Acute hepatitis

Background

Causes

1. Viral
2. Alcohol
3. Acetaminophen toxicity
4. Mushroom toxicity (Amanita phalloides)

Clinical Findings

• N/V
• RUQ pain
  • Enlarged, tender liver
• Fever
• Jaundice
• Bilirubinuria

Differential Diagnosis

RUQ Pain

• Gallbladder disease
  • Symptomatic cholelithiasis (biliary colic)
  • Choledocholithiasis
  • Acute cholecystitis
  • Ascending cholangitis
  • Acalculous cholecystitis
• Pancreatitis
• Acute hepatitis
• Pancreatitis
• GERD
• Appendicitis (retrocecal)
• Pyogenic liver abscess
• Bowel obstruction
• Cirrhosis
• Budd-Chiari syndrome
• GU
  • Pyelonephritis
  • Kidney stone
  • Fitz-Hugh-Curtis Syndrome
• Other
  • Hepatomegaly due to CHF
  • Peptic ulcer disease with or without perforation
  • Pneumonia
  • Herpes zoster
  • Myocardial ischemia
  • Pulmonary embolism
  • Abdominal aortic aneurysm

Treatment

• Treat underlying cause

Disposition

• Consider admission for:

1. Bilirubin > 20
2. PT 50% above normal
3. Hypoglycemia
4. Hypoalbuminemia
5. Any GI bleeding

See Also

• Jaundice
• Viral Hepatitis

Source

• Tintinalli