Serum sickness like syndrome

Clinical Presentation
characterized by arthralgia or
arthritis, angioedema, hematuria
and proteinuria (5-10% of px)
Acute Hepatitis

Prodromal Period Constitutional signs and symptoms of a viral infection

Clinical Jaundice or Icteric Phase • Diminished constitutional symptoms

• Liver: hepatomegaly, tenderness, RUQ pain, discomfort
• Cholestatic picture
Recovery phase Liver enlargement and biochemical abnormalities

----------1-5% of Hepatitis B and 85% of Hepatitis C----------

Fulminant Hepatitis
Neonates, down’s • Characterized by massive hepatic necrosis
• B or B+D or E
syndrome, chronically • Small liver, PT excessively prolonged, rapidly
hemodialyzed pxs, rising bilirubin, enzymes rise, signs of
immunosupressed, HIV encephalopathy, hepatic failure
• Cerebral edema, brainstem compression, sepsis,

Chronic Hepatitis
respiratory failure, cardiovascular collapse, and
renal failure
• Mortality rate >80%
Laboratory Features
 Clinical Features
• Lack of complete resolution of clinical symptoms
• Presence of bridging/interface or multilobular hepatic necrosis on
biopsy
• Persistence of elevation of enzymes, bilirubin, and globulin levels w/in
6-12 mos
• Persistence of HBeAg for >3mos or HBsAg for >6mos

Chronic Hepatitis Replicative Phase Nonreplicative Phase

HBeAg(+); high HBV DNA HBeAg(-); anti-Hbe (+); low HBV DNA normal enzymes

intrahepatocyte nucleocapsid Ag(HBcAg) (-) intrahepatocyte HBcAg

High infectivity Low infectivity

Accompanying liver injury Minimal liver injury

More severe disease Inactive hepatitis B carriers

Cirrhosis or Hepatocellular Ca
 Clinical Features
• Lack of complete resolution of clinical symptoms
• Presence of bridging/interface or multilobular hepatic necrosis on
biopsy
• Persistence of elevation of enzymes,“flares”
bilirubin, and globulin levels w/in
6-12 mos
• Persistence of HBeAg for >3mos or HBsAg for >6mos

Chronic Hepatitis Replicative Phase Nonreplicative Phase

HBeAg(+); high HBV DNA HBeAg(-); anti-Hbe (+); low HBV DNA

intrahepatocyte nucleocapsid Ag(HBcAg) (-) intrahepatocyte HBcAg

High infectivity Low infectivity

Accompanying liver injury Minimal liver injury

More severe disease Inactive hepatitis B carriers

Cirrhosis or Hepatocellular Ca
 Clinical Features
Chronic Hepatitis fatigue
intermittent jaundice, deepening of jaundice, recurrence of malaise and anorexia (like
acute hepatitis)
Hepatic decompensation
Arthralgias and arthritis (antibody mediated)
Purpuric cutaneous lesions, immune complex GN, vasculitis(PAN)

Portal Hypertension
Cirrhosis Hepatic Failure

Ascites Edema

Gastroesophageal varices Hepatic encephalopathy

hypersplenism coagulopathy
 Laboratory Features
Normal values
• Aminotransferase elevations tend to
be modest for chronic hepatits B ALT 7-41 U/L
• ALT>AST AST 12-38 U/L
• Once cirrhosis is established: ALP 33-96 U/L
ALT<AST
Albumin 4.1-5.3 g/dl
• ALP: normal or slt. Elevated
• Hypoalbuminemia, prolonged PT PT 12.7s-15.4s