Internal Medicine

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

Hepatitis B 685

Hepatitis B.........................................

JEFFREY S. GLENN, MD, PhD

history & physical

History

■maternal HBV infection

■sexual exposure

■exposure to blood/blood products (IVDA, tattoos, piercings,

hemophiliacs)

■occupational exposure

■non-endemic areas,∼1/3 patients deny known risk factors

Signs and Symptoms

■most asymptomatic

■when present, symptoms=anorexia, fatigue, myalgias, nausea

■jaundice < 50% 1–2 weeks after onset of symptoms

■less frequent findings=arthritis, rash, glomerulonephritis, and vas-

culitis

■advanced disease: cirrhosis with liver failure, HCC

tests

Laboratory

■characteristic (but nonspecific):

■acute: elevated ALT/AST; elevated bilirubin and INR in severe disease

■chronic: elevated bilirubin and INR; decreased albumin

Serology and Virology

■confirmation of infection

■in chronological sequence of appearance:

■HBsAg-first marker to appear; if present for >6 mo, indicates chronic

infection

■anti-HBc IgM – indicates acute, recent infection

■anti-HBs – detectable after resolution; may decrease with time; also

induced by active vaccination

■HBV DNA – hybridization, PCR or branched-DNA based assays

■HBeAg – associated with active viral replication; marker of high infec-

tivity

■Anti-HBe – signals decreased (but not absent) viral replication and

infectivity