Looks like acute hepatitis b. Ask for past jaundice and family history of liver disease. Needs further tests like prothrombin time. HBe antigen. Anti HBe antibody. Igm anti HBc. Endoscopy to look for varices. Agree with dr. Manu. Patient probably needs antiviral tenofovir or entecavir. Lamivudine is rarely used now because of high resistance
I would really question this radiology report. This person has acute hepatitis. How long has he had jaundice for? Usually in most patient the body will fight against the infection and control it. Management is symptomatic. Control nausea, vomiting, fluid intake. Only indication to give treatment is when patient is when patient has acute liver failure( jaundice + altered mental status+ INR>1.5)
There are two system involved.Acute Hepatitis B and multicystic kidney disease Both may turn chronic. Hepatitis follow up. For renal further investigation ie CBCESR, KFT. Ht monitor. Treatment accordingly.
This is surprising that au antigen is +ve with high serum bilirubin and still liver is normal on usg anyway this is a c/o of hepatitisB hence strat antiviral like heptavir or lamuvir 300mg twice daily with support of iv fluids and other supportive treatment you can add VIMLIV tab or syp for better and faster results check viral load qualitativeand quantitative.so that you can give antiviral for long period
No active treatment for renal cyst right now However urine analysis and plain Ct abdomen required. Gastroenterologist opinion for acute hepatitis
I believe your patient present acute failure liver, the cyst in kidney can offer diagnosis different at actual problem. may be need to begin research about other viral hepatitis, HIV, cytomegalovirus, Epstein Barr, autoimmune hepatitis, pharmacological reaction with liver failure, leptospirosis, fasciola... I'm think necessary other basical laboratory studies for better orientation.
Hbsag quantitative tests.if he than lactulose rifagut supplement potassium if low.if active hbsag carrier than antiviral can be started.if anaemic r/o variceal bleed.if ascites present than think of tapping if respiratory embarassment present.pleural effusion can also be there.if deranged coagulogram than correct it.by FFP.family counselling for liver transplantation.
Do hbeag if positive start antiviral do fibroscan looks infective hepatitis with hepatitis b udiliv 300 bd
Tab Heptral bd Tab udiliv 300 od Cap Raciper-D od syrup Betonin 2 tsp bd High carbohydrates diet
Repeat LFT after 5 days from some other reliable lab
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Hepatitis *Hepatitis* refers to an inflammatory condition of the liver. It’s commonly caused by a viral infection, but there are other possible causes of hepatitis. These include autoimmune hepatitis and hepatitis that occurs as a secondary result of medications, drugs, toxins, and alcohol. Autoimmune hepatitis is a disease that occurs when your body makes antibodies against your liver tissue. ￼ Timeline 8th Century: Infectious Nature of HBV suggested 17th-19th Centuries: Outbreaks of epidemics of jaundice in military and civilian populations during wars 1883: Lurman reports outbreaks of serum hepatitis follwing vaccination of dockers 1908: McDonald postulates that the infectious jaundice is caused by a virus 1939-1945: WWII-A series of outbreaks after vaccination for measles and yellow fever 1947: MacCallum classifies viral hepatitis into two types- Viral hepatitis A—> Infectious hepatitisViral hepatitis B—> Serum hepatitis 1965: Blumberg discovers Australia antigen (HBsAg) in aborigines and shows presence of antigen at high frequency in patients with leukemia and children with Down’s syndrome 1970: Dane discovers the Dane particle (complete HBV particle) 1972: Discovers HBeAg 1973: Feinstone and Purcell identifies HAV 1977: Rizzetto describes delta antigen HDV 1983: Recovery of HEV 1988: Chiron group (Choo, Kuo, Houghton) closes and identifies HCV. 1995: Abbot group reports GB Virus-C (GBV-C) and Genelabs group reports in 1996 hepatitis G virus (HGV)—GBV-C=HGV 1996: Chang’s group at NTUH reports in JAMA the successful prevention of HBV infection by nation-wide vaccination on newborn babies launched in 1984 in Taiwan. 