Core IM | Internal Medicine Podcast #8 Chronic Hepatitis B (Part 2) Management: 5 Pearls segment
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Jan 31, 2018 Dr. Amy Tang, a hepatology clinician and educator, walks through practical management of chronic hepatitis B. Short segments cover focused history and labs. Imaging and noninvasive fibrosis tools are compared. Clear criteria for who to treat and drug choice considerations are reviewed. Practical guidance on monitoring, stopping rules, and HCC screening rounds out the discussion.
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Focused Initial Evaluation For Chronic HBV
- Ask about alcohol, diet, and family history of liver cancer when evaluating chronic HBV to assess comorbid risks and vertical transmission.
- Send CBC, BMP, LFTs, INR, albumin, HBeAg/anti-HBe, HBV DNA, HIV/HCV testing, and HAV antibody as part of initial workup.
Family History Often Misunderstood
- Amy Tang notes patients often misinterpret family liver cancer as inherited rather than infectious, so ask family history directly.
- She has seen patients diagnosed with liver cancer at the initial HBV evaluation, so include AFP and imaging early when indicated.
Fibrosis Tests: Labs Miss The Middle
- APRI and FIB-4 only pick up advanced cirrhosis and miss intermediate fibrosis stages commonly seen in chronic HBV.
- Transient elastography (FibroScan) better assesses intermediate fibrosis and also estimates steatosis.