Disorders of the Hepatic and Mesenteric Circulation ACG Clinical Guideline: Disorders of the Hepatic and Mesente... : American Journal of Gastroenterology ')} You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page. Your account has been temporarily locked Your account has been temporarily locked due to incorrect sign in attempts and will be automatically unlocked in 30 mins. For immediate assistance, contact Customer Service: 800 (...) Abstract Disorders of the mesenteric, portal, and hepatic veins and mesenteric and hepatic arteries have important clinical consequences and may lead to acute liver failure, chronic liver disease, noncirrhotic portal hypertension, cirrhosis, and hepatocellular carcinoma. Although literature in the field of vascular liver disorders is scant, these disorders are common in clinical practice, and general practitioners, gastroenterologists, and hepatologists may benefit from expert guidance

Givosiran (Givlaari) - acute hepatic porphyria Drug Approval Package: GIVLAARI (givosiran)Injection U.S. Department of Health and Human Services Search FDA Submit search Drug Approval Package: GIVLAARI (givosiran)Injection Company: Alnylam Pharmaceuticals Inc. Application Number: 212194 Approval Date: 11/20/2019 Persons with disabilities having problems accessing the PDF files below may call (301) 796-3634 for assistance. FDA Approval Letter and Labeling (PDF) (PDF) FDA Application Review Files

Immunizations - travel: Scenario: Hepatitis A Scenario: Hepatitis A | Management | Immunizations - travel | CKS | NICE Search CKS… Menu Scenario: Hepatitis A Immunizations - travel: Scenario: Hepatitis A Last revised in May 2019 Scenario: Hepatitis A From age 12 months onwards. Indications for vaccine Vaccination against hepatitis A is recommended for: Anyone aged 1 year and over travelling to areas of moderate or high risk (such as the Indian subcontinent) for prolonged periods, particularly (...) if sanitation and food hygiene is likely to be poor. Hepatitis A vaccination is not recommended for children under the age of one year. Individuals going to live in, or likely to be posted for long periods to, hepatitis A virus-endemic . If rapid protection against hepatitis A is required, for example following exposure or during outbreaks, then a single dose of monovalent vaccine is preferred as this may provide protection more quickly than the two courses of combined vaccine. Give combined vaccines

Hepatitis B: What issues should I consider before prescribing analgesics? Analgesics | Prescribing information | Hepatitis B | CKS | NICE Search CKS… Menu Analgesics Hepatitis B: What issues should I consider before prescribing analgesics? Last revised in November 2019 What issues should I consider before prescribing analgesics? For prescribing information on paracetamol, ibuprofen, and codeine, see the CKS topic on . For more detailed prescribing information on nonsteroidal anti-inflammatory

Hepatitis B: What else might it be? Differential diagnosis | Diagnosis | Hepatitis B | CKS | NICE Search CKS… Menu Differential diagnosis Hepatitis B: What else might it be? Last revised in November 2019 What else might it be? The differential diagnoses of hepatitis B include: Viral hepatitis caused by other viruses (such as hepatitis B, C, D, and E), Epstein-Barr virus (infectious mononucleosis), or cytomegalovirus (CMV). For further information, see the CKS topics on , , and . Non-alcoholic (...) fatty liver disease. For further information, see the CKS topic on . Alcohol-induced hepatitis — suspect if there is a history of alcohol misuse. For further information, see the CKS topic on . Drug-induced liver disease — suspect if there is a history of paracetamol overdose or therapeutic use of paracetamol in a person who misuses alcohol. Autoimmune hepatitis — ninety percent of cases occur in women. Suspicion is raised by presence of other auto-immune disorders. Hepatitis caused by bacteria

Hepatitis B: Scenario: Prevention of infection with Hepatitis B Scenario: Prevention of infection with Hepatitis B | Management | Hepatitis B | CKS | NICE Search CKS… Menu Scenario: Prevention of infection with Hepatitis B Hepatitis B: Scenario: Prevention of infection with Hepatitis B Last revised in November 2019 Scenario: Prevention of infection with Hepatitis B From birth onwards. Hepatitis B immunization for people at high risk Offer hepatitis B immunization to of hepatitis B: Use (...) clinical judgement (based on the person's risk of already having been exposed to hepatitis B) to determine the requirement for serology testing for immunity to hepatitis B at the same time as vaccination. People at high risk of previous exposure include: Babies born to mothers infected with hepatitis B. People with needlestick injury. Sexual assault victims. Injecting drug users. People who change sexual partners frequently, particularly men who have sex with men, and sex workers. Close family contacts