1997: Chang’s group at NTUH reports in NEJM a decrease in annual incidence rate of hepatocellular carcinoma in children ascribed to nation-wide vaccination against HBV on newborn babies launched in 1984 in Taiwan. Epidemiology Globally, viral It was the seventh leading cause of death in 2013, up from the 10th leading cause in 1990. Worldwide, HAV is responsible for an estimated 1.4 million infections annually. About 2 billion people in the world have evidence of past or current HBV infection, with 240 million chronic carriers of HBsAg. HBV, along with the associated infection by the hepatitis D virus, is one of the most common pathogens afflicting humans. HBV leads to 650,000 deaths annually as a result of viral hepatitis–induced liver disease. The worldwide annual incidence of acute HCV infection is not easily estimated, because patients are often asymptomatic. An estimated 71 million people are chronically infected with HCV worldwide. About 55-85% of these people infected progress to chronic HCV infection, with a 15-30% risk of developing liver cirrhosis within two decades. China, the United States, and Russia have the largest populations of anti-HCV positive injection drug users (IDUs). It is estimated that 6.4 million IDUs worldwide are positive for antibody to hepatitis B core antigen (HBcAg) (anti-HBc), and 1.2 million are HBsAg-positive. Types and causes Viral infections of the liver that are classified as hepatitis include hepatitis A, B, C, D, and E. A different virus is responsible for each type of virally transmitted hepatitis. Hepatitis A is always an acute, short-term disease, while hepatitis B, C, and D are most likely to become ongoing and chronic. Hepatitis E is usually acute but can be particularly dangerous in pregnant women. Hepatitis A Hepatitis A is caused by an infection with the hepatitis A virus (HAV). This type of hepatitis is most commonly transmitted by consuming food or water contaminated by feces from a person infected with hepatitis A. Hepatitis B Hepatitis B is transmitted through contact with infectious body fluids, such as blood, vaginal secretions, or semen, containing the hepatitis B virus (HBV). Injection drug use, having sex with an infected partner, or sharing razors with an infected person increase your risk of getting hepatitis B. It’s estimated by the CDC that 1.2 million people in the United States and 350 million people worldwide live with this chronic disease. Hepatitis C Hepatitis C comes from the hepatitis C virus (HCV). Hepatitis C is transmitted through direct contact with infected body fluids, typically through injection drug use and sexual contact. HCV is among the most common bloodborne viral infections in the United States. Approximately 2.7 to 3.9 million Americans are currently living with a chronic form of this infection. Hepatitis D Also called delta hepatitis, hepatitis D is a serious liver disease caused by the hepatitis D virus (HDV). HDV is contracted through direct contact with infected blood. Hepatitis D is a rare form of hepatitis that only occurs in conjunction with hepatitis B infection. The hepatitis D virus can’t multiply without the presence of hepatitis B. It’s very uncommon in the United States. Hepatitis E Hepatitis E is a waterborne disease caused by the hepatitis E virus (HEV). Hepatitis E is mainly found in areas with poor sanitation and typically results from ingesting fecal matter that contaminates the water supply. This disease is uncommon in the United States. However, cases of hepatitis E have been reported in the Middle East, Asia, Central America, and Africa, according to the CDC. Autoimmune Hepatitis Autoimmune hepatitis is a rare form of chronic hepatitis. Like other autoimmune disorders, its exact cause is unknown. Autoimmune hepatitis may develop on its own or it may be associated with other autoimmune disorders, such as systemic lupus erythematosus. In autoimmune disorders, a misdirected immune system attacks the body’s own cells and organs (in this case the liver). Symptoms When symptoms occur, they can include: Jaundice (a yellowing of the skin and eyes)Abdominal painLoss of appetiteNausea and vomitingDiarrheaFeverClay-colored bowel movementsPainful joints ￼ Yellowing of skin and eye ￼ Complications of hepatitis Chronic hepatitis B or C can often lead to more serious health problems. Because the virus affects the liver, people with chronic hepatitis B or C are at risk for: Chronic liver diseaseCirrhosisLiver cancer When your liver stops functioning normally, liver failure can occur. Complications of liver failure include: Bleeding disordersA buildup of fluid in your abdomen, known as ascitesIncreased blood pressure in portal veins that enter your liver, known as portal hypertensionKidney failureHepatic encephalopathy , which can involve fatigue, memory loss, and diminished mental abilities due to the buildup of toxins, like ammonia, that affect brain functionHepatocellular carcinoma, which is a form of liver cancerDeath People with chronic hepatitis B and C are encouraged to avoid alcohol because it can accelerate liver disease and failure. Certain supplements and medications can also affect liver function. If you have chronic hepatitis B or C, check with your doctor before taking any new medications. Diagnosis and test History and physical exam To diagnose hepatitis, first your doctor will take your history to determine any risk factors you may have for infectious or noninfectious hepatitis. During a physical examination, your doctor may press down gently on your abdomen to see if there’s pain or tenderness. Your doctor may also feel to see if your liver is enlarged. If your skin or eyes are yellow, your doctor