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Internal Medicine
Chronic viral hepatitis
Complicates about 1% of acute hepatitis B (young, immunocompetent) and 85-90%
of acute hepatitis C will develop chronic hepatitis. About 20% of the later will develop
cirrhosis in 10-20yrs.
Subjects with either HBV or HCV infection have greater risk of developing
hepatocellular carcinoma
Treatment can suppress hepatic inflammatory activity in 30-40%
Hepatitis B - therapy is indicated for patients positive for HBsAg and HBcAg (High
replicative phase). Treat with interferon α and Lamivudine.
Hepatitis C can be treated with interferon α and ribavirin
B. Cirrhosis of the liver and its complications
It is the end result of fibrous scarring and hepatocellular regeneration, that constitute
the major responses of the liver, to a variety of long standing inflammatory, toxic,
metabolic and congestive insults.
The normal hepatic lobular architecture is replaced by interconnecting bands of fibrous
tissue surrounding nodules derived from foci of regenerating hepatocytes.
The following pathologic changes are the cause of the clinical manifestations and
complications of cirrhosis
Fibrous scarring and disruption of hepatic architecture distort vascular bed leading to
Portal hypertension and intrahepatic shunting
Disturbed hepatocellular function
Clinical and laboratory features resulting from
Hepatocellular dysfunction
• Hypoalbuminemia
• Decreased coagulation factors resulting in prolonged prothrombin time
• Hyperbilirubinemia
• Increased blood ammonia level
• Hepatic encephalopathy
• Ascites
Portal HTN
• Ascites.