Hepatitis B

Hepatitis B - Acute
Rahul Soman, M. Pharm

 

Definition  

 

Acute Hepatitis B  

Systemic viral infection causing inflammation of the liver ; an acute illness with a discrete onset of symptoms, and jaundice or elevated serum aminotransferase levels .

 

Medical History  

* Sexual exposure

* Hepatitis B contact

* Intravenous drug user

* Patient immunocompromised

* Fetus or neonate affected by maternal infection

* Surgical procedure

* Healthcare Worker

* Transfusion of blood product

* Hemodialysis

 

Findings  

* Fatigue

* Malaise

* Loss of appetite

* Nausea and vomiting - Acute

* Jaundice

* Right upper quadrant pain

* Hepatomegaly - Acute

* Splenomegaly

* Acholic stool

* Bilirubinuria

* Fever

* Arthralgia

* Rash - Acute

 

Tests  

 

Suspected or known hepatitis B infection and screening  

* Hepatitis B surface antigen measurement: The presence of hepatitis B surface antigen (HBsAg) indicates acute or chronic active infection .

 

Suspected hepatitis B virus infection  

* Hepatitis B core antibody measurement: A positive antibody to hepatitis B core antigen (anti-HBc) test indicates hepatitis B virus infection. IgM class anti-HBc is consistent with an acute or recent infection, while IgG class anti-HBc is consistent with a chronic or past infection .

 

Suspected hepatitis C in patients with evidence of clinical liver disease  

* Hepatitis C antibody test: A positive screening test with high signal-to-cutoff (s/co) ratio indicates past or present infection; positive screening tests with lower s/co ratios require confirmatory testing .

 

Suspected acute viral hepatitis A  

* Hepatitis A antibody level: The presence of IgM antibody to hepatitis A virus (anti-HAV) confirms acute infection; the presence of IgM and IgG antibody (total anti-HAV) confirms immunity to HAV but does not differentiate current from previous infection .

 

Suspected or known hepatitis B virus infection  

* Alanine aminotransferase measurement: Measurement of ALT is necessary for diagnosing acute hepatitis, monitoring chronic hepatitis B virus infection, and assessing treatment response .

 

Suspected or known liver disease  

* Bilirubin, total measurement: Conjugated hyperbilirubinemia may suggest acute viral hepatitis, autoimmune hepatitis, or toxic or ischemic liver injury when it occurs in the presence of substantially elevated aminotransferase levels .

 

Differential Diagnosis  

* Hepatitis A - Acute

* Hepatitis C

* Hepatitis E, acute

* Drug-induced liver disease

* Alcoholic liver disease - Acute

* Cholecystitis - Acute

* Autoimmune hepatitis

* Infectious mononucleosis - Acute

* Cytomegalovirus infection - Acute

* Ischemic hepatitis

 

Treatment  

 

Drug Therapy  

 

Type B viral hepatitis, acute  

 

LAMIVUDINE  

 

Procedural Therapy  

 

Reportable infectious diseases  

* Infectious disease notification: In the United States, specific infectious diseases must be reported to the state or local public health department .