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Gastrointestinal History
 
 
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Substance History
 

Hepatitis B

 
 

Overview

    • Ask About

    • Diagnosis - cause (if known), when diagnosed
    • Manifestations - cirrhosis, polyarteritis nodosa, membranous glomerulonephropathy
    • Management - antivirals, surveillance

    • Risk Factors for Hepatitis B Infection

    • Certain ethnic groups
    • Children of hepatitis B positive mothers
    • Iatrogenic exposure - surgery, colonoscopy, haemodialysis, blood transfusion prior to 1990
    • High risk sexual behaviour
    • Healthcare workers
    • IV drug use
    • Prisoners
    • Tattoos

Manifestations

    • Manifestations of Hepatitis B Infection

    • Hepatic

    • Acute hepatitis
    • Chronic hepatitis
    • Cirrhosis
    • Hepatitis D infection

    • Extrahepatic

    • Polyarteritis nodosa
    • Membranous glomerulonephropathy
    • Serum sickness-like syndrome (fevers, rash, myalgias, arthralgias)

    • Phases of Hepatitis B Infection

    • Immune tolerant - very early infection, prior to significant hepatitis
    • Immune active - attempted clearance of the virus by the immune system
    • Immune control - low viraemia due to clearance
    • Immune escape - recrudescence of viral replication and hepatitis

Management

    • Management of Hepatitis B

    • Non-Pharmacologic

    • Cirrhosis surveillance
    • HCC surveillance

    • Pharmacologic

    • Nucleoside analogues - entecavir, lamivudine
    • Nucleotide analogues - tenofovir
    • Pegylated interferon
Last updated on May 29th, 2019
 
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