Hepatitis C Flashcards
(19 cards)
Treatment of chronic hepatitis c
*No cirrhosis: Sofosbuvir + Daclatasvir for 12 weeks.
*Compensated cirrhosis (Child-Pugh A): Same regimen ± Ribavirin for 12 weeks.
*Decompensated cirrhosis:sv (Child-Pugh B/C): Sofosbuvir + Velpatasvir ± Ribavirin for 12–24 weeks under specialist care.
*If the patient has renal impairment,(gp)
Glecaprevir + Pibrentasvir may be preferable.
Extra hepatic manifestations of HCV
1-Haematological
*Essential Mixed Cryoglobulinemia (EMC)
*Auto immune hemolytic anemia
*ITP
*Lymphoma… There is increase of B-cell lymphoma in patients with HCV
Extra hepatic manifestations of HCV
2-Dermatological
4p
*Prophyrea cutena tarda (PCT)
Due to decrease the level of enzyme responsible for 5th step of heme senthesis
*Pruritis.
*Papule purpura
*Lichen planus..
Chronic muco cutenous disease affect skin,tongue ,oral
Extra hepatic manifestations of HCV
3-Endocrine disorders
*DM..hcv increase incedince of type 2 DM 3 times more than non hcv
*Autoimmune thyroiditis
* GH deficiency
*Vit D difeceny
Extra hepatic manifestations of HCV
4-Renal disorders
*HCV cause membranoproliferative GN
*Hbv cause membranous GN
Extra hepatic manifestations of HCV
5- Neurological
*Encephalitis
*Encephalomyelitis
*Peripheral neuropathy
*Subclinical neurocognitive changes
Extra hepatic manifestations of HCV
6-CVS
*Cardiomyopathy
*Myocarditis
*Cardiac atherosclerosis
Extra hepatic manifestations of HCV
7-Others
*Uveitis
*Corneal ulcers
*Sicca syndrome
*IPF
*Poly arteritis nodosa
You are called to consult on an inpatient with hepatitis C. The patient is a 54-year-old man
with genotype 1 hepatitis C, contracted through intravenous drug use 2 decades ago, who has
no previous evidence of cirrhosis, fibrosis, or any other sequelae of chronic hepatitis C infection.
He was in his usual state of health until 2 weeks prior to admission, when he developed ankle
edema that quickly spread up his legs. Within 1 week, he developed severe swelling in his legs,
abdomen, and scrotum, along with severe upper abdominal pain. Two days prior to admission, he
developed a rash across his thighs and arms.
Upon admission, he was found to have 3+ pitting edema in the lower extremity and flanks.
There was no evidence of ascites, nor any stigmata of chronic liver disease. His skin revealed
palpable purpuric lesions over the thighs and forearms. Abnormal labs include creatinine = 3.2;
albumin = 1.8; 24-hour urine protein = 5 g; AST = 55; ALT = 62; ALP = 50; total bilirubin = 1.3;INR = 1.0. Complement levels are low
Diagnosis
Mixed cryoglobulinemia
Hepatitis C + Positive rheumatoid factor + Low complement + Lower extremity
purpuric rash + Paresthesias + Renal disease
Mixed cryoglobulinemia
Hepatitis C + Positive rheumatoid factor + Low complement + Lower extremity
purpuric rash + Paresthesias + Renal disease
Mixed cryoglobulinemia
Young adult + Abdominal pain + Low complement + Purpuric rash on thighs
Henoch-Schönlein purpura
Mixed Cryoglobulinemia
A condition throw which there is large amount of cryoglobulins which is circulates in blood and form immune complex which precipitate in different organs.
Cryoglobulins are responsible for decreased temperature
Mixed Cryoglobulinemia
C/P
*Purpura
*Vasculitis
*Membranoproliferative gn
*Peripheral neuropathy
*Positive RF
*Decrease C4
Mixed Cryoglobulinemia
Treatment
*Asymptomatic : No treatment
*Symptomatic: antiviral”interferone”
Mixed Cryoglobulinemia
Are seen also in
*Hbv
*Hiv
61-year-old man with well-compensated cirrhosis due to chronic hepatitis C develops new-onset ankle edema. He presents to his primary care physician, who orders laboratory tests revealing:
Creatinine: 2.3 mg/dL (baseline: 1.0 mg/dL) Albumin: 1.8 g/dL (baseline: 3.1 g/dL) AST: 48 U/L
ALT: 53 U/L Total bilirubin: 1.6 mg/dL INR: 1.3 The patient is referred to a gastroenterologist, who orders additional investigations:
24-hour urine protein: 4.6 grams…Serum complement levels: Low….Rheumatoid factor: Positive
Essential mixed Cryoglobulinemia
Causes of sexual dysfunction in cirrhosis
1-Alchols
2-Alternation of sexual hormonal metabolism
3-portosystemic shunt may cause testicular dysfunction and increase estrogen and decrease testosterone.
4-coagulopathy
5-Drugs
6-Decreased albumin cause decrease physical activity
7-Diseses ascociated: as dm
Treatment of sexual dysfunction in cirrhosis
1-treatment of liver disease
2-improve quality of life
3-control depression
4-psycho sexual support
5-Cognetive behavioural therapy
