Hepatitis C

Also known as: HCV

Infection with HCV (RNA flavivirus, 6 genotypes), transmitted primarily via blood exposure (injection drug use, unscreened blood products historically, vertical transmission: lower than HBV, sexual transmission:lower efficiency, higher with HIV coinfection).

55-85% of acute infections progress to chronic infection (unlike HBV).

Major cause of chronic liver disease, cirrhosis, HCC.

Anti-HCV antibody: screening — positive indicates exposure (past or current)
HCV RNA (PCR): confirms active infection, required for chronic infection diagnosis and treatment guidance
Genotype: historically guided regimen selection, less critical with pan-genotypic DAAs
LFTs: often mildly elevated, poor correlate of fibrosis severity
Fibrosis assessment: transient elastography or FIB-4/APRI scores
Screen for HIV/HBV coinfection
HCC surveillance: 6-monthly ultrasound ± AFP if cirrhotic

DAA therapy — treatment of choice, >95% cure (SVR): sofosbuvir-velpatasvir (12 weeks) or glecaprevir-pibrentasvir (8 weeks treatment-naive without cirrhosis, extended if cirrhotic/experienced) — oral, well-tolerated
Treatment recommended for essentially all patients regardless of fibrosis stage per current WHO/AASLD guidance
Pre-treatment: HCV RNA, genotype (if regimen-dependent), fibrosis stage, renal function, drug interaction review
Monitor: HCV RNA at end of treatment and 12 weeks post (SVR12) confirms cure
Cirrhotic patients: continue HCC surveillance post-SVR
No vaccine available — prevention via harm reduction (needle exchange), blood screening, safe sexual practices

Referral: hepatology/gastroenterology or infectious disease for treatment initiation, cirrhosis management, HCC surveillance.

Clinical toolsCalculators

BMI GCS EDD Parkland Formula

Corrected Sodium Corrected Calcium Anion Gap Creatinine Clearance Insulin Calculations qSOFA Wells PE Wells DVT CHA₂DS₂-VASc HAS-BLED CURB-65 Centor/McIsaac

Gastroesophageal Reflux Disease

Also known as: GERD, GORD, Reflux

Retrograde flow of gastric contents into the esophagus causing troublesome symptoms/complications, from transient LES relaxation, hiatal hernia, or impaired clearance.

Classified: non-erosive reflux disease (NERD most common), erosive esophagitis (Los Angeles grade A-D), Barrett's esophagus (premalignant metaplasia).

Clinical for typical symptoms without alarm features, empirical PPI trial reasonable.

Endoscopy if alarm features, age ≥55 new onset, or refractory. 24-hour pH/impedance monitoring: atypical symptoms, treatment-refractory, or pre-surgical evaluation.

Manometry: motility/pre-surgical workup.

Differentials: cardiac chest pain (exclude first), PUD, eosinophilic esophagitis (young, dysphagia, food impaction, atopy), achalasia, esophageal malignancy, functional heartburn.

Lifestyle: weight loss, elevate head of bed, avoid large/late meals, reduce triggers (fatty, spicy, caffeine, alcohol, chocolate, citrus), smoking cessation
PPI — first-line: omeprazole 20-40mg od, 30-60 min before breakfast; 4-8 week trial, step down to lowest effective/on-demand dose
H2RA (famotidine): add-on for nocturnal breakthrough
Alginates (Gaviscon): adjunct for post-prandial breakthrough
Refractory: reassess adherence/timing before assuming failure; investigate before dose escalation beyond standard
Barrett's: PPI therapy, surveillance colonoscopy per dysplasia grade
Surgical fundoplication: for refractory disease, patient preference to avoid long-term medication, large hiatal hernia, or PPI-refractory regurgitation — requires pre-op manometry/pH studies

Referral: gastroenterology for alarm features, refractory symptoms, Barrett's surveillance, surgical consideration.

Hepatitis C

Overview

Clinical Features

Diagnosis

Management

Overview

Clinical Features

Diagnosis

Management