss of Appetite
  • Eventually, the liver damage can lead to symptoms such as weakness, loss of appetite, nausea, vomiting, itchy skin, jaundice, pain in the right upper abdomen, and fluid build up in the abdomen (ascites).[news-medical.net]
  • Long-term complications Liver cirrhosis Hepatocellular carcinoma ( HCC ) Post‑hepatitis syndrome Chronic fatigue, weakness Nausea, loss of appetite Possible upper quadrant pain Reactivation of previous HBV infection due to immunosuppression References[amboss.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]
  • However, common symptoms include: fatigue dark urine joint and muscle pain loss of appetite fever abdominal discomfort weakness yellowing of the whites of the eyes (sclera) and skin (jaundice) Any symptoms of hepatitis B need urgent evaluation.[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
  • Hepatitis Alcoholic hepatitis evident by fatty changes, cell death , and Mallory bodies Specialty Infectious disease , gastroenterology , hepatology Symptoms Yellowish skin , poor appetite, abdominal pain WHO fact sheet of hepatitis Viral Hepatitis at[en.wikipedia.org]
  • Snapshot A 35-year-old presents to the emergency department due to abdominal pain and malaise. He also reports "yellow-ing" of his skin. Medical history is noncontributory.[medbullets.com]
  • Many people don't have any troublesome symptoms, but if you do feel unwell, it can help to: get plenty of rest take over-the-counter painkillers, such as paracetamol or ibuprofen , for tummy (abdominal) pain maintain a cool, well-ventilated environment[nhs.uk]
  • Symptoms/Signs Serological diagnosis Treatment Prevention Complications Hepatitis A virus (HAV) Picornavirus Non-enveloped virus Positive sense, single-stranded, linear RNA Fecal-oral 15–50 Acute hepatitis: fever, malaise, loss of appetite, nausea, abdominal[amboss.com]
Jaundice
  • Eventually, the liver damage can lead to symptoms such as weakness, loss of appetite, nausea, vomiting, itchy skin, jaundice, pain in the right upper abdomen, and fluid build up in the abdomen (ascites).[news-medical.net]
  • Physical examination is remarkable for right upper quadrant tenderness, generalized jaundice, and scleral icterus. Laboratory studies demonstrate the presence of HBsAg and significantly elevated IgM anti-HBc, and HBeAg.[medbullets.com]
  • High levels of bilirubin cause jaundice.[drugs.com]
  • Serological diagnosis Treatment Prevention Complications Hepatitis A virus (HAV) Picornavirus Non-enveloped virus Positive sense, single-stranded, linear RNA Fecal-oral 15–50 Acute hepatitis: fever, malaise, loss of appetite, nausea, abdominal pain, jaundice[amboss.com]
  • If you have symptoms such as jaundice, fatigue or fever or have been exposed to hepatitis B, don’t delay: make an appointment to see a liver specialist who is experienced in diagnosing and treating the virus.[cpmc.org]
Hepatomegaly
  • Clinical signs include liver tenderness, hepatomegaly, and splenomegaly. Acute HBV infection typically lasts two to four months.[aafp.org]
Scleral Icterus
  • Physical examination is remarkable for right upper quadrant tenderness, generalized jaundice, and scleral icterus. Laboratory studies demonstrate the presence of HBsAg and significantly elevated IgM anti-HBc, and HBeAg.[medbullets.com]
Urticaria
  • Arthritis may be accompanied by urticaria, palpable purpura, erythema multiforme, erythema nodosum, liken planus.[meddean.luc.edu]
Withdrawn
  • Hepatitis B virus associated DNA polymerase activity, hepatitis b surface antigen (HBsAg), and serum aspartate aminotransferase were followed in 21 patients with chronic active hepatitis while immunosuppressive therapy (prednisone /- azathioprine) was being withdrawn[ncbi.nlm.nih.gov]
Dysesthesia
  • A 30-year-old, male HBV carrier complained of pricking and burning discomfort in the distal potions of the first to third fingers of the left hand, and dysesthesia of the left foot of 2 months duration.[synapse.koreamed.org]

