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Lavanchy D. Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures. Patients can have either an acute symptomatic disease or an asymptomatic disease.Icteric hepatitis is associated with a prodromal period, during which a serum sickness–like syndrome can occur. Available at Centers for Disease Control and Prevention. 7:CD009051. Patients with chronic active hepatitis, especially during the replicative state, may have symptoms similar to those of acute hepatitis.The physical examination findings in hepatitis B disease vary from minimal to impressive (in patients with hepatic decompensation), according to the stage of the disease.Examination in patients with acute hepatitis may demonstrate the following:Jaundice (10 days after appearance of constitutional symptomatology; lasts 1-3 mo)Signs of chronic liver disease include the following:Patients with cirrhosis may have the following findings:The following laboratory tests may be used to assess the various stages of hepatitis B disease:Alanine aminotransferase and/or aspartate aminotransferase levelsHematologic and coagulation studies (eg, platelet count, complete blood count [CBC], international normalized ratio)The serologic tests should include the following laboratory studies:Hepatitis B core antibody (anti-HBc) immunoglobulin M (IgM)hepatitis B virus (HBV) deoxyribonucleic acid (DNA)The following radiologic studies may be used to evaluate patients with hepatitis B disease:Liver biopsy, percutaneous or laparoscopic, is the standard procedure to assess the severity of disease in patients with features of chronic active liver disease (ie, abnormal aminotransferase levels and detectable levels of HBV DNA).The primary treatment goals for patients with hepatitis B infection are to prevent progression of the disease, particularly to cirrhosis, liver failure, or hepatocellular carcinoma (HCC).The following medications are used in the treatment of hepatitis B:Nucleos(t)ide reverse transcriptase inhibitors (eg, tenofovir disoproxil fumarate, tenofovir alafenamide, lamivudine)Hepatitis B/hepatitis C agents (eg, adefovir dipivoxil, entecavir, telbivudine, PEG-IFN-a 2a, interferon alfa-2b)For individuals with decompensated cirrhosis (prominent signs of portal hypertension or encephalopathy), the following dietary limitations are indicated:High-protein diet (ie, white-meat protein [eg, chicken, turkey, fish])Fluid restriction (1.5 L/day) in cases of hyponatremiaOrthotopic liver transplantation is the treatment of choice for patients with fulminant hepatic failure who do not recover and for patients with end-stage liver disease due to hepatitis B disease.Hepatitis B is a worldwide healthcare problem, especially in developing areas.
HBeAg can be detected in patients with circulating serum HBV DNA who have “wild type” infection. Hepatitis B virus (HBV) is a hepadnavirus, highly resistant to extremes of temperature and humidity, that invades the hepatocytes. 86: Viral hepatitis in pregnancy. Available at Blumberg BS. The site of integration is not constant but usually involves the terminal repeat sequences. Hepatic carcinoma, primary. Immunohistochemical staining is positive for HBsAg. Thursz MR, Thomas HC, Greenwood BM, Hill AV. European Concerted Action on Viral Hepatitis (EUROHEP). [Guideline] Kowdley KV, Wang CC, Welch S, Roberts H, Brosgart CL. Radiologic studies may be useful in all stages of hepatitis B infection. (Optional) Hepatitis B. AASLD guidelines for treatment of chronic hepatitis B. Arora S, Martin CL, Herbert M. Myth: interpretation of a single ammonia level in patients with chronic liver disease can confirm or rule out hepatic encephalopathy. 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