will note this during the exam. Liver function tests Liver function tests use blood samples to determine how efficiently your liver works. Abnormal results of these tests may be the first indication that there is a problem, especially if you don’t show any signs on a physical exam of liver disease. High liver enzyme levels may indicate that your liver is stressed, damaged, or not functioning properly. Other blood tests If your liver function tests are abnormal, your doctor will likely order other blood tests to detect the source of the problem. These tests can check for the viruses that cause hepatitis. They can also be used to check for antibodies that are common in conditions like autoimmune hepatitis. Ultrasound An abdominal ultrasound uses ultrasound waves to create an image of the organs within your abdomen. This test allows your doctor to take a close at your liver and nearby organs. It can reveal: Fluid in your abdomenLiver damage or enlargementLiver tumoursAbnormalities of your gallbladder Sometimes the pancreas shows up on ultrasound images as well. This can be a useful test in determining the cause of your abnormal liver function. Liver biopsy A liver biopsy is an invasive procedure that involves your doctor taking a sample of tissue from your liver. It can be done through your skin with a needle and doesn’t require surgery. Typically, an ultrasound is used to guide your doctor when taking the biopsy sample. This test allows your doctor to determine how infection or inflammation has affected your liver. It can also be used to sample any areas in your liver that appear abnormal. Treatment and medications Treatment options are determined by which type of hepatitis you have and whether the infection is acute or chronic. Hepatitis A Hepatitis A usually doesn’t require treatment because it’s a short-term illness. Bed rest may be recommended if symptoms cause a great deal of discomfort. If you experience vomiting or diarrhea , follow your doctor’s orders for hydration and nutrition. The hepatitis A vaccine is available to prevent this infection. Most children begin vaccination between ages 12 and 18 months. It’s a series of two vaccines. Vaccination for hepatitis A is also available for adults and can be combined with the hepatitis B vaccine. Hepatitis B Acute hepatitis B doesn’t require specific treatment. Chronic hepatitis B is treated with antiviral medications. This form of treatment can be costly because it must be continued for several months or years. Treatment for chronic hepatitis B also requires regular medical evaluations and monitoring to determine if the virus is responding to treatment. Hepatitis B can be prevented with vaccination. The CDC recommends hepatitis B vaccinations for all newborns. The series of three vaccines is typically completed over the first six months of childhood. The vaccine is also recommended for all healthcare and medical personnel. Hepatitis C Antiviral medications are used to treat both acute and chronic forms of hepatitis C. People who develop chronic hepatitis C are typically treated with a combination of antiviral drug therapies. They may also need further testing to determine the best form of treatment. People who develop cirrhosis (scarring of the liver) or liver disease as a result of chronic hepatitis C may be candidates for a liver transplant . Currently, there is no vaccination for hepatitis C. Hepatitis D No antiviral medications exist for the treatment of hepatitis D at this time. According to a 2013 study , a drug called alpha interferon can be used to treat hepatitis D, but it only shows improvement in about 25 to 30 percent of people. Hepatitis D can be prevented by getting the vaccination for hepatitis B, as infection with hepatitis B is necessary for hepatitis D to develop. Hepatitis E Currently, no specific medical therapies are available to treat hepatitis E. Because the infection is often acute, it typically resolves on its own. People with this type of infection are often advised to get adequate rest, drink plenty of fluids, get enough nutrients, and avoid alcohol. However, pregnant women who develop this infection require close monitoring and care. Autoimmune hepatitis Corticosteroids, like prednisone or budesonide, are extremely important in the early treatment of autoimmune hepatitis. They’re effective in about 80 percent of people with this condition.Azothioprine ( Imuran ), a drug that suppresses the immune system, is often included in treatment. It can be used with or without steroids.Other immune suppressing drugs like mycophenolate (CellCept), tacrolimus (Prograf) and cyclosporine (Neoral) can also be used as alternatives to azathioprine for treatment. Prevention There are many steps you can take to reduce the risk of viral hepatitis: Consider getting vaccinated against hepatitis A and B if you weren’t vaccinated as a child. This is the number one way to prevent these illnesses.Wash your hands