Acute hepatitis/es: Difference between revisions
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==Diagnóstico Diferencial== | |||
= | |||
{{DDX RUQ}} | {{DDX RUQ}} | ||
==Evaluación== | |||
= | |||
*[[Special:MyLanguage/LFTs|LFTs]] | *[[Special:MyLanguage/LFTs|LFTs]] | ||
**AST, ALT > 1000s | **AST, ALT > 1000s | ||
** | **Bilirrubina elevada | ||
** | **Fosfatasa alcalina elevada | ||
*INR | *INR | ||
**[[Special:MyLanguage/liver disease induced coagulopathy| | **[[Special:MyLanguage/liver disease induced coagulopathy|Coagulopatía]] | ||
* | *Considerar nivel de paracetamol | ||
* | *Panel de [[Special:MyLanguage/viral hepatitis|hepatitis viral]] aguda | ||
**Hep A Ab IgM | **Hep A Ab IgM | ||
**Hep B cAb IgM | **Hep B cAb IgM | ||
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**Hep B sAb | **Hep B sAb | ||
**Hep C Ab | **Hep C Ab | ||
{| class="wikitable" | {| class="wikitable" | ||
! Anti-hepatitis A, IgM | ! Anti-hepatitis A, IgM | ||
! | ! Antígeno de superficie de hepatitis B | ||
! Anti-hepatitis B core, IgM | ! Anti-hepatitis B core, IgM | ||
! Anti-hepatitis C | ! Anti-hepatitis C | ||
! | ! Interpretación | ||
|- | |- | ||
| | | Positivo | ||
| | | Negativo | ||
| | | Negativo | ||
| | | Negativo | ||
| | | Hepatitis A aguda | ||
|- | |- | ||
| | | Negativo | ||
| | | Positivo | ||
| | | Positivo | ||
| | | Negativo | ||
| | | Hepatitis B aguda | ||
|- | |- | ||
| | | Negativo | ||
| | | Positivo | ||
| | | Negativo | ||
| | | Negativo | ||
| | | Infección crónica por hepatitis B | ||
|- | |- | ||
| | | Negativo | ||
| | | Negativo | ||
| | | Positivo | ||
| | | Negativo | ||
| | | Hepatitis B aguda; la cantidad de antígeno de superficie de hepatitis B es demasiado baja para detectar | ||
|- | |- | ||
| | | Negativo | ||
| | | Negativo | ||
| | | Negativo | ||
| | | Positivo | ||
| | | Hepatitis C aguda o crónica; se requieren pruebas adicionales para hacer la determinación | ||
|} | |} | ||
==Manejo== | |||
= | |||
*Tratar la causa subyacente | |||
* | |||
==Disposición== | |||
= | |||
<div lang="en" dir="ltr" class="mw-content-ltr"> | <div lang="en" dir="ltr" class="mw-content-ltr"> | ||
Revision as of 01:52, 18 January 2026
Antecedentes
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
Drug or Toxin Related Liver Disease
- Liver damage from drugs or toxins may be cytotoxic from the primary drug or its metabolites, or may be caused by veno-occlusive disease or hypersensitivity disease[2]
- Common Drugs and Toxins
- Acetaminophen
- Amiodarone
- Amphotericin
- Anabolic steroids
- Azathioprine
- Carbamazepine
- Chlorpromazine
- Cisplatin
- Contraceptives
- Cyclophosphamide
- Erythromycin
- Gold salts
- Haloperidol
- Isoniazid
- Ketoconazole
- Lovastatin
- Methotrexate
- Methoxyflurane
- Methyldopa
- Phenobarbital
- Phenytoin
- Quinidine
- Salicylates
- Tetracycline
- Valproic acid
- Verapamil
Características Clínicas
Acute Hepatitis Features
- Nausea/Vomiting
- RUQ pain
- Enlarged, tender liver
- Fever
- Jaundice
- Bilirubinuria
Diagnóstico Diferencial
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
Evaluación
- LFTs
- AST, ALT > 1000s
- Bilirrubina elevada
- Fosfatasa alcalina elevada
- INR
- Considerar nivel de paracetamol
- Panel de hepatitis viral aguda
- Hep A Ab IgM
- Hep B cAb IgM
- Hep B sAg
- Hep B sAb
- Hep C Ab
| Anti-hepatitis A, IgM | Antígeno de superficie de hepatitis B | Anti-hepatitis B core, IgM | Anti-hepatitis C | Interpretación |
|---|---|---|---|---|
| Positivo | Negativo | Negativo | Negativo | Hepatitis A aguda |
| Negativo | Positivo | Positivo | Negativo | Hepatitis B aguda |
| Negativo | Positivo | Negativo | Negativo | Infección crónica por hepatitis B |
| Negativo | Negativo | Positivo | Negativo | Hepatitis B aguda; la cantidad de antígeno de superficie de hepatitis B es demasiado baja para detectar |
| Negativo | Negativo | Negativo | Positivo | Hepatitis C aguda o crónica; se requieren pruebas adicionales para hacer la determinación |
Manejo
- Tratar la causa subyacente
Disposición
Consider admission for:
- Bilirubin > 20
- PT 50% above normal
- Hypoglycemia
- Hypoalbuminemia
- Any GI bleeding
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.
- ↑ Oyama, LC: Disorders of the Liver and Biliary Tractin Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2014, (Ch) 107: p 1186-1204
