Hepatitis A: Difference between revisions
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==Background== | ==Background== | ||
*Transmission | *Transmission | ||
**Fecal-oral route | **Fecal-oral route | ||
**Most commonly transmitted from asymptomatic children to adults | **Most commonly transmitted from asymptomatic children to adults | ||
**Can also occur with improper food handling, oyster consumption | **Can also occur with improper food handling, oyster consumption | ||
==Clinical Features== | |||
*Incubation period 15-50 days | |||
**~ | *Prodrome of [[nausea/vomiting]], malaise | ||
**~1 week into illness, may have dark urine (bilirubinuria), clay-colored stools, [[jaundice]] | |||
*No chronic component | *No chronic component | ||
*~1-2% of HAV infections in adults lead to fulminant hepatic failure | *~1-2% of HAV infections in adults lead to fulminant [[hepatic failure]] | ||
*Death from hepatic failure is rare | *Death from hepatic failure is rare | ||
| Line 22: | Line 21: | ||
==Management== | ==Management== | ||
*Supportive care | *Supportive care | ||
**antiemetics | **[[antiemetics]] | ||
**oral or IV hydration | **oral or IV hydration | ||
**avoid hepatotoxic medications | **avoid hepatotoxic medications | ||
Revision as of 21:51, 28 September 2016
Background
- Transmission
- Fecal-oral route
- Most commonly transmitted from asymptomatic children to adults
- Can also occur with improper food handling, oyster consumption
Clinical Features
- Incubation period 15-50 days
- Prodrome of nausea/vomiting, malaise
- ~1 week into illness, may have dark urine (bilirubinuria), clay-colored stools, jaundice
- No chronic component
- ~1-2% of HAV infections in adults lead to fulminant hepatic failure
- Death from hepatic failure is rare
Differential Diagnosis
Causes of acute hepatitis
- Acetaminophen toxicity (most common cause of acute liver failure in the US[1])
- Viral hepatitis
- Toxoplasmosis
- Acute alcoholic hepatitis
- Toxins
- Ischemic hepatitis
- Autoimmune hepatitis
- Wilson's disease
Evaluation
Interpreting Acute Hepatitis Panel Results
| Anti-hepatitis A, IgM | Hepatitis B surface antigen | Anti-hepatitis B core, IgM | Anti-hepatitis C | Interpretation |
|---|---|---|---|---|
| Positive | Negative | Negative | Negative | Acute hepatitis A |
| Negative | Positive | Positive | Negative | Acute hepatitis B |
| Negative | Positive | Negative | Negative | Chronic hepatitis B infection |
| Negative | Negative | Positive | Negative | Acute hepatitis B; quantity of hepatitis B surface antigen is too low to detect |
| Negative | Negative | Negative | Positive | Acute or chronic hepatitis C; additional tests are required to make the determination |
Management
- Supportive care
- antiemetics
- oral or IV hydration
- avoid hepatotoxic medications
- Patients with fulminant hepatic failure (1-2% of HAV infections) may be considered for liver transplant
- Postexposure prophylaxis recommend for non-immunized close contacts of patient
Disposition
See Also
External Links
References
- ↑ Ostapowicz G, Fontana RJ, Schiodt FV, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med. 2002 Dec 17; 137(12): 947-54.