Histological, biochemical and clinical findings in hepatitis B carriers undergoing elective abdominal surgery
Pramoolsinsap, C.; Kurathong, S.; Bunyaratvej, S.
Southeast Asian Journal of Tropical Medicine and Public Health 19(4): 571-578
1988
ISSN/ISBN: 0125-1562 PMID: 3238467 Document Number: 321683
Prospective surveillance for serum Hepatitis B surface Antigen (HBsAg) was performed in 255 patients undergoing elective abdominal surgery at Ramathibodi Hospital during 1984-1987. HBsAg was detected in 13 patients (5.0%), 11 of whom gave consent for serial evaluation of liver histology and laboratory findings. There were eight males and three females aged 20-75 years (mean = 43.4 years). Nine of the eleven patients had wedge liver biopsies taken at operation and two patients had percutaneous biopsies performed. All patients were followed up at 3-6 month intervals and after 20-36 months, follow-up liver biopsies by the percutaneous route were performed in the nine cases who gave consent. The histological findings of initial and follow-up biopsies from these patients were all abnormal, ranging from reactive hepatitis to chronic active hepatitis. During the follow-up study, none of the patients lost their HBs antigenemia and orcein staining of liver biopsies for HBsAg was positive in all ten cases tested. In the nine cases who underwent follow-up liver biopsy, progression of liver pathology was found in seven, although none of these patients showed clinical deterioration or had significant rise in HBsAg titre or SGOT/SGPT levels. The mean age of the five cases who progressed to CAH (51.2 years) was higher than that of the remaining four cases (32.5 years) who had no or minor changes in liver histology, although the difference was not significant. Of the five cases with progression to CAH, four cases were more than 40 years old. None of the conventional clinical or laboratory parameters correlated with the progression of liver disease. This study indicates that liver disease among Thai HBsAg carriers is common and often not detected by routine laboratory tests. Liver biopsy by the percutaneous route should be appropriate for diagnosis and staging of liver disease in HBsAg carriers, particularly in those over 40 years old.