Monday, January 23, 2023

What Does Chronic Hepatitis C Without Hepatic Coma Mean

Can Chronic Hepatitis C Cause Hepatic Coma

Hepatitis C Easy Explained symptoms, transmission, causes, treatment

Hepatitis C is a blood-borne virus that affects the liver. Following infection, a small number of people can spontaneously clear the virus. However, others develop chronic hepatitis C. Left untreated, the infection can lead to advanced liver disease and even liver coma.

Many people with chronic hepatitis C do not know they have an infection until it is revealed by a routine blood test. It may cause no symptoms, and people can live with an infection for decades before being diagnosed.

Although chronic hepatitis C can lead to serious liver complications, doctors can treat it successfully with antiviral drugs. This prevents further damage to the liver, cures the infection and prevents it from spreading.

However, if people do not seek treatment, they can develop complications that lead to a condition called hepatic encephalopathy. They can even fall into a hepatic coma.

Keep reading to learn more about chronic hepatitis C, including complications that can lead to hepatic coma and how doctors treat hepatitis C in the absence of hepatic coma.

Hepatitis C is a virus that damages the liver. Doctors classify it as acute or chronic depending on how long it inflames and damages the liver.

Acute hepatitis C lasts and goes away alone. About 1015% of people infected with HCV live with this type.

People with hepatitis C may have no symptoms initially. However, they can develop chronic liver disease after years of infection. If symptoms appear, they may include Next

Treatment Of Hepatic Failure

Treatment depends on the stage of the disease.

Your doctor may prescribe medications. If only part of your liver is damaged, surgery may be recommended to remove the damaged part. A doctor can also take imagingtests of your liver to look for damage.

If a healthy liver is damaged, it can grow back.

If the damage is too severe, which can sometimes be the case with fast-acting acute liver failure, a liver transplant may be necessary.

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Whats The Difference Between Acute And Chronic Hepatitis C

Hepatitis C is a contagious disease caused by HCV, which is spread through contact with blood and bodily fluids that contain HCV. This disease damages your liver. There are two types of hepatitis C infection: acute and chronic.

Acute hepatitis C is a short-term viral infection. People with acute hepatitis C carry the infection for a small window of time, often just several months . Most people with the acute form of hepatitis C will experience illness and mild symptoms such as fatigue and vomiting within the first six months after exposure. In many cases, the disease causes no symptoms at all.

Acute hepatitis C may improve or resolve without treatment. It leads to chronic infection in 75 to 85 percent of cases. The chronic form may cause long-term problems in your liver, including liver damage and liver cancer.

HCV is spread through direct contact with blood or certain bodily fluids that contain HCV. Its safe to engage in the following activities without worry of transmission:

If your doctor suspects that you have hepatitis C, they will draw blood to check for HCV antibodies. Antibodies are substances your body produces when its fighting an infection. If you have them, your doctor may order a second test to confirm that the virus is still present.

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Recommended Testing For Diagnosing Acute Hcv Infection

RECOMMENDED RATING HCV antibody and HCV RNA testing are recommended when acute HCV infection is suspected due to exposure, clinical presentation, or elevated aminotransferase levels . I, C

Recommendations for HCV testing are also found in the Testing and Linkage to Care section.

Diagnosis of acute HCV infection enables estimation of annual incidence rates and transmission patterns, thereby facilitating implementation and assessment of prevention programs. At the individual level, a diagnosis of acute infection expedites linkage to care, counseling regarding high-risk behavior, and timely interventions to reduce virus transmission and liver disease progression . Some persons involved in high-risk behaviors practice serosorting, defined as using HCV antibody serostatus to determine whether to engage in high-risk behaviors with certain individuals . Thus, undiagnosed acutely infected persons may be at greater risk of transmitting HCV to their presumably seronegative contacts than would be expected by chance.

The best laboratory evidence to support a diagnosis of acute HCV infection is a positive HCV RNA test in the setting of a negative HCV antibody test , or a positive HCV antibody test after a prior negative HCV antibody test . There are rare instances in which these approaches may be misleading, such as in immunosuppressed individuals with impaired antibody production .

