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Hepatitis C

by Carlo Raj, MD
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    00:01 Hepatitis C It's an a RNA virus. Incubation period: 2-26 weeks.

    00:08 These are the type of viral hepatitides in which you worry about chronicity.

    00:13 40-80% of your cases, whenever you have hepatitis c ocurring and it going to chronicity, what are you worried about? Big time! liver cancer.

    00:26 hepatitis B back in the 70's and 80's was an absolute endemic.

    00:33 Since then, things have subsided quite a bit.

    00:35 And in pharmacology management, you should definitely know about hepatitis C, genotype 1.

    00:43 You focus on genotype 1.

    00:45 Because we can now treat hepatitis C. Not just treat cure a patient between 8-12 weeks with genotype 1.

    00:56 This is new information.

    00:58 This is research that is now thrown into clinical application and translating into patients that are completely cured.

    01:07 Interferon-free therapy.

    01:10 Amazing.

    01:11 Some of the prognosis you should know of, include *letopasphere Sofosbuvir the combination of the two without interferon.

    01:20 Most common reason for liver transplantation because of chronicity.

    01:24 Your liver dies... 4 million cases still in the U.S.

    01:28 Alcohol abuse accelerates the disease progression as you could imagine.

    01:35 Risk factors.

    01:37 Transfusions prior to 1990.

    01:40 At this point, we're good.

    01:42 I mean to say we have enough check and balances.

    01:45 You walk in and there is transfusion that is required.

    01:48 There is going to be a nurse that is always there with you to check things off.

    01:51 to make sure that you are not passing hepatitis c into your patient.

    01:57 Avid drug users, intranasal cocaine use.

    02:00 High risk sexual behavior or tattooing and hemodialysis.

    02:05 Keep in mind with tattoos.

    02:07 That you may then pass on hepatitis c.

    02:11 Clinical presentation. Acute disease usually asymptomatic.

    02:16 At some point, they may then show jaundice.

    02:19 Incidental findings on routine physicals.

    02:23 Meaning to say, the patient is seem so asymptomatic they might feel a little bit of fatigue and such but often times in clinical practice, it's an incidental finding.

    02:32 Dangerous.

    02:33 What about extra hepatic manifestations? This, you want to know as being cryoglobulinemia.

    02:40 Hepatitis B can also result in cryoglobulinemia but hepatitis C essential mixed cryoglobulinemia.

    02:47 What does that mean to you? Upon exposure to cold, the immunoglobulins will then aggregiate and causing more or less hyperviscocity syndrome throughout the entire body.

    02:58 Also, Mpgn Porphyria cutanea tarda could be an extra hepatic manifestation.

    03:06 What does Porphyria cutanea tarda mean to you? Your focus should be on cutanea Skin.

    03:12 And upon exposure to UV rays, there will be blistering pain.

    03:17 That you want to focus upon.

    03:19 Often times, let's say that your patient and you see a little bit of redness where? in the front of your leg.

    03:30 And then upon palpation you feel it, patient says: "Ow, stop hurting me, doc." I'm sorry, I don't mean to do this but what is this that you are causing? Why is the patient feeling pain? And what is the redness that you are seeing on the sheen? Or the anterior aspect of the leg.

    03:46 Erythema nodosum.

    03:49 There is a huge list in dermatology for erethyma nodosum.

    03:52 But keep in mind, that whenever there is an infection, many types including, coccidioides immitis such as... I mean the list is quite large.

    04:04 You might find Erythema nodosum already find this.

    04:07 The redness in the front of the leg.

    04:11 Hepatitis B could be associated with B cell lymphoma as could be Hepatitis C.

    04:21 We have another graph here for specifically hepatitis C.

    04:25 With hepatitis c, you may or may not find symptoms and definitely not as complicated as what we dealt with with hepatitis B.

    04:34 And everything that I have broken down for you in Hepatitis B, in terms of the markers, Know them well.

    04:40 Know that table of interpretation.

    04:43 That is money.

    04:46 In every possible respect.

    04:48 This is hepatitis c.

    04:50 The graph here is the following: It is an RNA virus.

    04:53 What type of transaminase that you will find elevated? You focus on ALT, And then Anti HCV kicks in. Approximately six months later, you're on your way to recovery.

    05:04 As I told you earlier, new information on your boards that you make sure that you are familiar with, please will be the interferon free therapy that I am not going to cover here.

    05:14 but with interferon free therapy with drugs such as Sofosbuvir and Velpatasvir.

    05:20 Serologic Pattern of Acute Hepatitis C infection with recovery continues and this time We have HCV. You'll notice then that ALT can then flactuate depending on as to whether your patient is on the road to recovery or not.

    05:36 Chronicity.

