Gastroenterology
Hepatitis & Cirrhosis
Gastroenterology

Hepatitis & Cirrhosis

Hep A/B/C + alcoholic hepatitis + complications.

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◆Hepatitis A & E

  • •Fecal-oral, acute, self-limited
  • •HEV: fulminant in pregnancy
  • •HAV IgM = acute; IgG = past or vaccinated
  • •Post-exposure: vaccine ± immune globulin

◆Hepatitis B

  • •HBsAg + for >6 months = chronic
  • •Treat: tenofovir or entecavir (oral antivirals)
  • •Long-term complications: cirrhosis, HCC (HBV can cause HCC WITHOUT cirrhosis via viral DNA integration)
  • •HCC surveillance: US ± AFP q6 months
  • •Vaccinated immune: anti-HBs+, anti-HBc-
  • •Past infection: anti-HBs+, anti-HBc+, HBsAg-

◆Hepatitis B PEP after needlestick

  • •Documented immune (anti-HBs ≥10) → no PEP
  • •Unvaccinated or non-responder → HBIG + start vaccine series

◆Hepatitis C

  • •Chronic + HCV RNA positive
  • •Direct-acting antivirals (sofosbuvir/velpatasvir): >95% cure
  • •8–12 weeks treatment
  • •Universal adult screening at least once
  • •HCV + heavy alcohol → markedly accelerated cirrhosis; alcohol cessation slows progression
  • •HCC surveillance if cirrhosis even after cure
  • •Mixed cryoglobulinemia: HCV + palpable purpura + arthralgias + weakness ± neuropathy/GN

◆Alcoholic hepatitis

  • •AST/ALT >2:1 with both <500
  • •Maddrey DF ≥32 or MELD ≥21 = severe
  • •Prednisolone 28 days (check Lille score day 7)
  • •Abstinence is critical
  • •N-acetylcysteine may be added

◆Cirrhosis complications

  • •Hepatic encephalopathy: identify trigger (GI bleed, infection, electrolytes, constipation), lactulose, rifaximin; AVOID benzos/opioids
  • •SBP: ascitic PMN ≥250 → ceftriaxone + IV albumin (↓HRS); prophylaxis with ciprofloxacin after first episode
  • •Ascites: diet, spironolactone + furosemide, paracentesis with albumin if large volume
  • •Variceal bleed (see bundle)
  • •HCC surveillance

◆HCC surveillance criteria

  • •All cirrhotic patients regardless of cause
  • •Chronic HBV without cirrhosis: Asian male >40, Asian female >50, African >20, FH HCC
  • •US ± AFP q6 months
  • •AFP >400 highly suggestive
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