HBsAg positive >6 months; risk of cirrhosis and HCC.
History taking
- • Onset, duration, progression, severity
- • Aggravating / relieving factors
- • Past history, drugs, allergies, comorbidities
- • Family & social history relevant to presentation
Examination
- • General: vitals, pallor, icterus, oedema, lymphadenopathy
- • Focused system examination
- • Look for red-flag findings
Red flags
- • Haemodynamic instability
- • Rapid deterioration
- • Severe pain or new neurological deficit
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • HBsAg, anti-HBs, anti-HBc, HBeAg/anti-HBe, HBV DNA
- • LFT, FibroScan
- • HIV, HCV, HDV co-infection
- • AFP + USS 6-monthly if cirrhosis or high risk
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Treat underlying cause
- • Symptomatic relief
- • Patient education
Drug therapy
- • Tenofovir 300 mg OD or entecavir 0.5 mg OD if treatment criteria met (ALT raised + HBV DNA above threshold or fibrosis)
Follow-up advice
- • Review in 2–4 weeks or earlier if worsening
- • Monitor response to therapy and adverse effects
Patient counselling
- • Vaccinate household / sexual contacts
- • Avoid alcohol
- • Use condoms, do not share razors
Referral criteria
- • Refer if diagnostic uncertainty, complications, or failure of first-line therapy
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
