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Evaluation, Staging, and Monitoring of Chronic Hepatitis C Overview4th Edition

Module Core Competency

Provide Evidence-Based Evaluation, Staging, and Monitoring to Persons with Chronic Hepatitis C Infection

Target Audience

Delve into how to manage persons with chronic hepatitis C. Seven lessons address initial evaluation, natural history, liver damage prevention, evaluation for cirrhosis, and surveillance for hepatocellular carcinoma.

Editor

H. Nina Kim, MD, MSc

H. Nina Kim, MD, MSc
Associate Editor
Professor of Medicine
Division of Allergy & Infectious Diseases
University of Washington

Disclosures: None

1Lesson 1 Initial Evaluation of Persons with Chronic HCV

Learning Objectives
- Describe key aspects of the medical history to obtain in a new evaluation of persons with HCV infection
- Identify key abnormal physical examination findings that may be present in a person with HCV and cirrhosis
- Summarize recommended laboratory studies to obtain for a person with HCV at the initial evaluation visit
- List immunizations that should be administered to persons with chronic HCV infection
- Discuss the evaluation of secondary causes of liver disease in persons with chronic HCV infection
Quick ReferenceInitial Evaluation of Persons with Chronic HCV Core Concepts
Activity 1B.Calculating Body Mass Index (BMI)
Activity 1C.Determining AUDIT-C Score

2Lesson 2 Natural History of HCV Infection

Learning Objectives
- Explain spontaneous viral clearance versus persistent infection following initial HCV acquisition
- Describe the variable outcomes that can occur in persons with chronic HCV infection
- Summarize the typical time course for developing liver complications in untreated chronic HCV
- List factors that influence the rate of progression of fibrosis in persons with chronic HCV infection
- Discuss the impact of alcohol intake on fibrosis progression in persons with chronic HCV infection
Quick ReferenceNatural History of HCV Infection Core Concepts

3Lesson 3 Counseling Persons with Chronic HCV Infection

Learning Objectives
- Determine which common liver health counseling messages should be addressed in persons with chronic HCV infection
- Explain recommendations for intake of acetaminophen and nonsteroidal anti-inflammatory medications in persons with chronic HCV infection
- Discuss recommendations for iron intake and vitamins for persons with chronic HCV infection
- Summarize key counseling messages related to coffee, diet, and complementary medications in persons with chronic HCV infection
- Clarify guidance related to alcohol and marijuana use in persons with chronic HCV infection
Quick ReferenceCounseling Persons with Chronic HCV Infection Core Concepts

4Lesson 4 Evaluation and Staging of Liver Fibrosis

Learning Objectives
- Discuss noninvasive indirect markers used for estimating liver fibrosis
- Describe noninvasive direct markers used for estimating liver fibrosis
- Summarize key radiologic methods that can estimate hepatic fibrosis
- List the transient elastography cutoff that is used to estimate cirrhosis in persons with chronic HCV
- Explain the indications, risks, and histologic assessment for liver biopsy in persons with chronic HCV
Quick ReferenceEvaluation and Staging of Liver Fibrosis Core Concepts
Activity 4B.Calculating APRI

5Lesson 5 Evaluation and Prognosis of Persons with Cirrhosis

Learning Objectives
- Differentiate compensated cirrhosis from decompensated cirrhosis
- Explain the classification and prognostic systems for cirrhosis
- Summarize important aspects of the medical history and physical examination in persons with cirrhosis
- Discuss the approach to treatment of HCV in persons with compensated cirrhosis
- Describe key manifestations and complications associated with decompensated cirrhosis
Quick ReferenceEvaluation and Prognosis of Persons with Cirrhosis Core Concepts

6Lesson 6 Surveillance for Hepatocellular Carcinoma

Learning Objectives
- Discuss the incidence of hepatocellular carcinoma (HCC) in persons with chronic HCV
- Describe major risk factors for developing HCC
- Explain the rationale for HCC surveillance in persons with chronic HCV infection
- Summarize the American Association for the Study of Liver Diseases (AASLD) recommendations for HCC surveillance indications
- List recommended HCC surveillance methods
Quick ReferenceSurveillance for Hepatocellular Carcinoma Core Concepts

7Lesson 7 Extrahepatic Conditions Related to HCV Infection

Learning Objectives
- Identify the most common clinical syndromes associated with HCV-related cryoglobulinemia
- Describe the renal extrahepatic manifestations associated with chronic HCV infection
- Recognize the most common dermatologic extrahepatic manifestations associated with chronic HCV infection
- Explain the relationship of chronic HCV infection and lymphomas
- Summarize the association of chronic HCV and cardiovascular disease
Quick ReferenceExtrahepatic Conditions Related to HCV Infection Core Concepts

The Check-on-Learning Questions are short and topic related. They are meant to help you stay on track throughout each lesson and check your understanding of key concepts.

HCV Test and Cure

Screening and Diagnosis of Hepatitis C Infection