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Hepatitis C
From WikEM
Contents
Background
- Bloodborne transmission
- NO acute phase
- >75% progress to chronic hepatitis C infection
- Disease course depends on comorbidities (e.g. alcohol use, HIV status, etc.)
- May progress to cirrhosis, +/- hepatocellular carcinoma
Clinical Features
- Asymptomatic during first few years
- Symptoms occur once cirrhosis has developed
- Malaise, weakness (from electrolyte derangements)
- Abdominal pain
- Ascites, SBP (fever, abdominal tenderness)
- Altered mental status due to hepatic encephalopathy
- Coagulopathy
- GI bleed
Differential Diagnosis
Acute hepatitis
- Viral hepatitis
- Hepatitis A
- Hepatitis B
- Hepatitis C
- Acute alcoholic hepatitis
- Acetaminophen toxicity
- Mushroom toxicity
- Ischemic hepatitis
Evaluation
Acute Hepatitis Panel
| Anti-hepatitis A, IgM | Hepatitis B surface antigen | Anti-hepatitis B core, IgM | Anti-hepatitis C | Interpretation |
|---|---|---|---|---|
| Positive | Negative | Negative | Negative | Acute hepatitis A |
| Negative | Positive | Positive | Negative | Acute hepatitis B |
| Negative | Positive | Negative | Negative | Chronic hepatitis B infection |
| Negative | Negative | Positive | Negative | Acute hepatitis B; quantity of hepatitis B surface antigen is too low to detect |
| Negative | Negative | Negative | Positive | Acute or chronic hepatitis C; additional tests are required to make the determination |
Management
Complications of cirrhosis
- Ascites
- Esophageal varices
- Hepatic encephalopathy
- Spontaneous bacterial peritonitis
- Hepatorenal syndrome
- Portal hypertension
- Upper gastrointestinal bleed
- Hepatocellular carcinoma
Outpatient HCV treatment may include:
- Interferon-α or pegylated interferons
- Ribavirin
- Direct-acting antiviral agents (boceprevir, telaprevir, simeprevir, sofosbuvir, Harvoni, etc.)
Disposition
- Often complex and should be based on presence/absence of acute complications
- If no complications present, discussion with patient's primary care provider or gastroenterologist recommended
