Hepatology PDF

Hepatology by Osama El-Minshawy,MD Prof. of Medicine  Viral hepatitis Viral hepatitis is an infection that causes liver inflammation and damage Clinical features of viral hepatitis  Clinical features of acute infection A non-specific sympto...

Hepatology by Osama El-Minshawy,MD Prof. of Medicine  Viral hepatitis Viral hepatitis is an infection that causes liver inflammation and damage Clinical features of viral hepatitis  Clinical features of acute infection A non-specific symptoms characterized by: Headache, Myalgia & arthralgia. Nausea & anorexia precedes development of jaundice by few days Vomiting & diarrhea may happen Abdominal discomfort is common. Dark urine and pale stools may precede jaundice. Symptoms rarely last longer than 3–6 weeks.  Clinical features of acute infection signs:. The liver is tender & minimally enlarged. Occasionally, mild splenomegaly Cervical lymphadenopathy are seen. Jaundice may be mild A B C D E  Diagnosis Viral markers Liver enzymes Liver function tests PCR abdominal ultrasonography Liver biopsy  Diagnosis 1-Viral markers in HAV : antibodies to HAV, HAV IgM is +ve in the acute illness HAV IgG gives lifelong immunity in HCV : This is made by finding HCV antibody in the serum HCV RNA should be assayed using quantitative HCV-RNA PCR. in HBV : HBsAg and HBV DNA are found in the serum,  Diagnosis 2-Moderate rise in ALT & AST. 3-A slightly raised Alkaline phosphatase. 4-The serum bilirubin is often normal. 5-Liver biopsy is indicated if active treatment is being considered  Treatment of acut HAV: No specific treatment, Rest, a balanced diet with healthy food and plenty of fluids are typically enough to treat symptom Avoid medication that affect the liver e.g. acetaminophen. Corticosteroids have no benefit. Admission to hospital is not usually necessary. Immune serum globulin can be effective in an outbreak of hepatitis, in a school or nursery, as injection of those at risk prevents secondary spread to families. People travelling to endemic areas are best protected by vaccination.  HBV fulminant hepatitis occurring in up to 1%. Some patients go on to develop chronic hepatitis, cirrhosis and hepatocellular carcinoma or become asymptomatic carriers. Treatment Prevention and prophylaxis Prevention depends on avoiding : 1- Shared needles, 2-contact with infected body fluids. Passive and active immunization  Vaccination: Groups at high risk are: 1- healthcare personnel 2-members of emergency and rescue teams; 3-patients on hemodialysis 4-homosexual and prostitutes; 5-intravenous drug abusers. : Interferon, lamivudine  Treatment of chronic HBV Interferon has been used in acute cases to prevent chronic disease. Needle-stick injuries must be treated early  Treatment of chronic HCV combined Pegylated Interferon + Ribavirin for 48 wks. Recently new drugs were approved with better results: Sovaldi (sofosbuvir) polymerase inhibitor: 2)Harvoni (HCV Protease Inhibitors / HCV Polymerase inhibitor ): 3) Olysio (simeprevir  Dental management of hepatic patient Liver disorders are important to dentist because of bleeding tendency intolerance to drugs, e.g. general anesthetics and benzodiazepines and possibility of the underlying infective causes for the liver dysfunction Consult the patient’s physician before using of any drug in a patient with liver disease Hepatic impairment will lead to failure of metabolism of many drugs that can result in toxicity In some patients dose reduction is required, some drugs should be avoided completely.  Dental management of hepatic patient Dentists should note that the antifungal drug miconazole is contraindicated if there is hepatic impairment and fluconazole requires dose reduction. Erythromycin, metronidazole and tetra cyclines should be avoided. Non-steroidal anti-inflammatory drugs increase the risk of GIT (are best avoided). Paracetamol doses should be reduced as this drug is hepatotoxic. The general anesthetic halothane (now used infrequently) should not be given twice to the same patient within 3 months (halothane hepatitis is likely to result) Thank you