Viral hepatitis: Difference between revisions
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Revision as of 10:18, 21 February 2016
Background
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; only marker in window period; IgG always present
- HBe-Ag: Implies active viral replication & infectivity
- Anti-HBe: low 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
- Active disease identified by reactive HCV ab and positive HCV RNA
Hepatitis D
- Only currently with hepatitis B
- High incidence of cirrhosis
Hepatitis E
- Fecal-oral transmission
- No carrier state
- High associated mortality
Clinical Features
Acute Hepatitis Features
- Nausea/Vomiting
- RUQ pain
- Enlarged, tender liver
- Fever
- Jaundice
- Bilirubinuria
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
Diagnosis
- Hepatitis panel, which typically consists of:
- HepA-Ab, IgM
- HBsAg
- HBc-Ab, IgM
- HC-Ab
- PT correlates well with severity and prognosis of acute hepatitis
Management
- Household or close contacts of positive HepA individual may require IM HepA Ig if within 14 days of exposure
Disposition
Admit Criteria
- INR >2
- Unable to tolerate POs
- Pain control
- Bilirubin >30
- Hypoglycemia
- Significant comorbid illness/immunocomp
- >50 years
See Also
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.