Viral Hepatitis

Aka: Viral Hepatitis

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II. Causes

  1. Hepatitis A
  2. Hepatitis B
  3. Hepatitis C
  4. Hepatitis D
  5. Hepatitis E
  6. Epstein Barr Virus (EBV)
  7. Cytomegalovirus (CMV)
  8. Coxsackie Virus

III. Symptoms: Prodrome

  1. Malaise
  2. Anorexia
  3. Nausea or Vomiting
  4. Diarrhea
  5. Low Grade fever

IV. Signs: Advanced disease

  1. Dark Urine
  2. Jaundice
  3. Tender Hepatomegaly

V. Differential Diagnosis

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

VI. 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

VII. 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

VIII. 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

IX. References

  1. Swencki (2015) Crit Dec Emerg Med 29(11):2-10

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