Hepatitis A: Difference between revisions
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**~1wk into illness, may have dark urine (bilirubinuria), clay-colored stools, jaundice | **~1wk 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 | |||
*Death from hepatic failure is rare | *Death from hepatic failure is rare | ||
Revision as of 18:11, 28 September 2016
Background
Clinical Features
- Transmission
- Fecal-oral route
- Most commonly transmitted from asymptomatic children to adults
- Can also occur with improper food handling, oyster consumption
- Clinical course
- Incubation period 15-50 days
- Prodrome of nausea, vomiting, malaise
- ~1wk 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.