Hepatitis B: Anti-pruritics Anti-pruritics | Prescribing information | Hepatitis B | CKS | NICE Search CKS… Menu Anti-pruritics Hepatitis B: Anti-pruritics Last revised in November 2019 Anti-pruritics Contraindications and cautions Chlorphenamine Sedating antihistamines should be used with caution in people with: Liver dysfunction — chlorphenamine can be used in people whose metabolic and synthetic function is unaffected (such as in mild hepatitis). However, seek specialist advice before using (...) chlorphenamine in people with moderate hepatic impairment. It must be avoided in people with severe hepatic impairment, such as those with cirrhosis or encephalopathy who may decompensate, because of its sedative effects. Urinary retention, prostatic hypertrophy, angle-closure glaucoma, or pyloroduodenal obstruction — if possible, avoid using sedating antihistamines because of their significant antimuscarinic activity (particularly in elderly people). Epilepsy — avoid chlorphenamine if possible, as it may

Hepatitis B: How do I test for hepatitis B? How to test for hepatitis B | Diagnosis | Hepatitis B | CKS | NICE Search CKS… Menu How to test for hepatitis B Hepatitis B: How do I test for hepatitis B? Last revised in November 2019 How do I test for hepatitis B? Diagnosis of hepatitis B virus (HBV) is based upon the presence of serological markers (antigens and antibodies) in plasma or serum. These include: Hepatitis B Surface Antigen (HBsAg) — indicates presence of viral envelope, and suggests (...) that the person is infectious. It rises during the incubation period, and may be cleared early in the course of the disease. It is undetectable in around 10% of people by the time the test is performed. Chronic HBV infection is indicated by the persistence of serum HBsAg for more than 6 months. Hepatitis B e antigen (HBeAg) — detectable in the serum during both the early phases of acute infection and some chronic infections. Usually associated with relatively high levels of virus replication. People

Hepatitis B: Scenario: Managing hepatitis B infection Scenario: Managing hepatitis B infection | Management | Hepatitis B | CKS | NICE Search CKS… Menu Scenario: Managing hepatitis B infection Hepatitis B: Scenario: Managing hepatitis B infection Last revised in November 2019 Scenario: Managing hepatitis B infection From birth onwards. How do I manage confirmed hepatitis B infection? Admit any person with hepatitis B infection to hospital if they are severely unwell. For all other people (...) : Refer anyone who is found to be to a hepatologist or to a gastroenterologist or infectious disease specialist with an interest in hepatology (depending on local service provision), to consider the need for additional treatment, follow up, and monitoring. Use clinical judgement to decide the urgency of referral (people with suspected chronic hepatitis B infection and severe symptoms, or significantly abnormal liver function tests should be referred more urgently). Pregnant women who screen positive

Hepatitis B Hepatitis B | Topics A to Z | CKS | NICE Search CKS… Menu Hepatitis B Hepatitis B Last revised in November 2019 Hepatitis B is an infectious disease of the liver caused by the hepatitis B virus. Diagnosis Management Prescribing information Background information Hepatitis B: Summary Hepatitis B is an infectious disease of the liver caused by the hepatitis B virus. The prevalence of people with antibodies to hepatitis B core antigen (anti-HBc) — a marker of current or previous (...) infection (seroprevalence) — is 1–2% in the UK. In parts of China and South Korea, the seroprevalence is 96%. In the UK, most new infections are acquired in adulthood. The source of infection is most commonly via sexual contact or sharing equipment for injecting drugs with other people with chronic hepatitis B. Acute hepatitis B symptoms and jaundice generally last for 1–3 months. Hepatitis B surface antigen (HBsAg) is cleared in around 95% of immunocompetent adults. Fulminant hepatitis occurs in less

Hepatitis A: What issues should I consider before prescribing analgesia? Analgesia | Prescribing information | Hepatitis A | CKS | NICE Search CKS… Menu Analgesia Hepatitis A: What issues should I consider before prescribing analgesia? Last revised in October 2019 What issues should I consider before prescribing analgesia? For prescribing information on paracetamol, ibuprofen, and codeine, see the CKS topic on . For more detailed prescribing information on nonsteroidal anti-inflammatory drugs

