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Viral hepatitis
From WikEM
Contents
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
Clinical Features
Acute Hepatitis Features
Differential Diagnosis
Acute hepatitis
- Viral hepatitis
- Acute alcoholic hepatitis
- Acetaminophen toxicity
- Mushroom toxicity
- Ischemic hepatitis
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
