hepatic and biliary disorders
Overview of Chronic Hepatitis
Treatment of Chronic Hepatitis
Supportive care Treatment of cause (eg, corticosteroids for autoimmune hepatitis, antivirals for HBV and HCV infection) Treatment goals for chronic hepatitis include treating the cause and, if cirrhosis and portal hypertension have developed, managing complications (eg, Ascites , Drugs that cause hepatitis should be stopped.Acetaminophenis contraindicated in patients with severe hepatic impairment or severe active liver disease. NSAIDs should also be avoided in patients with severe hepatic impairment. Underlying disorders should be treated. Lifestyle changes should be recommended for patients with Metabolic Dysfunction–Associated Liver Disease (MASLD) or Liver Transplantation may be required for decompensated cirrhosis. There are specific Treatment (eg, In chronic hepatitis due to HBV, prophylaxis (including immunoprophylaxis) for contacts of patients may be helpful. No vaccination is available for contacts of patients with HCV infection. Corticosteroids and immunosuppressants should be avoided in chronic hepatitis B and C because these drugs enhance viral replication. If patients with chronic hepatitis B have other disorders that require treatment with corticosteroids, immunosuppressive therapies, or cytotoxic chemotherapy, they should be treated with antiviral drugs at the same time to prevent a flare or reactivation of hepatitis B or acute liver failure due to hepatitis B. A similar situation with hepatitis C being activated or causing acute liver failure has not been described. (See alsoThe Diagnosis and Management of Nonalcoholic Fatty Liver Disease: Practice Guidance from the American Association for the Study of Liver Disease.) Treatment of Metabolic Dysfunction–Associated Liver Disease (MASLD) aims to Reduce weight Control risk factors and comorbidities It may involve Recommending weight loss of 7 to 10% of body weight via dietary changes and exercise Treating concomitant metabolic risk factors such as hyperlipidemias andinsulinresistance Stopping drugs associated with NASH (eg,amiodarone,tamoxifen,methotrexate, corticosteroids such asprednisoneorhydrocortisone, synthetic estrogens) Avoiding exposure to toxins (eg, pesticides) No pharmacotherapy is currently recommended specifically for the treatment of NASH (See also the American Association for the Study of Liver Disease’s practice guidelineDiagnosis and Management of Autoimmune Hepatitis.) Corticosteroids,with or withoutazathioprine, prolong survival.Prednisoneis usually started at 30 to 60 mg orally once a day, then tapered to the lowest dose that maintains aminotransferases at normal or near-normal levels. To prevent long-term need for corticosteroid treatment, clinicians can transition toazathioprine1 to 1.5 mg/kg orally once a day ormycophenolatemofetil 1000 mg twice a day after corticosteroid induction is complete and then gradually taper the corticosteroid. Most patients require long-term, low-dose, corticosteroid-free maintenance treatment. Hereditary hemochromatosis is treated with phlebotomy. 