Acute hepatitis

Question 1

What is the definition of acute hepatitis?

Answer 1

Sudden onset of liver inflammation, normally due to viral infection lasting less than 6 months

Question 2

What is the epidemiology of Hep A-C and E?

Answer 2

• Hep A most common
• Hep B - carriage rate of 0.1-0.5% → Hep D
• Hep C – 240 million people worldwide affected
• Hep E – Mortality of severe hepatic failure 1-2%

Question 3

What is the pathology of acute hepatitis (including Hep A-C and E specifically)?

Answer 3

• Non-specific changes – dependent on cause and individual
• Hepatocytes swell, granulose and vacuole
• Hepatocytes can undergo necrosis and shrink (spotty/focal to massive)
• Bridging between central veins and portal tracts
• Inflammation infiltrated by lymphocytes
• Fatty changes may also occur
• Hep A – replicates in liver, excreted in bile and then faeces 2 weeks before symptoms and up to 7 days after. Spread by faeco-oral route of contaminated food/water.
• Hep B – vertical transmission from mother to child, IV spread through blood, through abrasions on contaminated objects. Semen and saliva spread also possible.
• Hep C – spread by blood, limited sexual transmission.
• Hep E – transmitted by contaminated water or dogs/pigs/rodents

Question 4

What are the risk factors/aetiology of acute hepatitis?

Answer 4

• Infections (Hep A-E, toxoplasma gondii, cytomegalovirus, EBV, yellow fever)
• Paracetamol, ketoconazole, nitrofurantoin, Isoniazid (TB treatment), Methylodopa (hypertension treatment)
• Alcohol
• Poison (Aflatoxin)
• Pregnancy
• Wilsons disease
• Circulatory insufficiency

Question 5

What are the signs/symptoms of acute hepatitis?

Answer 5

• Non specific – feeling ‘unwell’
• Nausea/vomiting
• Anorexia
• Jaundice
• Dark urine
• Pale stools
• Palpable liver – spleen may also be palpable
• Lymphadonopathy
• Rashes
• Mental confusion

Question 6

What other diseases does acute hepatitis present similarly to?

Answer 6

• Other forms of hepatitis
• Cholecystitis
• Cholangitis
• Pancreatitis

Question 7

What investigations are carried out when acute hepatitis is suspected?

Answer 7

• LFT’s – bilirubinuria ↑, ↑ AST/ALT
• Urinary urobilinogen ↑
• WBC ↓ and ↑ lymphocytes
• Anaemia
• ESR ↑
• Anti-HAV IgM ↑

Question 8

What are the surgical treatments for acute hepatitis?

Answer 8

Liver transplant

Question 9

What are the pharmacological treatments for acute hepatitis?

Answer 9

• Formaldehye-inactive HAV vaccination (prevention)
• Human immunoglobulin
• Entercavir/tenofovir
• Hep C: interferon
• Fluids

Question 10

What are the non pharmacological treatments for acute hepatitis?

Answer 10

• Rehydration
• Rest – avoid physical exertion until symptoms have improved
• Hand hygiene