Hepatitis B: Anti-emetics Anti-emetics | Prescribing information | Hepatitis B | CKS | NICE Search CKS… Menu Anti-emetics Hepatitis B: Anti-emetics Last revised in November 2019 Anti-emetics Contraindications and cautions Metoclopramide Metoclopramide should not be used in people with: Gastrointestinal obstruction, perforation or haemorrhage. Confirmed or suspected pheochromocytoma, due to the risk of severe hypertensive episodes. History of neuroleptic or metoclopramide-induced tardive (...) dyskinesia. Metoclopramide should be used with caution in people with: Liver dysfunction — metoclopramide can be used in people whose metabolic and synthetic function is unaffected (such as in mild hepatitis). However, seek specialist advice before using metoclopramide in people with more severe hepatic impairment, as reduced clearance may increase the risk of gynaecomastia and extrapyramidal adverse effects. The dose should be reduced by 50% in people with cirrhosis. Renal impairment — metoclopramide

Hepatitis A: What issues should I consider before giving hepatitis A vaccine? Hepatitis A vaccine | Prescribing information | Hepatitis A | CKS | NICE Search CKS… Menu Hepatitis A vaccine Hepatitis A: What issues should I consider before giving hepatitis A vaccine? Last revised in October 2019 What issues should I consider before giving hepatitis A vaccine? What types of hepatitis A vaccine are available? There are several hepatitis A vaccines that are licensed for use in the UK. All (...) are inactivated, and prepared from different strains of the hepatitis A virus: Avaxim ® Havrix Monodose ® Havrix Junior Monodose ® Vaqta ® Vaqta Paediatric ® There are also combined hepatitis A and B vaccines: Twinrix ® (adult and paediatric formulations) Ambirix ® (paediatric formulation) A combined hepatitis A and typhoid vaccine (ViATIM ® ) is also available. [ ; ] What is the immunization schedule for the hepatitis A vaccine? The hepatitis A monovalent vaccine is given as two doses, 6–12 months apart

Hepatitis A: What investigations should I do? Investigations | Diagnosis | Hepatitis A | CKS | NICE Search CKS… Menu Investigations Hepatitis A: What investigations should I do? Last revised in October 2019 What investigations should I do? The following tests should be carried out if hepatitis A is suspected: Hepatitis serology — note: suspicion of hepatitis A should be specifically stated on the request form. Be aware that: The most sensitive test for diagnosing acute hepatitis A infection (...) is a PCR test for hepatitis A RNA, however, this test is not widely available. In the absence of routine RNA testing, detection of hepatitis A virus immunoglobulin M (HAV-IgM) and hepatitis A virus immunoglobulin G (HAV-IgG) should both ideally be conducted to strengthen diagnostic accuracy. HAV-IgM antibodies are detectable from at least five days after the onset of symptoms, peak during the acute or early convalescent phase of the disease, and usually remain positive for 45—60 days but can persist

Hepatitis A: What else might it be? Differential diagnosis | Diagnosis | Hepatitis A | CKS | NICE Search CKS… Menu Differential diagnosis Hepatitis A: What else might it be? Last revised in October 2019 What else might it be? The differential diagnoses of hepatitis A include: Viral hepatitis caused by other viruses (such as hepatitis B, C, D, and E), Epstein-Barr virus (infectious mononucleosis), or cytomegalovirus (CMV). For further information, see the CKS topics on , , and . Alcohol-induced (...) hepatitis — suspect if there is a history of alcohol misuse. For further information, see the CKS topic on . Drug-induced liver disease — suspect if there is a history of paracetamol overdose or therapeutic use of paracetamol in a person who misuses alcohol. Acute HIV infection. For further information, see the CKS topic on . Autoimmune hepatitis — ninety percent of cases occur in women. Suspicion is raised by presence of other auto-immune disorders. Hepatitis caused by bacteria, such as Leptospirosis

