Acute hepatitis

Background

Acute hepatitis

• Viral hepatitis
  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
• Acute alcoholic hepatitis
• Acetaminophen toxicity
• Mushroom toxicity
  • Crotinarius mushrooms
  • Gyromitra mushrooms
  • Amanita mushrooms
• Ischemic hepatitis

Clinical Features

Acute Hepatitis Features

• Nausea/Vomiting
• RUQ pain
  • Enlarged, tender liver
• Fever
• Jaundice
• Bilirubinuria

Differential Diagnosis

RUQ Pain

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

Evaluation

• LFTs
  • AST, ALT > 1000s
  • Elevated bilirubin
  • Elevated alk phophatase
• INR
  • Coagulopathy
• 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:

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

See Also

• Jaundice
• Viral Hepatitis

References

Authors

Daniel Eggeman, Jordan Swartz, Ross Donaldson, Neil Young