Niaz Ahmed Shaikh, Akhter Ali Baloch, Muhammad Irfan, Aneel Sham Vaswani, Fayaz Ahmed Moghal, Syed Ehsan Ali.
Clinical signs of chronic liver disease: is there any difference in patients with hepatitis B and C.
Med Channel Jan ;16(2):233-6.

OBJECTIVE: To observe the pattern of admission, clinical signs and their difference in patients with chronic liver disease due to Hepatitis B and C. PATIENTS AND METHODS: This descriptive study was conducted in Medical wards of Civil Hospital Karachi over a period of six months from June to December 2009. One hundred and sixty four (n=164) adult patients with established diagnosis of chronic liver disease due to HBV and/or HCV infection were included in the study. SPSS 16 was used to analyze the cause of admission presence of clinical signs and to compare them in HBV and HCV patients. RESULTS: A total of 164 patients were analyzed out of them 53.7% were male and 46.3% female. Mean age of patients was 51 years. The majority of patients (40.5%) were admitted in hospital with Hepatic encephalopathy, 26.8% with upper Gastro intestinal bleeding, 17.1% with ascites and its complication like spontaneous Bacterial Peritonitis and Hepatorenal Syndrome and 15.6% of patients were admitted with other causes like infections. Hepatitis C was the most common cause and present alone in 52.4% of patients followed by Hepatitis B in 40.9%, both viruses were present in 6.7% of patients. The most common signs were anemia 79.3%, ascites 78% pedal edema 73.8%, splenomegaly 72.6%, palmer erythema 48.8%, leuconychia 48.8% jaundice 35.4%, spider navei 31.1%, clubbing 26.8%. Although breast atrophy, testicular atrophy, parotid enlargement, pigmentation and ascites was more common in HCV patients while jaundice, gynecomastia, leuconychia, clubbing and palmer erythema was more common in HBV patients. However these differences were not statistically significant. Anemia, edema, splenomegaly and loss of axillary hair were equally common in both HBV and HCV patients. Interestingly spider nevi were significantly more common in HCV patients. CONCLUSION: Hepatitis C virus remains the commonest cause of chronic liver disease in our country. The well known clinical signs of chronic liver disease are still valuable in the diagnosis and should be purposely looked for in these patients. The pattern of clinical signs in HBV and HCV patients although different but is not significantly different except spider nevi which were statistically more in HBV patients. Further studies might be done to validate these findings.

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