Hepatitis A: What are the clinical features of hepatitis A infection? Clinical features | Diagnosis | Hepatitis A | CKS | NICE Search CKS… Menu Clinical features Hepatitis A: What are the clinical features of hepatitis A infection? Last revised in October 2019 What are the clinical features of hepatitis A infection? Note: most children and up to half of adults are asymptomatic or have mild nonspecific symptoms with little or no jaundice. The clinical features of acute hepatitis A are common (...) to all forms of acute viral hepatitis, and it cannot easily be distinguished by history, examination, or by routine biochemistry tests. Suspicion may be increased, however, by a history of a specific . The clinical features of the prodromal phase of hepatitis (usually lasts 3—10 days) include: Flu-like symptoms (such as general fatigue, malaise, joint and muscle pain, low-grade fever up to 39°C). Gastrointestinal symptoms (such as anorexia, nausea, vomiting, and right upper quadrant abdominal

Hepatitis A: Scenario: Prevention of infection with hepatitis A Scenario: Prevention of infection with hepatitis A | Management | Hepatitis A | CKS | NICE Search CKS… Menu Scenario: Prevention of infection with hepatitis A Hepatitis A: Scenario: Prevention of infection with hepatitis A Last revised in October 2019 Scenario: Prevention of infection with hepatitis A From birth onwards. Who should be offered vaccination for hepatitis A? Vaccination is indicated for people considered to be at high (...) risk of acquiring hepatitis A infection, and/or those at the highest risk of complications, including: People travelling to or going to reside in areas of high or intermediate prevalence — vaccine should preferably be given at least two weeks before departure, but may still provide some protection when given up to the day of departure. People with chronic liver disease (including hepatitis B or C infection) — risk of complications is increased. People receiving plasma-derived clotting factors

Hepatitis A: Scenario: Contact with a person with hepatitis A Scenario: Contact with hepatitis A | Management | Hepatitis A | CKS | NICE Search CKS… Menu Scenario: Contact with hepatitis A Hepatitis A: Scenario: Contact with a person with hepatitis A Last revised in October 2019 Scenario: Contact with a person with hepatitis A From birth onwards. How do I manage someone who has been in contact with a person with hepatitis A? If a person presents who has been in contact with someone with known (...) hepatitis A infection: Contact the local Health Protection Unit (HPU) immediately, who will advise on further management if the person has not previously received hepatitis A vaccine. This may include giving hepatitis A vaccination and/or arranging for the administration of human normal immunoglobulin, depending on the timing and circumstances of contact, as well as other factors including the person's age and co-morbidities. Basis for recommendation The advice on management of a person following

Hepatitis A: How do I know my patient has it? Diagnosis | Diagnosis | Hepatitis A | CKS | NICE Search CKS… Menu Diagnosis Hepatitis A: How do I know my patient has it? Last revised in October 2019 How do I know my patient has it? Public Health England uses the following case definitions for hepatitis A: Clinical case (possible): A person with an acute illness, discrete onset of symptoms AND jaundice or elevated serum aminotransferase levels. For further information, see the sections (...) on and . Probable case : Meets the clinical case definition (above) and has an epidemiological link to a confirmed hepatitis A case, OR Meets the clinical case definition and has IgM antibody to the hepatitis A virus ( ). Confirmed case: Meets the clinical case definition and has IgM and IgG antibodies to hepatitis A, OR Has hepatitis A RNA (HAV RNA) detected regardless of clinical features, OR Is asymptomatic with no recent history of immunisation, but has anti HAV IgM in oral fluid or serum, and has

Hepatitis A: Scenario: Managing hepatitis A infection Scenario: Managing hepatitis A infection | Management | Hepatitis A | CKS | NICE Search CKS… Menu Scenario: Managing hepatitis A infection Hepatitis A: Scenario: Managing hepatitis A infection Last revised in October 2019 Scenario: Managing hepatitis A infection From birth onwards. How should I manage a person with confirmed or probable hepatitis A infection? Admit any person with hepatitis A infection to hospital if they are severely (...) tracing. If an outbreak is suspected, or the person is a food handler, notify the HPU immediately. Provide the person with information and advice about hepatitis A. In particular, advise them to: Avoid drinking alcohol during the acute illness, as this can increase the risk of liver damage. Avoid work, school, or nursery , until they are no longer infectious (typically 7 days after the onset of jaundice, or 7 days after the onset of symptoms if there is no history of jaundice). Take steps to minimize