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ACUTE HEPATITIS

General Signs/Symptom s Labs/Diagnosis Prevent ion Treatment

Hepati t is ARNAhepatovirus(picornavirusfamily)

Transmission: fecal-oralroute, crowding, poorsanitation

Incubation: avg 30 D

No chronic carrier state

Onset: abrupt or insidious

Malaise, arthralgias,myalgias, fatigue, URI sx,anorexia, N/V, +/-

diarrhea, constipation,fever

Abd pain: mild, constant,RUQ or epigastrium,worse w/ jarring/exertion

Jaundice,hepatosplenomegaly, softenlarged LN (MCcervical, epitrochlear)

WBC nl to low, +/- largeatypical lymphocytes

Mild proteinuria, bilirubinuria

Elevated AST, ALT, bilirubin,

alk phos

Anti-HAV: IgM anti-HAV peakfirst, IgG anti-HAV rise after 1month

IgG anti-HAV indicatesprevious exposure,noninfectivity, immunity

Hand washing

Vaccine

Postexposure

prophylaxis: HAVvaccine for 40 yrs or 6mos=chronic

Anti-HBs: recovery from infxn,noninfectivity, immunity

Anti-HBc: IgM indicates acute;IgG persists indefinitely

HBeAG: viral replication &infectivity; >3 mos= chronic

HBV DNA: parallels HBeAG;viral replication & infectivity

Hand washing

Careful needledisposal byhealthcare workers

Screen donatedblood, pregnant F

Vaccine

HBIG given within 7days of exposure

Bed rest if sx are severe

IV 10% glucose if severeN/V or PO intakedecreased

Hospitalization at livertransplant center ifencephalopathy or severecoagulopathy

Prognosis: acute illnesssubsides 2-3 weeks,complete recovery within3-6mo

Hepati t is CSingle stranded

RNA virus(hepacivirus), 6genotypes

Transmission: IVDU,infected blood products

Coinfection w/ HIV foundin at least 30% of HIV pts

Incubation: 6-7 wks

Increased risk: non-Hodgkin lymphoma, insulin

Usually mild,asymptomatic

Complications: lichenplanus, AI thyroiditis,sialadenitis, idiopathicpulmonary fibrosis

Waxing & waningaminotransferase elevations

Enzyme immunoassay todetect anti-HCV

Test blood products

Vaccine against HAVand HBV for pts withchronic Hep C

Peginterferon x 6-24 wks

Ribavirin if peginterferonfails after 3 months

Prognosis: recovery within3-6 mos

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resistance, chronic Hep C,cirrhosis, hepatocellularCA

Hepati t is DRNA virus, 8genotypes (I-VIII)

Co-infection w/ Hep B;most specifically inpresence of HBsAG

Transmission:percutaneous

Increased risk of cirrhosis,hepatocellular CA

Detection of anti-HDV or HDVRNA in serum

Hepati t is E

RNA hepevirus

MC found in Asia, middleEast, North Africa

Transmission: waterborneoutbreaks; spread byswine

Self-limited Improved publichygiene in endemicareas

Prognosis: mortality ratehighest in pregnant F

Hepati t is G

Flavivirus

Transmission:

percutaneous

Associated with chronic

viremia

Very rare

** All information from Lange, Chapter 16, pgs 642-649 **