Discrete Exposure

No Discrete Exposure

Questions For Your Doctor

When you visit the doctor, you may want to ask questions to get the information you need to manage your hepatitis C. If you can, have a family member or friend take notes. You might ask:

  • What kinds of tests will I need?
  • Are there any medications that might help?
  • What are the side effects of the medications you might prescribe?
  • How do I know when I should call the doctor?
  • How much exercise can I get, and is it all right to have sex?
  • Which drugs should I avoid?
  • What can I do to prevent the disease from getting worse?
  • How can I avoid spreading hepatitis C to others?
  • Are my family members at risk for hepatitis C?
  • Should I be vaccinated against other types of hepatitis?
  • How will you keep tabs on the condition of my liver?
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    Retreatment Of Persons With Prior Peginterferon And Ribavirin Failure

    The latest version of the AASLD-IDSA HCV Guidance no longer provides specific recommendations for retreatment of persons with a history of peginterferon plus ribavirin therapy, with or without an earlier generation direct-acting antiviral agent . The AASLD-IDSA HCV Guidance notes that these individuals respond to retreatment similar to treatment-naïve persons, thus implying the treatment approach should be the same as with treatment-naïve individuals. Although the pool of persons with a history of failure with a peginterferon-based regimen who need retreatment is small and diminishing, there are some individuals with this treatment history who need retreatment and may require special consideration that differs from that of treatment-naïve individuals. The following outlines a few of these key considerations based on available data and previous guidance that should be noted when retreating an individual with a history of prior treatment failure with peginterferon plus ribavirin, with or without an earlier generation DAA . Note that except for the 8-week option of glecaprevir-pibrentasvir , when retreating these individuals with first-line DAA combinations that have pangenotypic activity , the treatment will be the same as their treatment-naïve counterparts.

    Hcv And Changes In Metabolic Pathways

    On proton magnetic resonance spectroscopy, metabolic abnormalities of choline/creatine ratio in basal ganglia and white matter have been detected in patients with histologically proven mild hepatitis C with respect to both healthy volunteers and chronic hepatitis B patients, suggesting a role for HCV itself in affecting cerebral functions. Moreover, significant correlations have been reported between cognitive dysfunction and HCV replication and between degree of impairment and the choline/creatine ratio in the basal ganglia and white matter in contrast to what is commonly observed in hepatic encephalopathy, a higher content in cerebral choline has been recorded in these patients. Although the exact significance of elevated choline in the white matter remains uncertain, it may be implicated in glial activation secondary to oxidative stress a similar mechanism has been suggested for chronic fatigue syndrome in HIV infection.

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    What Are The Treatments For Hepatitis C

    Treatment for hepatitis C is with antiviral medicines. They can cure the disease in most cases.

    If you have acute hepatitis C, your health care provider may wait to see if your infection becomes chronic before starting treatment.

    If your hepatitis C causes cirrhosis, you should see a doctor who specializes in liver diseases. Treatments for health problems related to cirrhosis include medicines, surgery, and other medical procedures. If your hepatitis C leads to liver failure or liver cancer, you may need a liver transplant.

    Unspecified Viral Hepatitis C Without Hepatic Coma

    Cirrhosis of the Liver Nursing Care Management Symptoms NCLEX
      2016201720182019202020212022Billable/Specific Code
    • B19.20 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
    • The 2022 edition of ICD-10-CM B19.20 became effective on October 1, 2021.
    • This is the American ICD-10-CM version of B19.20 other international versions of ICD-10 B19.20 may differ.
    • Applicable To annotations, or

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    Medications Used To Treat Hepatitis C

    The HCV Medications section on this website provides detailed information for each of the Food and Drug Administration -approved medications listed in the treatment recommendations, including links to the full prescribing information and to patient assistance programs. The DAAs exert their action at specific steps in the HCV life cycle. There are three major classes of DAA medications: nonstructural proteins 3/4A protease inhibitors, NS5A inhibitors, and NS5B polymerase inhibitors the NS5B polymerase inhibitors include the nucleoside analogs and nonnucleoside analogs. Adherence with the treatment regimen is of paramount importance. Thus, individuals should receive detailed counseling regarding the importance of adherence prior to starting therapy, as well as intensive monitoring and follow-up during therapy.

