Hepatitis B

Risk Factors

  • Shared needles
  • Spread via sexual contact
  • Vertical vertical (mother to child in-utero)
  • Needle sticks in health care workers
  • Unscreened blood transfusion
  • ~5% of acute infxn become chronic
  • Long term risk cirrhosis and HCC

Symptoms

  • Most (2/3) are asx w/acute hep B infection
  • Incubation is 1-4m
  • 1/3 of those w/acute infxn have symptoms: n, v, jaundice, RUQ pain, puritus, icterus, dark urine, light colored stool, malaise
  • Other acute sx: occasionally symmetric inflammatory arthritis MCPs, PIPs, knees, ankles x few weeks
  • Acute symptoms are typically self limited, w/resolution in 2-3m
  • Majority clear infection w/o sequelae; 5% develop chronic infxn w/risk cirrhosis (fatigue, edema, GI bleeding, etc), spread to others, and hepatocellular carcinoma (w/chronic Hep B, 20% develop HCC w/o cirrhosis)
  • Small # of those w/chronic Hep B will develop PAN, membranous nephropathy, mucocutaneous vasculitis

Physical Exam Findings

  • Acute hep B (findings in 1/3): jaundice, icterus, RUQ pain, hepatomegaly, joint pain and swelling
  • Chronic hep B: asymptomatic until develop cirrhosis w/portal hypertension (ascites, edema, jaundice, spider angioma, muscle wasting, upper GI bleeding, etc)
  • HCC: RUQ mass, mets

Tests

Links