Acute hepatitis: Difference between revisions
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== | ==Background== | ||
{{Acute hepatitis causes}} | |||
==Clinical | ==Clinical Features== | ||
* | {{Acute hepatitis features}} | ||
* | |||
** | ==Differential Diagnosis== | ||
* | {{DDX RUQ}} | ||
* | |||
* | ==Evaluation== | ||
*[[LFTs]] | |||
**AST, ALT > 1000s | |||
**Elevated bilirubin | |||
**Elevated alk phosphatase | |||
*INR | |||
**[[liver disease induced coagulopathy|Coagulopathy]] | |||
*Consider acetaminophen level | |||
*Acute [[viral hepatitis|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 | |||
|} | |||
==Management== | |||
*Treat underlying cause | |||
==Disposition== | ==Disposition== | ||
| Line 17: | Line 68: | ||
#Bilirubin > 20 | #Bilirubin > 20 | ||
#PT 50% above normal | #PT 50% above normal | ||
#Hypoglycemia | #[[Hypoglycemia]] | ||
#Hypoalbuminemia | #Hypoalbuminemia | ||
#Any GI bleeding | #Any [[GI bleeding]] | ||
==See Also== | ==See Also== | ||
| Line 25: | Line 76: | ||
*[[Viral Hepatitis]] | *[[Viral Hepatitis]] | ||
== | ==References== | ||
<references/> | |||
[[Category:GI]] | [[Category:GI]] | ||
[[Category:ID]] | [[Category:ID]] | ||
Revision as of 18:49, 29 September 2019
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
Evaluation
- LFTs
- AST, ALT > 1000s
- Elevated bilirubin
- Elevated alk phosphatase
- INR
- 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 |
Management
- Treat underlying cause
Disposition
- 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.