    What Is The Difference Between Hepatitis A Hepatitis B And Hepatitis C

    Although they are all viruses that infect the liver, how you get them and how they can cause long-term health problems differ. Hepatitis A can be contracted through food or water that has been contaminated by fecal matter and raw shellfish. It does not lead to chronic disease and can be prevented through vaccinations. People generally recover within three to six weeks with no permanent liver damage.

    Hepatitis B is also less common in the U.S. affecting less than five percent of our population. It is spread through blood and body fluids, including saliva. There are also vaccines to prevent hepatitis B and newborns are vaccinated against this form of hepatitis before they even leave the hospital.

    Unfortunately, there are no preventative vaccinations for hepatitis C, but early detection and advances in treatment can cure many strains of the disease.

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    Hepatitis C Information Center

    Hepatitis C is a disease caused by a virus that infects the liver. The virus, called the Hepatitis C virus or HCV for short, is just one of the hepatitis viruses. The other common hepatitis viruses are A and B, which differ somewhat from HCV in the way they are spread and treated. According to the Centers for Disease Control , an estimated 2.7 million people in the United States have chronic Hepatitis C infection. The CDC now recommends one-time hepatitis C testing of all adults and all pregnant women during every pregnancy. CDC continues to recommend people with risk factors, including people who inject drugs, be tested regularly.

    Explore this Hepatitis C Information Center by clicking through to the Diagnosis, Treatment and Support landing pages where youll find more information to help you manage Hepatitis C.

    Electronic Medical Record Screening Protocol

    Where possible, the EMR offers an essential component of successful HCV screening through a best practice alert that notifies clinicians and staff when a patient is eligible for screening . Ideally this alert links to a one-time HCV screening test for eligible patients with the appropriate diagnosis code . After the test is completed, the BPA should turn off but highlight a positive result. The most efficient test to order is an anti-HCV antibody that reflexes to a quantitative HCV RNA on the same blood sample to confirm chronic HCV. This is essential as 15-35% of anti-HCV antibody positive patients have cleared the infection. In summary:Eligible patients for HCV screening:

    • Birth year 1945-1965
    • Prior record of HCV diagnosis based on ICD-9-CM or ICD-10 codes
    • Prior record of any HCV test based on an array of Current Procedural Terminology codes .
    • Z11.59 Encounter for screening for other viral diseases
    • B17.11 Acute hepatitis C with hepatic coma
    • B18.2 Chronic viral hepatitis C
    • B17.10 Acute hepatitis C without hepatic coma
    • B19.20 Unspecified viral hepatitis C without hepatic coma
    • B19.21 Unspecified viral hepatitis C with hepatic coma
    • Z22.52 Carrier of Hepatitis C

    ICD-9 codes:

    For a more complete list, visit Support Path

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    Cms National Coverage Policy

    Social Security Act Standard References:

    • Title XVIII of the Social Security Act, Section 1833 states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

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    Blood And Vessel Problems

    People with hepatitis C often get a condition called cryoglobulinemia. This happens when certain proteins in your blood stick together in cold weather. They can build up in vessels and block blood flow, which causes swelling and damage. The condition can affect your skin, organs, nerves, and joints.

    Hepatitis C also can cause problems with blood itself. You may not make enough white blood cells, which fight infections, or platelets, which help your blood clot.

    The infection can also make you bruise easily or get red or purple spots under your skin. Those are signs of a bleeding disorder called immune thrombocytopenic purpura.

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    How Is Acute Hepatitis C Treated

    Acute hepatitis C is typically monitored and not treated. Treatment during the acute stage doesnt change the risk that the disease will progress to the chronic form. An acute infection may resolve on its own without treatment. The following treatment may be all thats necessary:

    • adequate fluids

    Some people may need treatment with prescription medication. Your doctor will be able to work with you about what treatment options may be best for you.

