Viral hepatitis

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Hepatitis A

  • Most common form of transmission occurs from asymptomatic children to adults
  • Incubation period: 15-50d
  • Prodrome: nausea and vomiting, malaise, fever, abdominal pain
    • 1wk later bilirubinuria, clay-colored stool, jaundice
  • Death from hepatic failure is rare

Hepatitis B

  • Incubation period: 1-3 months
  • Presentation is similar to hep A
  • Lab tests:
    • HBsAg: + implies infection
    • Anti-HBs: implies clearance or vaccination
    • Anti-HBc: Implies prior infection; IgM = acute & in flares; only marker in window period; IgG always present
    • HBe-Ag: Implies active viral replication & infectivity
    • Anti-HBe: low infectivity
    • HBV DNA: Similar to HBe-Ag but more sensitive

Hepatitis C

  • Unlike Hep A and B, most often asymptomatic in acute phase of infection
  • >75% of patients advance to chronic stage
  • Active disease identified by reactive HCV ab and positive HCV RNA

Hepatitis D

  • Only currently with hepatitis B
  • High incidence of cirrhosis

Hepatitis E

  • Fecal-oral transmission
  • No carrier state
  • High associated mortality

Clinical Features

Acute Hepatitis Features

Differential Diagnosis

Acute hepatitis


  • Hepatitis panel, which typically consists of:
    • HepA-Ab, IgM
    • HBsAg
    • HBc-Ab, IgM
    • HC-Ab
  • PT correlates well with severity and prognosis of acute hepatitis


  • Household or close contacts of positive HepA individual may require IM HepA Ig if within 14 days of exposure


  • Admit
    • INR >2
    • Unable to tolerate PO
    • Intractable pain
    • Bilirubin >30
    • Hypoglycemia
    • Significant comorbidity/immunocompromised
    • Age >50 years

See Also