Workup

  • An extensive workup for the etiology of MM including fasting blood sugar, cerebrospinal fluid examination, and tests for cryoglobulin and immunoglobulins (IgM, IgG, IgA, and IgE) with serum protein electrophoresis, antinuclear, antineutrophil cytoplasmic[synapse.koreamed.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]
HLA-B8
  • The apparent predisposition of individuals with HLA-B8 and DR3 haplotypes to develop IACAH suggests that genetically conditioned abnormalities may have a role in pathogenesis.[hepatitiscentral.com]
Liver Biopsy
  • Liver biopsy revealed cirrhosis in each patient. With the development of anti-HBs, these patients became serologically indistinguishable from patients with a cryptogenic cirrhosis who had prior unrelated exposure to hepatitis B.[ncbi.nlm.nih.gov]
Hepatocellular Carcinoma
  • Transforming growth factor alpha was expressed in 26 (68.4%) of 38 chronic active hepatitis B, 18 (56.3%) of 32 cirrhosis and 16 (51.6%) of 31 hepatocellular carcinoma tissue samples.[ncbi.nlm.nih.gov]
  • Presence of hepatitis B e antigen (HBeAg) is associated with an increased risk for hepatocellular carcinoma regardless of serum level of alanine aminotransferase (ALT).[library.med.utah.edu]
  • Meta-analysis: surveillance with ultrasound for early-stage hepatocellular carcinoma in patients with cirrhosis. Aliment Pharmacol Ther. 2009;30(1):37–47. 30. El-Serag HB, Mason AC. Rising incidence of hepatocellular carcinoma in the United States.[aafp.org]
  • carcinoma, from seroclearance to hepatocellular carcinoma, from inactive to active CHB, from inactive CHB to seroclearance, from active hepatitis to hepatocellular carcinoma, and from hepatocellular carcinoma to HBV-related death (see Figures A-6, A-[nap.edu]

Treatment

  • Hence, while interferon is a promising agent for treatment of CAH-B, efforts must continue to define more optimal treatment regimes and to identify those patients most likely to respond to this agent.[ncbi.nlm.nih.gov]

Prognosis

  • In conclusion, the prognosis of anti-HBe-positive patients with chronic hepatitis B is poor, as 54% of the cases developed cirrhosis during a mean histologic follow-up period of 4.5 years, mainly in association with hepatitis delta virus infection or[ncbi.nlm.nih.gov]
  • […] most immunocompetent adult patients spontaneously recover most neonates progress to chronic infection worse prognosis with coinfection with hepatitis D or hepatitis C infection Presentation Symptoms acute hepatitis anorexia nausea right upper quadrant[medbullets.com]
  • The former have a good prognosis with a low risk of complications, while the latter patient population have active liver disease with a high risk of progression to liver cirrhosis and/or hepatocellular carcinoma (HCC).[bjmp.org]
  • Soloway RD, Summerskill WHJ, Baggenstoss AH et al. (1972) Clinical biochemical and histological remission of severe chronic active liver disease: A controlled study of treatments and early prognosis.[link.springer.com]
  • Prognosis The prognosis for chronic hepatitis has improved dramatically over the last few years. In fact, for hepatitis C, many people can now be cured. Despite treatment, some people will progress to cirrhosis.[drugs.com]

Etiology

  • It is a syndrome of diverse causes including diabetes mellitus, demyelinating, infectious, or neoplastic etiology. In association with chronic active hepatitis B, MM associated with PAN is relatively common.[synapse.koreamed.org]
  • However, it is unequivocally heterogenous with regard to etiology.[hepatitiscentral.com]
  • Etiology Virus Transmission The frequency and patterns of transmission vary worldwide.[amboss.com]
  • This old system is no longer in use because it does not include the disease stage and etiology, and cannot be correlated with the newer semi-quantitative scoring systems.[hepatitisbannual.org]
  • The same type of grading and staging is used for chronic hepatitis due to other causes such as chemicals and immunological etiologies.[meddean.luc.edu]

Epidemiology

  • Hepatitis B-associated polyarteritis nodosa in Alaskan Eskimos: clinical and epidemiologic features and long-term follow-up. Hepatology 1989;9:97–101. 6. Bron KM, Strott CA, Shapiro AP.[synapse.koreamed.org]
  • We therefore suggest that HBV genotyping become a routine exercise in clinical medicine and molecular epidemiology.[virologyj.biomedcentral.com]
  • 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]
  • Introduction Classification a Hepadnavirus in the Hepadnaviridae family circular, partially double-stranded DNA virus Epidemiology risk factors not receiving hepatitis B virus (HBV) vaccine sexual contact with a person with HBV illicit drug use having[medbullets.com]
  • However, such a high prevalence is not recognized in the United States; this may be because of the differences in epidemiology of HBV, which may be predominantly perinatal in other geographic areas of the world (see Epidemiology ).[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Furthermore, treatment with AM3 may help to elucidate the pathophysiology of CAHB.[ncbi.nlm.nih.gov]
  • 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[amboss.com]

Prevention

  • In general the data show that hepatitis B virus infection does not prevent hepatocytes from undergoing ductular metaplasia.[ncbi.nlm.nih.gov]
  • WHO has recently launched a new policy on injection safety that will also help prevent new hepatitis B infections. The policy calls for the worldwide use of “smart” syringes to prevent the re-use of syringes or needles.[who.int]
  • Clinical trials Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.[mayoclinic.org]
  • ) Hepatitis virus panel (Medical Encyclopedia) Preventing hepatitis B or C (Medical Encyclopedia) [ Read More ][icdlist.com]

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