Acute hepatitis: Difference between revisions
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{{DDX RUQ}} | {{DDX RUQ}} | ||
== | ==Evaluation== | ||
*LFTs | *[[LFTs]] | ||
**AST, ALT > 1000s | **AST, ALT > 1000s | ||
**Elevated bilirubin | **Elevated bilirubin | ||
**Elevated alk | **Elevated alk phosphatase | ||
*INR | *INR | ||
**Coagulopathy | **[[liver disease induced coagulopathy|Coagulopathy]] | ||
*Consider acetaminophen level | *Consider acetaminophen level | ||
*Acute hepatitis panel | *Acute [[viral hepatitis|hepatitis panel]] | ||
**Hep A Ab IgM | **Hep A Ab IgM | ||
**Hep B cAb IgM | **Hep B cAb IgM | ||
Line 65: | Line 65: | ||
==Disposition== | ==Disposition== | ||
Consider admission for: | |||
*Bilirubin > 20 | |||
*PT 50% above normal | |||
*[[Hypoglycemia]] | |||
*[[Hypoalbuminemia]] | |||
*Any [[GI bleeding]] | |||
==See Also== | ==See Also== | ||
*[[Jaundice]] | *[[Jaundice]] | ||
*[[Viral Hepatitis]] | *[[Viral Hepatitis]] | ||
*[[Acute hepatic failure]] | |||
==References== | ==References== |
Revision as of 18:18, 4 June 2020
Background
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
Clinical Features
Acute Hepatitis Features
- Nausea/Vomiting
- RUQ pain
- Enlarged, tender liver
- Fever
- Jaundice
- Bilirubinuria
Differential Diagnosis
RUQ Pain
- Gallbladder disease
- Pancreatitis
- Acute hepatitis
- Pancreatitis
- GERD
- Appendicitis (retrocecal)
- Pyogenic liver abscess
- Bowel obstruction
- Cirrhosis
- Budd-Chiari syndrome
- GU
- Other
- Hepatomegaly due to CHF
- Peptic ulcer disease with or without perforation
- Pneumonia
- Herpes zoster
- Myocardial ischemia
- Pulmonary embolism
- Abdominal aortic aneurysm
Evaluation
- LFTs
- AST, ALT > 1000s
- Elevated bilirubin
- Elevated alk phosphatase
- INR
- 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
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.