“Inflammation of the liver caused by an infection with the Hepatitis B virus”

Risk Factors
  • High risk sexual activities with multiple partners
  • IV drug users
  • People receiving blood regularly (haemophilia)
  • Chronic liver disease
  • Sex workers
  • Haemodialysis and chronic renal failure
  • Mother-baby transmission
  • Tattoos, body piercings, or acupuncture with non-sterile equipment People with
  • HIV
Aetiology
  • DNA virus
  • Spread via the blood contact, sexual transmission, sharing of IV drug injections, direct contact
Pathophysiology
  1. Virus enters the body
  2. Replicates in hepatocytes
  3. Interferes with cell function
  4. Causes inflammation of the liver
Clinical Presentation
  • Children under 5 frequently asymptomatic
  • Symptoms:
    • Abdominal discomfort
    • Nausea
    • Anorexia
    • Arthralgia
    • Dark urine, pale stool
    • Pruritus
  • Signs:
    • Fever
    • Jaundice
    • RUQ tenderness
    • Hepatomegaly
  • Chronic Infection:
    • Signs of chronic liver disease
    • Jaundice
    • Hepatosplenomegaly
    • Severe cases: ascites, liver flap, encephalopathy
Investigations
  • Serology:
    • Hepatitis B surface antigen (HBsAg)
    • Hepatitis B e antigen (HBeAg)
    • Antibody to HBeAg (anti-HBe)
    • Antibody to HBcAg (anti-HBc)
    • IgM antibody to hepatitis core antigen (anti-HBc IgM)
    • IgG antibody to hepatitis core antigen (anti-HBc IgG)
  • LFTs
  • FBC
  • Prothrombin time
TestAcute Hepatitis BImmunity Following InfectionImmunity due to VaccinationChronic Hepatitis B – ActiveChronic Hepatitis B – Inactive Carrier
HBsAg+++
Anti-HBs++
HBeAg++ / –
Anti-HBe+ /-+ / –+
Anti-HBc++++
Anti-HBc IgM+
HBV DNA+++ (low)
ALTElevatedNormalNormalElevatedNormal
  • Abbreviations:
    • ALT, alanine transaminase;
    • HBc, hepatitis B core;
    • HBe, hepatitis B early;
    • HBsAg, hepatitis B surface antigen;
    • HBV, hepatitis B virus;
    • IgM, immunoglobulin M
  • (HBsAg)- persistent in chronic hepatitis for more than 6 months
  • (HBeAg)- detectable in both acute and chronic infections
  • (anti-HBc IgM)- indicates recent HBV infection
  • (anti-HBc IgG)- persists for life and is indicative of past infection
Management
  • Notify the Health Protection Unit
  • Conservative:
    • Avoid unprotected sexual intercourse
    • Avoid drinking alcohol during acute illness
    • Avoid sharing needles and other drug injections
  • Medical:
    • Analgesia (paracetamol, weak opioid if liver impairment mild)
    • Antiemetics- metoclopramide if liver impairment mild; seek specialist advice for those with severe liver impairment
    • Chlorphenamine for itch
    • Antivirals for chronic hepatitis
  • Surgical:
    • N/A
  • Consider referral to GUM clinic or drug rehabilitation services
  • Vaccination
Complications
  • Can develop into chronic hepatitis
  • Fulminant liver failure
  • Cirrhosis
  • Cholangiocarcinoma
  • Hepatocellular carcinoma
  • Membranous nephropathy

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