Viral Hepatitis

Aka: Viral Hepatitis

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II. Causes

  1. Typical acute Viral Hepatitis causes
    1. Hepatitis A
    2. Hepatitis B
    3. Hepatitis C
    4. Hepatitis D
    5. Hepatitis E
  2. Mild Viral Hepatitis causes
    1. Cytomegalovirus (CMV)
    2. Mononucleosis (EBV)
    3. Coxsachievirus
  3. Potentially severe hepatitis (especially in Immunocompromised patients)
    1. Herpes Simplex Virus (HSV)
    2. Varicella Zoster Virus
  4. Other Viral Hepatitis causes
    1. Adenovirus
    2. Influenza Virus
    3. Human Herpesvirus 6
    4. Chikungunya
    5. Dengue Fever

III. History

  1. See Acute Hepatitis

IV. Symptoms: Prodrome

  1. Malaise and Fatigue
  2. Anorexia
  3. Nausea or Vomiting
  4. Diarrhea
  5. Low Grade fever
  6. Right Upper Quadrant Abdominal Pain

V. Signs: Advanced Disease

  1. Dark Urine
  2. Pale stools
  3. Jaundice
  4. Tender Hepatomegaly

VI. Differential Diagnosis

  1. See Acute Hepatitis Causes
  2. Alcoholic Hepatitis
  3. Hepatotoxins
  4. Hypotension
  5. Ischemia
  6. Biliary tract disease

VII. Labs

  1. See Acute Hepatitis
  2. Alkaline Phosphatase (up to twice normal)
  3. Serum Direct Bilirubin (Conjugated Bilirubin) increased
  4. Liver Aminotransferases increased (up to 10-20 fold above baseline)
    1. Alanine Aminotransferase (ALT)
    2. Aspartate Aminotransferase (AST)
  5. Viral Hepatitis Serology
    1. Hepatitis A
      1. xHAV IgM
    2. Hepatitis B
      1. HBsAg
      2. xHBc IgM
    3. Hepatitis C
      1. xHCV Antibody

VIII. Management

  1. See Acute Hepatitis
  2. Post-exposure Prophylaxis
    1. See Hepatitis A
    2. See Hepatitis B Postexposure Prophylaxis
    3. No Post-exposure Prophylaxis is available for Hepatitis C (as of 2015)
  3. Acute Viral Hepatitis
    1. Symptomatic management is primary treatment for Hepatitis A and Hepatitis B
    2. Consider early Interferon based monotherapy for Acute Hepatitis C (started within first 4 weeks)
      1. See Hepatitis C
  4. Chronic Viral Hepatitis
    1. See Chronic Hepatitis B Antiviral Therapy
    2. See Hepatitis C Antiviral Regimen
  5. Cirrhosis
    1. See Chronic Liver Failure

IX. Prevention

  1. See Prevention of Liver Disease Progression
  2. Vaccination
    1. Combined Hepatitis A and Hepatitis B Vaccine (Twinrix)
    2. Hepatitis A Vaccine
    3. Hepatitis B Vaccine

X. References

  1. Swencki (2015) Crit Dec Emerg Med 29(11):2-10
  2. Swencki (2023) Crit Dec Emerg Med 37(8):4-12

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