management of acute hepatitis by mgabr

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									 Management of
 Acute Hepatitis


Moderator
Prof. Mamdouh Gabr
Tanta University, Egypt
Late in the
afternoon of…

Sunday,
August 9, 2009
A 57  years old male diabetic
 patient was presented to me with
 RUQ pain associated with
 nausea, vomiting and extreme
 lethargy!
         On
Physical Examination
   Pulse:                 85 / min
   Temp:                  37.8oC
   ABP:                   90 / 70 mmHg
 Deep       jaundice
   Neck veins:            Normal
   Chest and Heart: NAD


   There was no edema in both LL
Abdominal        exam:

     Slightly tender hepatomegaly


     There was no shifting dullness
Lessons from
 the experts
What does this
 presentation suggest
                  you
What should
you consider
 Thepatient’s past medical history was
   remarkable for:


    Schistosomiasis and IV antischistosomal
     therapy (1960)

    2 operations for L disc (1994, 2002)

    Tooth extraction (May, 2009)
 Inview of the above mentioned data we
  conducted a diagnostic work-up… (9/8/2009)
          Urine analysis
          CBC
          Liver function tests
          B. sugar
          Viral markers:
           › HAV Ab
           › HBs Ag
           › HCV Ab
 Abdominal

US Scan
What’s your

comment   ?
What should
you consider
What’s Next
Friedrich Engels




  “An ounce of action is
   worth a ton of theory”
So don’t delay!
 order now!
HCV RNA

(13 August 2009)
Very high
 viremia!
What’s your

comment   ?
What should
 you advise
He  was placed on what was thought
 to be the appropriate medications
 with close watching, including:
      • Insulin Twice daily
      • UDC acid
      • Silymarin
      • Antioxidants
      • With bed rest and low fat diet for 2 weeks..
Are we in the
right way
If not, what do you
  suggest
After
 2 weeks!
Follow-up lab studies
          (24/8/2009)


Marked clinical & biochemical
      improvements
     With
  continuation of the previous
supportive treatment for further
          2 weeks
After
 1 month
 Follow-up lab studies
           (8/9/2009)


  Marked improvement
regarding…
Liver functions
Viral load
CBC
What’s your

comment   ?
Have we missed
 something valuable
Is it a must for
  every case
          ?
Please vote
What’s the ideal
 management
     M. Gabr




                       !
Keep walking . . . . . .
. . straight
The same supportive treatment
          for further
         3 months
The last word
After
4 months
 (31/12/2009)
He was completely normal
 regarding…
Liver functions
CBC
 HCV RNA




Undetectable
 Abdominal

US Scan
What about
 CMV  ?
?
 What’s your
final comment

     ?
My Message


             Is
 Although common   things are common,


             yet,
The uncommon could be addressed
 and identified if there is will &
 wisdom,

     Some Wisdom !
Acute VC     hepatitis is actually
 rare, yet it must be put in
 consideration whenever we are
 confronted with any case of
 acute hepatitis.
Regarding      management of AHC:


 › SVC is frequent in AHC (40% of patients) and

  this usually occurs within 3 months particularly

  in symptomatic (Jaundice) and nosocomial

  infections.
› Therefore, we have to wait to
 save money and side effects.
› To date, no treatment has received
 approval, however 24 weeks of
 pegylated interferon alpha
 monotherapy is a good option.
› Results of IFN therapy in AHC

 much more better than chronic

 HC (SVR 68 – 95%)
Thank you

								
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