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Hepatitis B

Jason Chao, MD, MS and Navpreet K. Singh, MD Reviewed 06/2018
 


BASICS

DESCRIPTION

Systemic viral infection associated with acute and chronic liver disease and hepatocellular carcinoma (HCC) 

EPIDEMIOLOGY

Incidence

  • Predominant age: can infect patients of all ages

  • Predo...

DIAGNOSIS

HISTORY

  • Exposure: detailed family and social history

  • Acute HBV

    • Fever, malaise, fatigue, arthralgias, myalgias

    • Anorexia, nausea, vomiting

    • Jaundice, scleral icterus

    • Dark urine, pale stools

    • Right up...

TREATMENT

GENERAL MEASURES

  • Vaccinate for HAV if seronegative.

  • Monitor CBC, coagulation, electrolytes, glucose, renal function, and phosphate.

  • Monitor ALT and HBV DNA; increased ALT and reduced DNA implie...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

Patient Monitoring

  • Serial ALT and HBV DNA:

    • High ALT + low HBV DNA associated with favorable response to therapy

  • Serologic markers: See table.

  • CBC for WBC and platel...

REFERENCES

1
Weinbaum CM, Williams I, Mast EE, et al. Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. MMWR Recomm Rep.  2008;57...

ADDITIONAL READING

  • Terrault NA, Bzowej NH, Chang K-M, et al. AASLD guidelines for treatment of chronic hepatitis B. Hepatology.  2016;63(1):261–283. [View Abstract on OvidMedline]

SEE ALSO

  • Cirrhosis of the Liver; Hepatitis A; Hepatitis C

  • Algorithm: Cirrhosis; Jaundice

CODES

ICD10

  • B19.10 Unspecified viral hepatitis B without hepatic coma

  • B16.9 Acute hepatitis B w/o delta-agent and without hepatic coma

  • B18.1 Chronic viral hepatitis B without delta-agent

  • Z22.51 Carrier of...

CLINICAL PEARLS

  • Screen for HBV infection in all patients born in countries with endemic disease using HBsAg.

  • Patients with chronic HBV need lifetime monitoring for disease progression and HCC.

  • HBV is th...

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