with soap and water after using the bathroom or changing a baby’s diaper and before handling food.When traveling in developing countries, avoid unpeeled or raw foods. Drink only bottled, boiled or chemically treated water.Practice safe sex. Hepatitis B is about 50–100 times more transmissible during sex than HIV. Condoms and other barrier methods greatly reduce the risk.Never share syringes, shaving razors, toothbrushes or tattooing or piercing supplies.Wear gloves when performing first aid.Disinfect blood spills (including dried ones) with diluted bleach and wear gloves during clean-up.Follow all occupational safety precautions in your workplace.If you are pregnant, seek early and regular prenatal care. To reduce the risk of non-viral hepatitis, avoid excessive alcohol consumption and consult with a healthcare professional about medications and supplements.Dr. Shailendra Kawtikwar7 Likes25 Answers
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12 yo female of 33 kg admitted with c/o periumbilical pain, intermittent fever,loss of appetite, yellowish discoloration of eyes, Sensorium wnl Icterus++ PALLOR + Clubbing absent LN non palpable stool Malena urine yellowish chest b/l not clear with costophrenic crepts P/A soft with +3cm liver, spleen non palpable RR 22pm PR 121 SPO2 80 % without O2 ,>95%on o2 Via nasal Our ddx acute liver failure with enteric fever vs acute viral hepatitis with Pulmonary Koch kindly add ddx Kindly comments on CXray what may be pathophysiology AC to you thanksDr. Dhananjay Pandey1 Like10 Answers
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#CCA update Hepatitis B What is hepatitis B? Hepatitis B is a liver infection caused by the hepatitis B virus (HBV). HBV is one of five types of viral hepatitis. The others are hepatitis A, C, D, and E. Each is a different type of virus, and types B and C are most likely to become chronic. The Centers for Disease Control and Prevention (CDC) state that around 3,000 people in the United States die each year from complications caused by hepatitis B. It’s suspected that 1.4 million people in America have chronic hepatitis B. HBV infection can be acute or chronic. Acute hepatitis B causes symptoms to appear quickly in adults. Infants infected at birth rarely develop only acute hepatitis B. Nearly all hepatitis B infections in infants go on to become chronic. Chronic hepatitis B develops slowly. Symptoms may not be noticeable unless complications develop. Is hepatitis B contagious? Hepatitis B is highly contagious. It spreads through contact with infected blood and certain other bodily fluids. Although the virus can be found in saliva, it’s not spread through sharing utensils or kissing. It also doesn’t spread through sneezing, coughing, or breastfeeding. Symptoms of hepatitis B may not appear for 3 months after exposure and can last for 2–12 weeks. However, you are still contagious, even without symptoms. The virus can live outside the body for up to seven days. Possible methods of transmission include: • direct contact with infected blood • transfer from mother to baby during birth • being pricked with a contaminated needle • intimate contact with a person with HBV • oral, vaginal, and anal sex • using a razor or any other personal item with remnants of infected fluid Who is at risk for hepatitis B? Certain groups are at particularly high risk of HBV infection. These include: • healthcare workers • men who have sex with other men • people who use IV drugs • people with multiple sex partners • people with chronic liver disease • people with kidney disease • people over the age of 60 with diabetes • those traveling to countries with a high incidence of HBV infection What are the symptoms of hepatitis B? Symptoms of acute hepatitis B may not be apparent for months. However, common symptoms include: • fatigue • dark urine • joint and muscle pain • loss of appetite • fever • abdominal discomfort • weakness • yellowing of the whites of the eyes (sclera) and skin (jaundice) Any symptoms of hepatitis B need urgent evaluation. Symptoms of acute hepatitis B are worse in people over the age of 60. Let your doctor know immediately if you have been exposed to hepatitis B. You may be able to prevent infection. How is hepatitis B diagnosed? Doctors can usually diagnose hepatitis B with blood tests. Screening for hepatitis B may be recommended for individuals who: • have come in contact with someone with hepatitis B • have traveled to a country where hepatitis B is common • have been in jail • use IV drugs • receive kidney dialysis • are pregnant • are men who have sex with men • have HIV To screen for hepatitis B, your doctor will perform a series of blood tests. Hepatitis B surface antigen test A hepatitis B surface antigen test shows if you’re contagious. A positive result means you have hepatitis B and can spread the virus. A negative result means you don’t currently have hepatitis B. This test doesn’t distinguish