Hepatitis A

Hepatitis A - Acute
Rahul Soman, M. Pharm

 

Definition  

Acute systemic viral infection producing a symptomatic or asymptomatic illness that resolves spontaneously in most cases

 

Medical History  

* Male homosexual

* Substance Abuse

* Environmental Exposure

* Past medical history of Transfusion of blood product

* Liver disease, chronic

 

Findings  

* Malaise

* Fatigue

* Fever

* Headache

* Nausea and vomiting - Acute

* Loss of appetite

* Bradyarrhythmia - Acute

* Lymphadenopathy - Acute

* Hepatomegaly - Acute

* Splenomegaly

* Abdominal tenderness

* Jaundice

* Urine looks dark

* Acholic stool

* Myalgia

* Arthralgia

* Diarrhea

* Constipation

* Urticaria - Acute

* Pruritus - Acute

* Localized cutaneous vasculitis

 

Tests  

 

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 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 or known viral hepatitis  

* Alanine aminotransferase measurement: Marked increases in aminotransferase levels from 5-fold to more than 10-fold above the upper reference limit occur in acute viral hepatitis .

 

Suspected or known viral hepatitis  

* Aspartate aminotransferase measurement

 

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 .

 

Suspected hepatitis B  

* Complete blood count with white cell differential, automated: Thrombocytopenia may suggest advanced liver disease in patients with hepatitis .

 

Suspected abnormal liver function  

* Prothrombin time: A prolonged prothrombin time (PT) may be a sign of serious liver dysfunction, vitamin K deficiency, or coagulopathy .

 

Differential Diagnosis  

* Fulminating type A viral hepatitis, acute

* Relapsing type A viral hepatitis

* Hepatitis B - Acute

* Acute hepatitis B with hepatitis D

* Hepatitis E, acute

* Hepatitis C

* Infectious mononucleosis - Acute

* Cholecystitis - Acute

* Alcoholic liver disease - Acute

* Drug-induced liver disease

* Cytomegalovirus infection - Acute

* Ischemic hepatitis

* Autoimmune hepatitis

* Fitz-Hugh-Curtis syndrome

* Wilson's disease

* Toxoplasmosis - Acute

 

Treatment  

 

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 .

 

Dehydration  

* Intravenous fluid replacement: Intravenous fluid replacement is indicated for patients with dehydration when oral replacement cannot be accomplished .

 

Acute and chronic liver failure  

* Transplantation of liver: Orthotopic liver transplantation is the accepted treatment for patients with acute and chronic liver failure who are otherwise unlikely to survive .