    Those most at risk for acute and chronic hepatitis C are people who use or share contaminated needles. Mothers can transmit HCV to their babies during childbirth, but not through breastfeeding. Other risk factors for transmission of HCV include:

    • healthcare work, especially work around needles
    • getting a tattoo or body piercing with unsterile equipment
    • undergoing hemodialysis
    • living in a household with someone with HCV
    • sharing personal hygiene products, such as razors or toothbrushes
    • engaging in sexual activity with multiple partners without condoms or dental dams
    • having a blood transfusion or organ transplant before July 1992 or receiving clotting factors before 1987

    The most serious long-term risk of acute hepatitis C is developing chronic hepatitis C, which can lead to cirrhosis and liver cancer. In 75 to 85 percent of those with acute hepatitis C, the disease will progress to the more serious chronic hepatitis C.

    What Is Viral Hepatitis

    Cirrhosis of the Liver | Signs, Symptoms, Interventions & Nursing Care

    Hepatitis means inflammation of the liver. The liver is a vital organ that processes nutrients, filters the blood, and fights infections. When the liver is inflamed or damaged, its function can be affected. Heavy alcohol use, toxins, some medications, and certain medical conditions can cause hepatitis. However, hepatitis is often caused by a virus. In the United States, the most common types of viral hepatitis are hepatitis A, hepatitis B, and hepatitis C.

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    Who Is At Risk For Hepatitis C

    You are more likely to get hepatitis C if you:

    • Have injected drugs
    • Had a blood transfusion or organ transplant before July 1992
    • Have hemophilia and received clotting factor before 1987
    • Have been on kidney dialysis
    • Were born between 1945 and 1965
    • Have abnormal liver tests or liver disease
    • Have been in contact with blood or infected needles at work
    • Have had tattoos or body piercings
    • Have worked or lived in a prison
    • Were born to a mother with hepatitis C
    • Have had more than one sex partner in the last 6 months
    • Have had a sexually transmitted disease
    • Are a man who has had sex with men

    If you are at high risk for hepatitis C, your health care provider will likely recommend that you get tested for it.

    Who Should Get Tested

    Since universal screening of blood and blood products did not occur until 1992, anyone who had a blood transfusion or organ transplant before that time should be tested. It is recommended that people be tested for hepatitis C if they were/are:

    • Born between 1945 and 1965
    • Exposed to blood and body fluids
    • Sharing toothbrushes, razors, nail clippers or other personal items with an infected individual
    • Using and/or sharing needles to inject drugs
    • Receiving tattoos and body piercings with unsterile needles
    • Women thinking about becoming pregnant
    • Born to an infected mother
    • Receiving long-term hemodialysis
    • Having unprotected sex with multiple sex partners or have a history of sexually transmitted diseases

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    What Are The Chances Of Surviving Liver And Kidney Failure

    Prognosis for Anyone Living with HRS

    The prognosis for people with liver failure is much worse if they develop HRS. Most patients die within weeks of the onset of renal failure without therapy. In fact, 50% of people die within 2 weeks of diagnosis and 80% of people die within 3 months of diagnosis.

    Hcv Infection And Peripheral Neuropathy Disorders

    In contrast to the brain, there is currently no evidence for peripheral nerves as permissive sites for HCV replication however, a wide variety of motor, sensory or sensorimotor mono- or polyneuropathies has been described during chronic HCV infection. Most peripheral neuropathies have been reported in patients with HCV-related mixed cryoglobulinemia, with prevalence up to 86% of cases. In particular, a sensory motor peripheral neuropathy has been found in up to 30% of HCV-positive cryoglobulinemic patients. Such neuropathy is the consequence of ischemic nerve changes, secondary to small-vessel vasculitis or necrotizing arteritis of medium-sized vessels. Frequently, the clinical onset is sub-acute as a distal, symmetric, sensory or sensorimotor polyneuropathy, although asymmetrical sensory impairment has also been reported. Small fiber sensory polyneuropathy , a painful condition mainly characterized by burning feet and tingling, is the most frequent neuropathy observed in patients with mild cryoglobulinemia syndrome, whereas the so called large fiber sensory neuropathy has been described less frequently. HCV-associated restless legs syndrome has also been reported as expression of SFSN. SFSN may later evolve in LFSN. LFSN symptoms include sensory loss, paresthesias, numbness, and cramps.

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