chronic hepatitis

duration- 3 months
defined biochemically - raised aminotransferase or other related (autoimmune markers, G-glob)
3 mon bec unlike in adults where 6 months, liver demage can be minimized if not withheld within this period and after 6 months it may be irreversible.
assess general condition of patient, monitor hepato billliary tree (ALP, Bill), hepatocytes (ALT, AST), function (PT, Alb),
Most due to infective courses ( even in HUSM)
In HUSM 1/5 children recieving multiple transfusions become positive with hepatitis C.
Hepatitis A and EBV does not cause chronic hepatitis.
if no etiology - consider autoimmune hepatitis.
autoimmune 3 types,
1- raised ASMA, ANA, age 10-20, 45-70, more felmales, milder
2- raised ALKMA, young age, more severe, fem=male
3- ASMA and ANA negative, coombs +ve
AIH need to differentiate from primary sclerosing cholangits, onion skin lesion is pathognommonic, ANCA +ve
PSC has no treatment, AIH responds well to steroids, azathioprine, CPM, tacrolimus, cyclosporine
some can not differentiate, called 'overlap syndrome".
transplanted liver can still be demaged by same autoimmune process.
AMA is raisesd in liver disease bec. it is the mitochondria of liver that is been targettedmost. ACA is a type of AMA found in inner membrane of mitochondria
AIH may be due to provokers like HLA DR it self or demage by oxidation or xenobiotics.