00:01
Hepatitis C
is an RNA virus incubation
period 2 to 26 weeks.
00:08
These are the type of viral hepatitis
in which you worried about chronicity
40 to 80 percent of the cases whenever
you have hepatitis C occurring
and it go into chronicity.
00:20
What are you worried about?
Big Time,
Liver Cancer.
00:25
Right,
Hepatitis C
back in the 70's and 80's
was an absolute endemic.
00:32
Since then things have
subsided quite a bit
and in Pharmacology management,
you should definitely
but Hepatitis C
Genotype 1
you focus on genotype 1
because we can now
treat Hepatitis C
not just treat,
cure a patient between 8 to
12 weeks with Genotype 1.
00:56
This is new information.
00:58
This is research
that now turned into
clinical application
and translating into
patients that are completely
cured interferon free therapy.
01:10
Amazing,
some of these drugs
that you should know of
include Ledipasvir, Sofosbuvir
combination of the
2 without interferon
most common reason for liver
transplantation because a chronicity
if liver dies 4 million
cases still in the US.
01:28
Alcohol abuse accelerates the disease
progression as you can imagine.
01:35
Risk factors:
transfusions prior to 1990,
at this point we're good.
01:42
I mean to say that we have
enough checks and balances
you walk in and there's
transfusion, it's required.
01:47
There's going to be a nurse
that's always there with
you to check things of
to make sure that
you are not passing
hepatitis C into your patient
IV drug abusers
high risk sexual
behavior or tattooing,
and
Hemodialysis.
02:03
keep in mind what tattoos that
you made then pass on Hepatitis C.
02:09
Clinical presentation acute
disease usually asymptomatic
at some point they
made then show jaundice
incidental finding on
routine physicals mean to say
the patient is so asymptomatic.
02:22
They might feel maybe a little
bit of fatigue and such but
often times in
clinical practice.
02:28
It's an incidental
finding, dangerous.
02:31
What about the extra
Paddock manifestation
this, you want to know
is being cryoglobulinemia
Hepatitis B could also
result in cryoglobulinemia.
02:41
But hepatitis C
Essential mixed cryo.
02:45
What does that mean to you?
upon exposure to cold
the immunoglobulins are
then going to aggregate,
and causing more or less
hyperviscosity syndrome
throughout the entire body.
02:56
Also MPGN
Porphyria cutanea tarda.
03:01
Could be an extra
hepatic manifestation
what has porphyria
cutanea tarda mean to you?
your focus should be on Catania
skin and upon
exposure to UV rays.
03:12
There will be blistering pain
that you want to focus upon.
03:17
Often times.
03:19
Let's say that your patient
and you see a little
bit of redness.
03:24
Where?
In the front of your leg,
and then upon palpation.
You feel it.
03:30
Our patients is aww.
03:31
Stop hurting me Doc.
03:33
Well, I'm sorry. I don't mean to do this.
But what is this that you're causing?
Why is the patient feeling pain?
and what is this redness that
you're seeing on the chin?
or the inter aspect of
the leg erythema nodosum?
There's a huge list and
dermatology for erythema nodosum,
but keep in mind
that whenever
there's an infection
many types including
coccidioides immitis
such as cryptococcus new
from the list is quite large.
04:02
You might find Erythema immitis
immitisthe redness in
the front of the leg.
04:09
Hepatitis B
could be associated
with B-cell Lymphoma.
04:15
As could be Hepatitis C.
04:19
Have another graph here for
specifically hepatitis C.
04:23
What hepatitis C?
you may or may not find symptoms
and definitely not as complicated
as what we dealt
with in Hepatitis B
and everything that I've broken
down for you in hepatitis B
in terms of the markers
know them well
know that table
of interpretation.
04:41
That is money.
04:44
And every possible respect.
This is Hepatitis C, the graph here
is the following:
It's an RNA virus.
04:50
What type of transaminase are
you going to find elevated
you focus on ALT,
and then Anti-HCV
kicks in approximately
6 months later.
05:01
You're on your way to recovery.
05:02
As I told you earlier,
new information on your boards that you
make sure that you're familiar with.
05:07
Please,
would be the interferon
free therapy at that.
05:10
I'm not going to cover here,
but interfer on free therapy
with drugs such as
simple boast fear
and let it pass fear.
05:18
So logic pattern more
chronic hepatitis C infection
with recovery this
time we have HCV
you'll notice that the
ALT could then fluctuate
depending as to whether
or not your patient
is on the road to
recovery or not.
05:32
Chronicity.
05:36
Diagnosis Anti-HCV
antibody by Elisa
Viral application measured
by HCV that is important.
05:45
The replication becomes important
because one of the objectives
that you will be
using clinically
is seeing what the rate of the
sustained viral replication will be SVR.
05:58
And obviously the less
that you find your replication
the better of you
and your practice
and the patient is going to be.
06:05
So viral replication measured
by RNA by PCR testing
and indicate chronic infection.
06:12
ALT does not indicate
degree of liver damage
and that's important
for you to know,
ALT will tell you.
06:17
Oh, yes your patient may be
suffering from viral hepatitis,
but it will not,
it will not be translated into
the severity of
and that is a discussion
we've had many a time.
06:29
Liver biopsy used for
staging, staging, staging,
especially if you're worried about
your patient chronicity going into
Hepatocellular Carcinoma
for major Genotypes that you
want to be very responsible for,
we have Genotype 1,
which is the most important one
that you're paying
attention to on your boards
US and Europe
Genotype 2.
06:55
Take a look at the
Mediterranean population,
that's where you
would be for that.
07:00
Genotype 3
Would bethe Indian subcontinent
and that'll be your
major type Hepatitis C,
and Hepatitis C in
Egypt and North Africa.
07:11
In other words,
the northern region
if you thinking,
Egypt, Libya so on and so forth
and they'll be Genotype 4
spend a
little bit of time,
very important,
that you know what
Genotype is dealing with
which population.
07:26
And what the different Genotypes
you focus upon the new
management therapy and regimen
that we have for Genotype 1.
07:35
Please,
what about the remainder?
Well without I'll give you a
brief overview for that coming up.
07:41
The standard of treatment
is now to use a combination
of Ledipasvir, Simeprevir,
Sofosbuvir, Velpatasvir,
Glecaprevir and Pibrentasvir.
07:52
Interference should be avoided,
the goal now is to
cure Hepatitis C,
not just symptomatic treatment.
08:00
If HTV goes into chronicity
to measure things that
you're worried about
complete death of
the liver cirrhosis,
and if cirrhosis has kicked in
in you need to make sure that
you then yearly checkup for
Hepatocellular Carcinoma.
08:19
What marker do you
know of that will then
perhaps indicate that your
patient has gone on to HCC?
Increase in which
marker please.
08:29
Good, a feeder protein
will be increased.