    05:38 Diagnosis: Anti-HCV Antibody by ELISA viral application is measured by HCV. That is important.

    05:47 The replication becomes important because one of the objectives that you will be using clinically, is seeing what the right of the sustained viral replication will be.

    05:58 SVR.

    06:00 And obviously, the less that you find your replication, the better of you and your practice and the patient is going to be.

    06:07 So, viral replication measured by RNA by PCR testing and indicates chronic infection.

    06:14 ALT does not indicate degree of liver damage but it is important for you to know.

    06:18 ALT will tell you: "Oh, yes." The patient may be suffering from viral hepatitis but it will not be translated into the severity of.

    06:29 And that is a discussion we had many a time.

    06:32 Liver biopsy used for staging.

    06:35 Especially if you are worried about your patients chronicity going into Hepato cellular carcinoma.

    06:43 Four major genotypes that you want to be very responsible for.

    06:47 We have Genotype 1, which is the most important one that you are paying attention to on your boards.

    06:53 USA and Europe, you are looking at well, greater than 50% Genotype 2.

    06:59 Take a look at the Mediterranean population.

    07:02 That is where you will be for that.

    07:04 Genotype 3.

    07:06 Would be the Indian sub-continent and that will be a major type of hepatitis C.

    07:11 And hepatitis C in Egypt and North Africa.

    07:16 In other words, the northern regions. If you are thinking Egypt, Libya and so on, and so forth.

    07:21 and they will be genotype 4.

    07:23 50-60% spend a little bit of time.

    07:26 Very important that you know what genotype is dealing with which population.

    07:32 And what the different genotypes you focus upon the new management therapy and regimen that we have that we have for genotype 1, please.

    07:42 What about the remainder, well I'll give you a brief overview for that coming up.

    07:48 Management of Hepatitis C standard care.

    07:51 is still pegylated interferon and ribavirin for periods of almost 24-48 weeks.

    08:00 So, you are looking close to a year of therapy Once again, let me mention here, that you want to make sure that you find The new information for genotype1.

    08:11 Multiple side effects of limited therapy is the following.

    08:15 With interferon therapy, this is what you are worried about: depression, fatigue, low grade fever, anemia to the point where now, the patient might have a decrease of RBC count resulting in susceptibility to other infections.

    08:31 leucopenia.

    08:33 or they might be bleeding involved- thrombocytopenia.

    08:36 Hair loss and hyperthyroidism are also, are also incredibly important side effects.

    08:42 that you are worried about interferon, therapy.

    08:45 So imagine if you are able to find an alternate form of therapy, where you might not need to give interferon.

    08:53 Fantastic huh? You avoid all of this and you cure your patient.

    09:00 If HCV goes into chronicity, two major things that you are worried about, complete death of the liver- cirrhosis.

    09:09 And if cirrhosis has kicked in, You need to make sure that you then, yearly, check up for, hepato cellular carcinoma.

    09:19 What more you could know of that would then, perhaps indicate that your patient has go on to a HCC.

    09:26 Increase in? ( which marker please?) Good. Alpha-fetoprotein.


    About the Lecture

    The lecture Hepatitis C by Carlo Raj, MD is from the course Cirrhosis – Liver Diseases.


    Included Quiz Questions

    1. Genotype 1
    2. Genotype 2
    3. Genotype 3
    4. Genotype 4
    5. Genotype 5
    1. Poor sanitation
    2. Hemophiliac who was diagnosed before 1990
    3. Intranasal cocaine use
    4. Unclean methods of tattooing
    5. Hemodialysis
    1. Mixed essential cryoglobinuria
    2. Porphyria cutanea tarda
    3. Membranous glomerulonephritis
    4. Erythema nodosum
    5. B cell lymphoma
    1. Hyperviscosity due to cryoglobulins
    2. Hyperviscosity due to complement
    3. Hyperviscosity due to increased immunoglobulins
    4. Hyperviscosity due to increased leucocyte count
    5. Hyperviscosity due to drugs used to treat Hepatitis C
    1. AntiHCV by ELISA
    2. Anti-HCV by PCR
    3. HCV DNA by PCR
    4. HCV DNA by ELISA
    5. Serum transaminases
    1. Alcohol
    2. Smoking
    3. Gall stones
    4. Steatorrhea
    5. Pregnancy
    1. Hepatocellular carcinoma
    2. Pan sclerosing cholangitis
    3. Hepatic adenoma
    4. Focal nodular hyperplasia

    Author of lecture Hepatitis C

     Carlo Raj, MD

    Carlo Raj, MD


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    update
    By QUANHUI Z. on 04. December 2016 for Hepatitis C

    Since December 2013, Several DAA drugs were approved by FDA. So you can update this lecture.