Viral hepatitis: Difference between revisions
Neil.m.young (talk | contribs) (Text replacement - "==Diagnosis==" to "==Evaluation==") |
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*No carrier state | *No carrier state | ||
*High associated mortality | *High associated mortality | ||
*Common in Southeast Asia, but different genotypes found globally across Asia, Africa, Latin America<ref>Chaudhry SA et al. Hepatitis E infection during pregnancy. Can Fam Physician. 2015 Jul; 61(7): 607–608.</ref> | |||
*Mortality in pregnancy dependent on trimester<ref>Ranger-Rogez S, Alain S, Denis F. Hepatitis viruses: mother to child transmission [article in French] Pathol Biol (Paris) 2002;50(9):568–75.</ref> | |||
**1.5% in first trimester | |||
**8.5% in second trimester | |||
**21% in third trimester | |||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 21:54, 10 October 2018
Background
Hepatitis A
- Most common form of transmission occurs from asymptomatic children to adults
- Incubation period: 15-50d
- Prodrome: nausea and vomiting, malaise, fever, abdominal 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 patients 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
- Common in Southeast Asia, but different genotypes found globally across Asia, Africa, Latin America[1]
- Mortality in pregnancy dependent on trimester[2]
- 1.5% in first trimester
- 8.5% in second trimester
- 21% in third trimester
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[3])
- Viral hepatitis
- Toxoplasmosis
- Acute alcoholic hepatitis
- Toxins
- Ischemic hepatitis
- Autoimmune hepatitis
- Wilson's disease
Evaluation
- 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
- INR >2
- Unable to tolerate PO
- Intractable pain
- Bilirubin >30
- Hypoglycemia
- Significant comorbidity/immunocompromised
- Age >50 years
See Also
References
- ↑ Chaudhry SA et al. Hepatitis E infection during pregnancy. Can Fam Physician. 2015 Jul; 61(7): 607–608.
- ↑ Ranger-Rogez S, Alain S, Denis F. Hepatitis viruses: mother to child transmission [article in French] Pathol Biol (Paris) 2002;50(9):568–75.
- ↑ 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.