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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Related Studies

Ontology: Viral hepatitis (C0042721)

Definition (NCI) An acute or chronic inflammation of the liver parenchyma caused by viruses. Representative examples include hepatitis A, B, and C, cytomegalovirus hepatitis, and herpes simplex hepatitis.
Definition (NCI_CTCAE) A disorder characterized by a viral pathologic process involving the liver parenchyma.
Concepts Disease or Syndrome (T047)
ICD9 070
ICD10 B15-B19.9 , B19, B19.9, B15-B19
SnomedCT 187432005, 154346007, 186642009, 3738000
LNC MTHU020837
English Viral hepatitis, VIRUS HEPATITIS, HEPATITIS VIRAL, Hepatic viral infections, Viral hepatitis not otherwise specified, Hepatitis viral NOS, Viral hepatitis NOS, Virus hepatitis, Unspecified viral hepatitis, infectious hepatitis (viral hepatitis), virus hepatitis, Hepatitis;viral, Viral hepatitis (B15-B19), viral hepatitis, hepatitis viral, viral hepatitis (diagnosis), Unspecified viral hepatitis (disorder), Hepatitis viral, VH - Viral hepatitis, Viral hepatitis (disorder), hepatitis; virus, virus; hepatitis, Viral hepatitis, NOS, Viral Hepatitis
Italian Epatite virale, Infezioni virali del fegato, Epatite virale NAS, Epatite virale non altrimenti specificata
Dutch hepatitis viraal NAO, virushepatitis, virale hepatitis, virale hepatitis niet elders gespecificeerd, virale hepatitis NAO, Virushepatitis, hepatitis; virus, virus; hepatitis, hepatitis viraal, leverinfecties viraal, Niet gespecificeerde virushepatitis
French Hépatite virale SAI, Virus de l'hépatite, Hépatite virale sans autre indication, HEPATITE VIRALE, Hépatite virale, Hépatites virales
German virale Hepatitis, virale Hepatitis, nicht anderenorts klassifiziert, Hepatitis viral NNB, virale Hepatitis NNB, Nicht naeher bezeichnete Virushepatitis, VIRUSHEPATITIS, Virushepatitis, Virusinfektionen der Leber
Portuguese Hepatite a vírus NE, Hepatite viral NE, Hepatite a vírus, HEPATITE VIRAL, Hepatite viral, Infecções hepáticas a vírus
Spanish Hepatitis por virus, Hepatitis viral, Hepatitis viral NEOM, Hepatitis vírica no especificada de otra manera, Hepatitis vírica NEOM, HEPATITIS VIRICA, hepatitis vírica, hepatitis viral no especificada (trastorno), hepatitis viral no especificada, hepatitis por virus, hepatitis viral (trastorno), hepatitis viral, hepatitis virósica, Hepatitis vírica, Infecciones víricas hepáticas
Japanese ウイルス肝炎, ウイルス肝炎ＮＯＳ, 肝ウイルス性感染症, ウイルス性肝炎, ウイルス性肝炎ＮＯＳ, ｳｲﾙｽｾｲｶﾝｴﾝNOS, ｳｲﾙｽｶﾝｴﾝ, ｶﾝｳｲﾙｽｾｲｶﾝｾﾝｼｮｳ, ｳｲﾙｽｾｲｶﾝｴﾝ, ｳｲﾙｽｶﾝｴﾝNOS
Czech Virové infekce jater, Virová hepatitida NOS, Virová hepatitida, Virová hepatitida, jinak neurčená
Korean 상세불명의 바이러스간염
Hungarian Hepatikus vírusos fertőzések, Viralis hepatitis egyébként nem meghatározott, virusos hepatitis k.m.n., Viralis hepatitis, Vírushepatitis, virusos hepatitis, virushepatitis k.m.n.
Derived from the NIH UMLS (Unified Medical Language System)

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