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home - Liver - Hepatitis B - Hepatitis B Extrahepatic manifestations 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

Hepatitis B Extrahepatic manifestations

Types:1) Membranous nephropathy2) Membranoproliferative glomerulonephritis3) Polyarteritis nodosaClin Pres:Isolated kidney disease +/- known underlying liver diseasePAN present with systemic symptomsDiagnosis:HBV DNAHep CKidney biopsy (or another site if PAN)Treatment for Glomerular DIseaseAntiviral agent- consider entecavir (duration unknown)Alternative is interferon, or pegylated interferon.Avoid immunosuppression unless vasculitis or RPGM (steroids).Give antivirals before immunosupressionHBV-associated PAN — Antiviral eg entecavir with steroids started concurrentlyPlasma exchange if severe manifestations of vasculitis. Other Manifestations of Hepatitis B Written by Dr Sebastian Zeki Renal

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