Acute hepatitis: Difference between revisions

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**Elevated alk phosphatase
**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

Revision as of 18:49, 29 September 2019

Background

Causes of acute hepatitis

Clinical Features

Acute Hepatitis Features

Jaundice of the skin
Pediatric jaundice with icterus of sclera.

Differential Diagnosis

RUQ Pain

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:
  1. Bilirubin > 20
  2. PT 50% above normal
  3. Hypoglycemia
  4. Hypoalbuminemia
  5. Any GI bleeding

See Also

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.