Viral hepatitis: Difference between revisions

Revision as of 06:54, 1 August 2011

Causes

Hepatitis A

Most common form of transmission occurs from asymptomatic children to adults
Incubation period: 15-50d
Prodrome: N/V, malaise, fever, abd pain
- 1wk later bilirubinuria, clay-colored stool, jaundice
Death from hepatic failure is rare

Hepatitis B

Incubation period: 1-3 months
Presentation is similar to hep A
Lab tests:
- HBsAg: + implies infection
- Anti-HBs: implies clearance or vaccination
- Anti-HBc: Implies prior infection; IgM = acute & in flares; IgG always present
- HBe-Ag: Implies active viral replication & infectivity
- HBV DNA: Similar to HBe-Ag but more sensitive

Hepatitis C

Unlike Hep A and B, most often asymptomatic in acute phase of infection
>75% of pts advance to chronic stage

Disposition

Admit Criteria

INR >2
Unable tol POs
Pain control
Bilirubin >30
Hypoglycemia
Significant comorbid illness/immunocomp
>50 years

Source

Adapted from Stevens, Donaldson, Pani

Authors:

@@ Line 1: / Line 1: @@
 ==Causes==
-===Hep B===
+===Hepatitis A===
-HBsAg: first +; if + long time may be chronic; implies infection -infectivity.
+*Most common form of transmission occurs from asymptomatic children to adults
+*Incubation period: 15-50d
+*Prodrome: N/V, malaise, fever, abd pain
+**1wk later bilirubinuria, clay-colored stool, jaundice
+*Death from hepatic failure is rare
-Anti-HBs: + p clearance of Ag or vaccination; appears p windon period; if Ag neg then implies recovery, noninfectious
+===Hepatitis B===
+*Incubation period: 1-3 months
-Anti-HBc: +in window; appears early; IgM = acute & in flares; IgG always present.
+*Presentation is similar to hep A
+*Lab tests:
-HBe-Ag: implies viral replication & infectivity; if + > 3 months may be chronic.
+**HBsAg: + implies infection
+**Anti-HBs: implies clearance or vaccination
-HBV dna: like HBe-Ag but more sensitive & precise.
+**Anti-HBc: Implies prior infection; IgM = acute & in flares; IgG always present
+**HBe-Ag: Implies active viral replication & infectivity
+**HBV DNA: Similar to HBe-Ag but more sensitive
 ===Hepatitis C===
-Risk: Drugs (IVDA/intranasal cocaine), hemodialysis, transplant-92, needle stick, maternal-fetal transmission (5%), sex.
+*Unlike Hep A and B, most often asymptomatic in acute phase of infection
+*>75% of pts advance to chronic stage
-Blood products: cyro> 1987, PRBC>94, 1/10000-100000.
-of 100 pt infected>85 chronic, 70 chronic active, 15 cirrohsis, hcc, 5 die.
-No vaccine.
-#acutely>asymptomatic: 60%
-#syx>constitutional
-#chronic: HCC 1- 4%
-#extrahepatic: PAN, cryoglobulinemia, porphyria cutanatardica.
-LFTs q3-6 months if all normal then q1year.
-LFTs: do NOT indicate infectivity or chronicty.
-Infectious: based on PCR
-Tx: alpha interferon 50% respond in 1 year. May try ribavarin in conjuction if failed.
-SE: fatigue, worsened hepatitis.
-ribavirin- anemi
 ==Disposition==
@@ Line 48: / Line 32: @@
 ==See Also==
-GI: Jaundice
+[[Jaundice]]
 ==Source ==