Chronic viral hepatitis

1. Big picture

Chronic viral hepatitis means persistent viral liver infection causing chronic hepatocellular inflammation, fibrosis, and possible progression to cirrhosis and hepatocellular carcinoma (HCC).

For the final exam, think mainly about:

1. Chronic hepatitis B virus (HBV)
2. Chronic hepatitis C virus (HCV)
3. Chronic hepatitis D virus (HDV) — only in patients with HBV
4. Chronic hepatitis E virus (HEV) — mainly in immunocompromised patients

HAV never causes chronic hepatitis.

The examiner usually wants you to know:

Chronic viral hepatitis
        ↓
Often asymptomatic for years
        ↓
Mild/fluctuating ALT elevation
        ↓
Fibrosis staging is essential
        ↓
Treat HBV to suppress replication; treat HCV to cure
        ↓
Monitor for cirrhosis and HCC

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