HEPATITIS B

1. CHIEF COMPLAINT
•Hepatitis B

2. HPI

3. ROS

4. SYMPTOMS
•Anorexia
•Nausea
•Vomiting
•Low-grade fever
•Myalgia
•Right upper quadrant and epigastric pain
•Hepatic encephalopathy
•Somnolence
•Disturbances in sleep pattern
•Mental confusion
•Coma
•Fatigue
•Mild upper quadrant pain or discomfort
•Hepatic decompensation

5. HISTORY
a. FAMILY History
b. SOCIAL History
c. PAST MEDICAL HISTORY
d. SURGICAL HISTORY
e. CHRONIC CONDITIONS

6. ALLERGIES

7. PHYSICAL EXAMINATION
•Low-grade fever
•Jaundice
•Hepatomegaly
•Splenomegaly
•Palmar erythema
•Spider nevi
 •Ascites
•History of variceal bleeding
•Peripheral edema
•Gynecomastia
•Testicular atrophy
•Abdominal collateral veins (caput medusa)

8. SPECIFIC DATA LIKE GRADING ETC

•Liver damage grading according to the inflammatory component is
described as follows:
o Grade 0 - Portal inflammation only, no activity
o Grade 1 - Minimal portal inflammation and patchy
lymphocytic necrosis with minimal lobular inflammation and
spotty necrosis
o Grade 2 - Mild portal inflammation and lymphocytic necrosis
involving some or all portal tracts, with mild hepatocellular
damage
o Grade 3 - Moderate portal inflammation and lymphocytic
necrosis involving all portal tracts, with noticeable lobular
inflammation and hepatocellular change
o Grade 4 - Severe portal inflammation and severe
lymphocytic bridging necrosis, with severe lobular
inflammation and prominent diffuse hepatocellular damage

•Liver damage staging (ie, fibrosis) is described as follows:

o Stage 0 - No fibrosis
o Stage 1 - Portal fibrosis
o Stage 2 - Periportal fibrosis
o Stage 3 - Septal, bridging fibrosis
o Stage 4 - Cirrhosis

9. TESTS TO BE ORDERED
•CBP
•Liver function tests
•Alanine aminotransferase (ALT)
•Aspartate aminotransferase (AST)
•Alkaline phosphatase levels
•Serum Albumin levels
•Serum iron levels
•Prothrombin time
•HBsAg
•HBeAg
 •HBcAb (IgM)
•Abdominal ultrasonography
•CT scan
•MRI
•Liver biopsy

10. ASSESSMENT /PLAN

•Surgical Care
o Orthotopic liver transplantation (OLT)

11. EDUCATION
•Diet
o Decompensated cirrhosis- Low-sodium diet (1.5
g/d), high-protein diet, ie, white-meat protein (eg,
pork, turkey, fish), and, in cases of hyponatremia,
fluid restriction (1.5 L/d)

12. MEDICATION
•Interferon alfa-2b
•Lamivudine
•Adefovir dipivoxil
•Entecavir
•Telbivudine Emtricitabine
•BL-thymidine (L-dT)
•DAPD
•Clevudine (l-FMAU)
•Thymosin

13. FOLLOW UP