Hepatitis survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mydah Sajid, MD[2]

Hepatitis Survival Guide Microchapters
Overview
Causes
Diagnosis
Treatment
Dos

Overview

This section provides a short and straight-to-the-point overview of acute hepatitis. Acute hepatitis is defined as an acute inflammation of the hepatocytes resulting in deranged liver functions and hepatocyte injury. It can be due to infective or non-infective causes. The most common infective causes included hepatitis viruses (including Hepatitis A, B, C, D, and E). The non-infective causes include medications, alcohol, and autoimmune hepatitis. The treatment is mainly supportive. Regular monitoring should be done to look for adequate resolution of infection, signs of hepatic failure, encephalopathy, or chronic disease.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

• Acetaminophen overdose
• Heat stroke
• Mushroom poisoning

Common Causes

• Hepatitis A
• Hepatitis B
• Hepatitis D
• Hepatitis E
• Autoimmune hepatitis
• Epstein Barr virus
• Cytomegalovirus
• Herpes simplex virus
• Alcoholic hepatitis
• Antibiotics
• Anticonvulsant drugs

Diagnosis

Shown below is an algorithm summarizing the diagnosis of hepatitis.

Patients commonly present with: Loss of appetite Nausea Vomiting Right upper quadrant abdominal pain Muscle aches Fatigue Icterus Dark-colored urine Clay-colored stool and diarrhea Artharalgia Pruritis Urticaria Fever

On physical examination there can be: Jaundice Hepatomegaly Splenomegaly

Perform liver function tests and abdominal ultrasound

The following results are suggestive of acute hepatitis: Elevated serum bilirubin levels Elevated levels of transaminases enzymes including Alanine aminotransferase and Aspartate aminotransferase greater than five folds the normal reference values. Mild elevation or normal value of Alkaline phosphatase and Gamma-glutamyl transpeptidase. Marked elevation of these enzymes show peri-ampullary or biliary obstruction.

Perform Viral titers and antigen detection tests: IgM levels for HAV IgM levels for HBV core antigen Serological assay to detect antibody levels for HCV IgM levels for HDV

Treatment

Shown below is an algorithm summarizing the treatment of acute hepatitis.

Look for severe clinical symptoms like nausea, vomiting, hepatic encephalopathy, i.e., changes in sleep pattern, altered mental status, agitated behavior, and lab finding of hepatic failure, i.e., prolonged prothrombin time and elevated serum bilirubin levels.

No

Yes

For Hepatitis A: Supportive treatment. Give patients anti-emetics, antipyretics, and proton pump inhibitors. Maintain adequate hydration with oral or intravenous fluid. Regular monitoring of INR and LFTs to assess liver function.

For Hepatitis B: Supportive treatment. All family members and close contacts should be screened for the infection. Hepatitis B surface antigen should be rechecked at regular intervals to assess the chronicity of infection.

For Hepatitis C: Early Interferon alpha therapy should be initiated as it results in undetectable viral levels with sustained anti-viral action.

Requires hospitalization with regular monitoring

Dos

• The ALT and AST levels on average raise to the thousands in acute hepatitis indicating hepatocellular injury.
• Alkaline phosphatase can also be raised showing a cholestatic picture. Serum total bilirubin levels are elevated with an increase in conjugated bilirubin levels.
• AST and ALT levels in alcoholic hepatitis are usually below 300 iu/L and rarely over 500.
• Drug-induced hepatitis is indistinguishable from viral hepatitis as it also shows AST and ALT levels in the thousands.
• Abdominal ultrasound is also done in initial management of acute hepatitis patients. It might show increase in the liver span, changes in echogenicity, texture, acalculous cholecystitis and splenomegaly.