Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:12

682 Hepatic Veno-Occlusive Disease Hepatitis A and E

specific therapy

■treatment is largely supportive

■prophylactic heparin for high-risk BMT patients is controversial

■various antithrombotic and thrombolytic agents have been used

■liver transplantation: usually required for chronic VOD

■TIPS and surgical shunts: options for chronic portal hypertension

follow-up

■acute VOD: careful inpatient monitoring as above

■chronic VOD: similar follow-up as in chronic Budd-Chiari syndrome:

■periodic surveillance for TIPS or portosystemic shunt patency

■periodic monitoring for progressive chronic liver disease

complications and prognosis

Complications

■same as for treatment of Budd-Chiari syndrom

Prognosis

■incidence of VOD in BMT patients: 50%

■mortality: 20–40%

Hepatitis A and E....................................

EMMET B. KEEFFE, MD

history & physical

History

■HAV and HEV enterically transmitted viruses; shed in feces

■HAV and HEV not associated with chronic viremia or chronic liver

disease

■HAV worldwide distribution; highly endemic in developing coun-

tries; decreasing incidence in U.S.

■HEV widely distributed; rare in U.S. (seen in travelers returning from

endemic areas)

■HAV risk factors: day care centers, institutions for developmentally

disadvantaged, international travel, homosexual contact, injection

drug use

■HEV risk factors: largely waterborne epidemic disease; contaminat-

eded water supply; most common type of sporadic hepatitis in devel-

oping countries

■Anti-HAV seroprevalance rate in U.S. – 33%