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home - Liver - Hepatitis B - Acute hepatitis B Written by Dr Sebastian Zeki
Knowledge


Understands the serological interpretation categorisation and
investigation of patients with chronic hepatitis B and/or C with
particular emphasis on the need for treatment and surveillance

Recognises the particular populations at risk
Aware of national and international agreed guidelines on viral
hepatitis management and use of interferon and antiviral drugs

Aware of hepatitis B reactivation in the context of immunosuppression
Skills
Uses appropriate diagnostic modalities including serology
genotyping viral load measurements liver biopsy and related
investigations

Monitors anti-viral and immunomodulatory therapies with appropriate
investigations

Behaviours
Communicates effectively with patients and relatives in the context of
viral liver disease and underlying social and psychological risk factors

Marshals multi-disciplinary support networks and in particular
recognise the crucial role of nurse practitioners in disease
management

Also...

Knowledge


Identifies patients with acute hepatitis B and can a rtain the
severity of their illness

Defines the different phases of chronic hepatitis B infection with a
clear understanding of serological results

Appreciates risks of transmission to close contacts
Has awareness of indications for therapy in both HBeAg positive and
negative hepatitis and the potential influence of genotype on choice of
therapy

Identifies patients where prophylaxis is required to prevent
reactivation and vertical transmission

Can determine an appropriate surveillance programme for those
patients with varices and/or hepatocellular carcinoma

Identifies patients who are appropriate candidates for liver transplant


Skills
Demonstrates ability to take a relevant history perform examination
and organise appropriate investigations

Able to advise risks of viral transmission
Interprets results of blood tests for hepatitis B antigen and antibody
Appreciates when liver biopsy is appropriate
Be able to select the most appropriate treatment and how to monitor
patient response

Able to select appropriate imaging techniques for evaluation of
abnormal results
Behaviours
Appreciates the cultural differences in the ethnic populations infected
and the influence this may have on screening


Provides advice and education to families and shows appreciation of
the potential difficulties that may arise

Understands the importance of cooperation with virologists and staff
in other clinical laboratories

Acute hepatitis B

Acute Hepatitis B 70 % subclinical or anicteric hepatitis/ 30 % develop icteric hepatitis.More severe in patients coinfected with other hepatitis viruses or with underlying liver disease. Clinical PresentationThe incubation is1-4 months.The prodrome is a serum sickness-like syndrome.The prodrome is followed by constitutional symptoms, anorexia, nausea, jaundice and right upper quadrant discomfort.The symptoms and jaundice generally disap-pear after 1-3 months.Some patients have prolonged fatigue even after normalization of serum aminotrans-ferase concentrations.The ALT can be as high as 1000 to 2000 IU/L.The bilirubin may be normal.The PT is the best indicator of prognosis.ALT normalises in 1-4 months if the patient recovers. Treatment It is supportive. Avoid interferon (increased risk of hepatic necroinflammation)Telbivudine, lamivudine, adefovir, entecavir, or tenofovir are acceptable options given as monotherapy as the duration of treatment should be short.Treatment can be stopped after confirmation (two consecutive tests four weeks apart) that the patient has cleared HBsAg. Lamivudine indications:Severe (such as those who develop a coagulopathy {INR >1.5} Protracted course (eg. persistent symptoms or marked jaundice {bilirubin >10 mg/dl} > four weeks after presentation).Treat patients with fulminant hepatitis B to reduce the likelihood of reinfection post-liver transplant, those who are immunocom-promised, have concomitant infection with hepatitis C or D virus, have preexisting liver disease, or are elderly. Written by Dr Sebastian Zeki

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