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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
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
- 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
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
- 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.