Hepatitis A: Difference between revisions
| (7 intermediate revisions by 4 users not shown) | |||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Transmission by | |||
*Transmission | |||
**Fecal-oral route | **Fecal-oral route | ||
**Most commonly transmitted from asymptomatic children to adults | **Most commonly transmitted from asymptomatic children to adults | ||
**Can also occur with improper food handling, oyster consumption | **Can also occur with improper food handling, oyster consumption | ||
==Clinical Features== | |||
[[File:Jaundice eye.jpg|thumb|Jaundice from Hepatitis A.]] | |||
**~ | *Incubation period 15-50 days | ||
*Prodrome of [[nausea/vomiting]], malaise | |||
**~1 week into illness, may have dark urine (bilirubinuria), clay-colored stools, [[jaundice]] | |||
*No chronic component | *No chronic component | ||
*~1-2% of HAV infections in adults lead to fulminant hepatic failure | *Can cause aversion to tobacco among smokers | ||
*Death from hepatic failure is rare | *~1-2% of HAV infections in adults lead to fulminant [[hepatic failure]] | ||
*Death from [[hepatic failure]] is rare | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 18: | Line 19: | ||
==Evaluation== | ==Evaluation== | ||
[[File:Hepatitis A serology.jpg|thumb|Hepatitis A serology.]] | |||
{{Acute hepatitis panel}} | {{Acute hepatitis panel}} | ||
==Management== | ==Management== | ||
*Supportive care | *Supportive care | ||
** | **[[Antiemetics]] | ||
**oral or IV hydration | **[[oral rehydration therapy|Oral]] or [[IVF|IV hydration]] | ||
** | **Avoid hepatotoxic medications | ||
*Patients with fulminant hepatic failure (1-2% of HAV infections) may be considered for liver transplant | *Patients with fulminant hepatic failure (1-2% of HAV infections) may be considered for liver transplant | ||
*Postexposure prophylaxis recommend for non-immunized close contacts of patient | *Postexposure prophylaxis recommend for non-immunized close contacts of patient | ||
==Disposition== | ==Disposition== | ||
*Typically discharge, admit if: | |||
**INR >2 | |||
**Unable to tolerate PO | |||
**Intractable pain | |||
**Bilirubin >30 | |||
**[[Hypoglycemia]] | |||
**Significant comorbidity/immunocompromised | |||
==See Also== | ==See Also== | ||
Latest revision as of 20:34, 28 February 2024
Background
- Transmission by
- Fecal-oral route
- Most commonly transmitted from asymptomatic children to adults
- Can also occur with improper food handling, oyster consumption
Clinical Features
- Incubation period 15-50 days
- Prodrome of nausea/vomiting, malaise
- ~1 week into illness, may have dark urine (bilirubinuria), clay-colored stools, jaundice
- No chronic component
- Can cause aversion to tobacco among smokers
- ~1-2% of HAV infections in adults lead to fulminant hepatic failure
- Death from hepatic failure is rare
Differential Diagnosis
Causes of acute hepatitis
- Acetaminophen toxicity (most common cause of acute liver failure in the US[1])
- Viral hepatitis
- Toxoplasmosis
- Acute alcoholic hepatitis
- Toxins
- Ischemic hepatitis
- Autoimmune hepatitis
- Wilson's disease
Evaluation
Interpreting Acute Hepatitis Panel Results
| 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
- Supportive care
- Antiemetics
- Oral or IV hydration
- Avoid hepatotoxic medications
- Patients with fulminant hepatic failure (1-2% of HAV infections) may be considered for liver transplant
- Postexposure prophylaxis recommend for non-immunized close contacts of patient
Disposition
- Typically discharge, admit if:
- INR >2
- Unable to tolerate PO
- Intractable pain
- Bilirubin >30
- Hypoglycemia
- Significant comorbidity/immunocompromised
See Also
External Links
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.