Acute hepatitis: Difference between revisions
No edit summary |
|||
| Line 7: | Line 7: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{DDX RUQ}} | {{DDX RUQ}} | ||
==Diagnosis== | |||
*LFTs | |||
**AST, ALT > 1000s | |||
**Elevated bilirubin | |||
**Elevated alk phophatase | |||
*INR | |||
**Coagulopathy | |||
*Consider acetaminophen level | |||
*Acute hepatitis panel | |||
**Hep A Ab IgM | |||
**Hep B cAb IgM | |||
**Hep B sAg | |||
**Hep B sAb | |||
**Hep C Ab | |||
{| class="wikitable" | |||
! 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 | |||
|} | |||
==Treatment== | ==Treatment== | ||
Revision as of 22:28, 25 May 2016
Background
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
Clinical Features
Acute Hepatitis Features
- Nausea/Vomiting
- RUQ pain
- Enlarged, tender liver
- Fever
- Jaundice
- Bilirubinuria
Differential Diagnosis
RUQ Pain
- Gallbladder disease
- Pancreatitis
- Acute hepatitis
- Pancreatitis
- GERD
- Appendicitis (retrocecal)
- Pyogenic liver abscess
- Bowel obstruction
- Cirrhosis
- Budd-Chiari syndrome
- GU
- Other
- Hepatomegaly due to CHF
- Peptic ulcer disease with or without perforation
- Pneumonia
- Herpes zoster
- Myocardial ischemia
- Pulmonary embolism
- Abdominal aortic aneurysm
Diagnosis
- LFTs
- AST, ALT > 1000s
- Elevated bilirubin
- Elevated alk phophatase
- INR
- Coagulopathy
- Consider acetaminophen level
- Acute hepatitis panel
- Hep A Ab IgM
- Hep B cAb IgM
- Hep B sAg
- Hep B sAb
- Hep C Ab
| 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 |
Treatment
- Treat underlying cause
Disposition
- Consider admission for:
- Bilirubin > 20
- PT 50% above normal
- Hypoglycemia
- Hypoalbuminemia
- Any GI bleeding
See Also
Source
- Tintinalli
- ↑ 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.