Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • high risk of exposure

Other diagnostic factors

  • normal physical examination
  • jaundice
  • hepatomegaly
  • ascites
  • fever/chills
  • malaise
  • maculopapular or urticarial rash
  • RUQ pain
  • fatigue
  • nausea/vomiting
  • arthralgia/arthritis
  • palmar erythema
  • spider angiomata
  • splenomegaly
  • asterixis

Risk factors

  • perinatal exposure in an infant born to an HBV-infected mother
  • multiple sexual partners
  • men who have sex with men (MSM)
  • injection drug use
  • male gender
  • born in highly endemic region
  • FHx of HBV and/or chronic liver disease
  • FHx of hepatocellular carcinoma (HCC)
  • history of STDs
  • infected with HIV
  • infected with hepatitis C virus (HCV)
  • blood or blood product transfusion
  • health care worker (HCW)
  • history of incarceration
  • household contact with HBV
  • hemodialysis

Diagnostic investigations

1st investigations to order

  • hepatic panel
  • CBC
  • basic metabolic panel (BMP)
  • coagulation profile (PT/INR)
  • serum HBsAg
  • serum anti-HBs
  • serum anti-HBc (IgM)
  • serum anti-HBc (IgM + IgG)
  • serum HBeAg
  • HBV DNA
Full details

Investigations to consider

  • serum anti-HBe
  • HBV genotype
  • ultrasound of liver
  • serum ammonia
  • liver biopsy
  • alpha-fetoprotein (AFP)
Full details

Emerging tests

  • transient elastography
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Professor of Medicine

Division of Liver Diseases

Mount Sinai Hospital

New York

NY

Disclosures

JA declares that he has no competing interests.

Dr Jawad Ahmad would like to gratefully acknowledge Dr Sateesh R. Prakash, Dr Siddarth Verma, Dr Smruti R. Mohanty, and Dr Jared Hossack, previous contributors to this monograph. SRP, SV, and JH declare that they have no competing interests. SRM serves as a speaker bureau for Bristol-Myers Squibb regarding the use of entecavir for the treatment of chronic hepatitis B.

Peer reviewers VIEW ALL

Chief

Hepatology Section

Department of Medicine

University of Connecticut Health Center

Farmington

CT

Disclosures

GYW is on the medical advisory boards of Gilead Sciences and Bristol-Myers Squibb.

Director

Clinical Epidemiology Unit

Marilia Medical School

Sao Paulo

Brazil

Disclosures

LOC declares that she has no competing interests.

Chairman

Bangladesh Primary Care Research Network

Dhaka

Bangladesh

Disclosures

MAM declares that he has no competing interests.

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