Acute hepatitis

Background

Causes of acute hepatitis

Drug or Toxin Related Liver Disease

Clinical Features

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Acute Hepatitis Features

Jaundice of the skin
Pediatric jaundice with icterus of sclera.
  • Nausea/Vomiting
  • RUQ pain
    • Enlarged, tender liver
  • Fever
  • Jaundice
  • Bilirubinuria

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Differential Diagnosis

RUQ Pain

Evaluation

  • LFTs
    • AST, ALT > 1000s
    • Elevated bilirubin
    • Elevated alk phosphatase
  • INR
    • Coagulopathy
  • 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

  • Jaundice
  • Viral Hepatitis
  • Acute hepatic failure

References

  1. ↑ 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.
  2. ↑ Oyama, LC: Disorders of the Liver and Biliary Tractin Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2014, (Ch) 107: p 1186-1204
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