between chronic and acute infection. This test is used together with other hepatitis B tests to determine the state of a hepatitis B infection. Hepatitis B core antigen test The hepatitis B core antigen test shows whether you’re currently infected with HBV. Positive results usually mean you have acute or chronic hepatitis B. It may also mean you’re recovering from acute hepatitis B. Hepatitis B surface antibody test A hepatitis B surface antibody test is used to check for immunity to HBV. A positive test means you are immune to hepatitis B. There are two possible reasons for a positive test. You may have been vaccinated, or you may have recovered from an acute HBV infection and are no longer contagious. Liver function tests Liver function tests are important in individuals with hepatitis B or any liver disease. Liver function tests check your blood for the amount of enzymes made by your liver. High levels of liver enzymes indicate a damaged or inflamed liver. These results can also help determine which part of your liver may be functioning abnormally. If these tests are positive, you might require testing for hepatitis B, C, or other liver infections. Hepatitis B and C viruses are a major cause of liver damage throughout the world. You will likely also require an ultrasound of the liver or other imaging tests. What are the treatments for hepatitis B? Hepatitis B vaccination and immune globulin Talk to your doctor immediately if you think you have been exposed to hepatitis B within the last 24 hours. If you have not been vaccinated, it may be possible to prevent infection by receiving the hepatitis B vaccine and an injection of HBV immune globulin. This is a solution of antibodies that work against HBV. Treatment options for hepatitis B Acute hepatitis B usually doesn’t require treatment. Most people will overcome an acute infection on their own. However, rest and hydration will help you recover. Antiviral medications are used to treat chronic hepatitis B. These help you fight the virus. They may also reduce the risk of future liver complications. You may need a liver transplant if hepatitis B has severely damaged your liver. A liver transplant means a surgeon will remove your liver and replace it with a donor liver. Most donor livers come from deceased donors. What are the potential complications of hepatitis B? Complications of having chronic hepatitis B include: • hepatitis D infection • liver scarring (cirrhosis) • liver failure • liver cancer • death Hepatitis D infection can only occur in people with hepatitis B. Hepatitis D is uncommon in the United States but can also lead to chronic liver disease. How can I prevent hepatitis B? The hepatitis B vaccine is the best way to prevent infection. Vaccination is highly recommended. It takes three vaccines to complete the series. The following groups should receive the hepatitis B vaccine: • all infants, at the time of birth • any children and adolescents who weren’t vaccinated at birth • adults being treated for a sexually transmitted infection • people living in institutional settings • people whose work brings them into contact with blood • HIV-positive individuals • men who have sex with men • people with multiple sexual partners • injection drug users • family members of those with hepatitis B • individuals with chronic diseases • people traveling to areas with high rates of hepatitis B In other words, just about everyone should receive the hepatitis B vaccine. It’s a relatively inexpensive and very safe vaccine. There are also other ways to reduce your risk of HBV infection. You should always ask sexual partners to get tested for hepatitis B. Use a condom or dental dam when having anal, vaginal, or oral sex. Avoid drug use. If you’re traveling internationally, check to see if your destination has a high incidence of hepatitis B and make sure you are fully vaccinated prior to travel.Dr. Rina Upadhyay6 Likes9 Answers
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27 yr female c/o abdominal distension, generalised swelling,indigestion vomiting rt sided chest pain since 1 month. ur comments on the case pls!!! (amylase 227)Dr. Siddharth Ajay2 Likes18 Answers
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four years male present with anasarca bilateral pitting oedema fluid thrill and shifting dullness positive umbilicus everted periorbital puffiness icterus positive hepatosplenomegaly with attached report. rk 39 and Australia antigen is negative. usg report suggestive of ascites and hepatosplenomegaly.is there possibility of autoimmune hepatitis because SGPT IS NOT MUCH ELEVSTED IN COMPARISION TO SERUM BILIRUBIN ELEVATION. HISTORY of blood TRANFUSION one time. history of casualty of sister three months ago. sister suffering from same problem according to patient father. father is migrant worker. chest X-RAYS suggestive of cardiomegaly. further investigation and treatment.Dr. Rajeev Gupta2 Likes16 Answers