Acute hepatitis
Background
Causes of acute hepatitis
- Acetaminophen toxicity (most common cause of acute liver failure in the US[1])
- Viral hepatitis
- Hepatitis A
- Hepatitis B
- Hepatitis C
- Hepatitis D
- Hepatitis E
- HSV
- Epstein-Barr virus
- Varicella zoster virus
- Toxoplasmosis
- Acute alcoholic hepatitis
- Toxins
- Ischemic hepatitis
Clinical Features
Differential Diagnosis
RUQ Pain
- Gallbladder disease
- Symptomatic cholelithiasis (biliary colic)
- Choledocholithiasis
- Acute cholecystitis
- Ascending cholangitis
- 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 phosphatase
- INR
- 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:
- Bilirubin > 20
- PT 50% above normal
- Hypoglycemia
- Hypoalbuminemia
- Any GI bleeding
See Also
References
- Ostapowicz G, Fontana RJ, Schiodt FV, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med. 2002 Dec 17; 137(12): 947-54.
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