Chronic hepatitis is liver inflammation that lasts more than six months, most often from hepatitis B or C, but also from alcohol, fatty liver or autoimmune disease. Over years it can scar the liver and lead to cirrhosis and liver cancer.
Key symptoms
- Often no symptoms for many years
- Tiredness and poor appetite
- Mild discomfort in the right upper belly
- Jaundice, swelling or confusion once disease is advanced
What you find on exam
- Often normal in early disease
- Liver size and tenderness
- Signs of chronic liver disease: spider angiomas, red palms, enlarged spleen
- Jaundice, ascites or asterixis in advanced disease
Tests
- Liver tests, albumin, INR and platelet count
- Hepatitis B surface antigen, hepatitis C antibody with RNA if positive
- Autoimmune markers, iron studies and ultrasound to find other causes
- Elastography or a fibrosis score to stage scarring
Treatment basics
- Hepatitis C: direct-acting antivirals such as sofosbuvir-velpatasvir
- Hepatitis B: tenofovir or entecavir when treatment criteria are met
- Stop alcohol, manage weight and vaccinate against hepatitis A and B
- Liver cancer screening with ultrasound every 6 months if cirrhosis is present
Red flags
- New jaundice, confusion or vomiting blood
- Rapidly growing belly from fluid
- INR rising or bilirubin rising quickly
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.