ACUTE  HEPATITIS

 

Etiology:

  1. ETOH, Viral (HAV, HBV, HCV, EB, toxo, CMV, Herpes), Toxins (APAP, mushrooms, INH, Valporic acid), Salicylates (Reye's syndrome) and other (for more complete list see text books).

S & S:

  1. We will focus here on viral hepatitis. For other etiologies refer to textbooks.
     
  2. Can be "Unicteric " form and thus symptom free or  mild non-specific symptoms.
     
  3. Can be "Icteric" form and manifest  by  following:
    1. Prodromal stage (precedes icteric stage) c/o constitutional S&S such as N/V, low grade fever, anorexia, malaise, light color stools.
    2. Icteric stage that presents with vasculo/collagen manifestations (purpura, arthritis),jaundice,hepatomegaly (RUQ pain), pruritis. This form may resolve,  become chronic or become fulminate.

DX:

  1. CBC, SMA (hypoglycemia is common and indicates admission).
     
  2. PT/PTT. If PT is > 3 sec it constitutes indication for admission (like hypoglycemia).
     
  3. Serum albumin. This, when low, indicates significant liver damage.
     
  4. ALT (SGPT), AST(SGOT) are elevated, generally in thousands. When elevation is in hundreds and the ratio is inverted (AST>ALT and ratio is > 1) it suggests alcoholic hepatitis.
     
  5. AP (alkaline phosphate) may be normal or slightly elevated; if elevated, suggests biliary obstruction. Bilirubin is variably elevated in icteric form.
     
  6. Hepatitis serology:

*HBsAg appears »1 mo before ALT/AST elevation and lasts through the icteric form.  Presence of this marker beyond 6 mo. states chronic state.

*The above marker disappears  with onset of clinical symptoms and pt enters the "window stage" where only anti-HBc is present that does not confirm immunity.*Once the illness resolves, anti-HBsAb appears, that confirms recovery, immunity and non infectivness. Present also in pt s/p vaccination.

*HCV is diagnosed based on presence of anti HCV antibody that are present 2 months after exposure.

Treatment:

    1. For Prophylaxis and Needle Stick see chapter on ID .
       
    2. Pt with diagnosis of hepatitis are admitted to the hospital if following are present:
       
      1. Intractable N/V, inability  to care for him/herself, social status.
      2. encephalopathy.
      3. > PT (if pt is bleeding Vit.K and FFP are given),  ­ bilirubin > 20mg/dL, hypoglycemia, electrolyte abnormality.
         
    3. Pts that does not meet  above criteria for admission can be treated as an OPD (abstinence from ETOH, fat-free high carbohydrate food, no APAP,
      Diphenhydramine or Cholestyramine for  pruritis, Metoclopramide for N/V).

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