Acute hepatitis

Question 1

How common is it?

Answer 1

Relatively common

Question 2

Who does it affect?

Answer 2

Viral - IVDU, sexually transmitted

Alcoholic

Question 3

What causes it?

Answer 3

Acute hepatitis is usually cause by viruses: A,B,C,D & E & EBV

Question 4

What risk factors are there (and how can they be reduced)?

Answer 4

Hygiene and sanitation
Unprotected sex
IV drug use
Alcohol abuse
Other drugs

Question 5

What signs may the patient have on examination?

Answer 5

Acute viral hepatitis follows a pattern of infection that involves three distinct phases:

1. The initial prodromal phase involves non-specific and flu-like symptoms: fatigue, nausea, vomiting, poor appetite, joint pain, and headaches. Late in this phase, people can experience liver-specific symptoms, including choluria and clay-colored stools.
2. Jaundiced skin/sclera follow prodrome after about 1–2 weeks and can last for up to 4 weeks. The non-specific symptoms seen in the prodromal typically resolve by this time, but people will develop an enlarged liver and right upper abdominal pain or discomfort. 10–20% of people will also experience an enlarged spleen, while some people will also experience a mild unintentional weight loss.
3. The recovery phase characterized by resolution of the clinical symptoms of hepatitis with persistent elevations in liver lab values and potentially a persistently enlarged liver. All cases of hepatitis A and E are expected to fully resolve after 1–2 months. Most hepatitis B cases are also self-limiting and will resolve in 3–4 months. Few cases of hepatitis C will resolve completely.

Question 6

Which other conditions might present similarly?

Answer 6

Acute Cholangitis
Acute Cholecystitis and Biliary Colic
Blunt Abdominal Trauma
Emergent Management of Pancreatitis
Emergent Treatment of Gastroenteritis
Gallstones (Cholelithiasis)
Intussusception
Pediatric Gastroenteritis in Emergency Medicine
Peptic Ulcer Disease
Small-Bowel Obstruction

Question 7

How would you investigate this patient?

Answer 7

LFTs
Serology
Immunology
USS

Question 8

What would you tell the patient and how would you explain the condition to them?

Answer 8

Hepatitis is the term used to describe inflammation of the liver. It’s usually the result of a viral infection or liver damage caused by drinking alcohol.

Some types will pass without any serious problems, while others can be long-lasting (chronic) and cause scarring of the liver (cirrhosis), loss of liver function and, in some cases, liver cancer.

Question 9

How do you think the patient and/or family might be affected by the diagnosis? Will it affect their
ability to work/care for themselves?

Answer 9

Acute hepatitis is usually self-limiting and will resolve in time.

The exception is with hep C which may develop into a chronic infection.

Question 10

What questions are they likely to have?

Answer 10

Is it treatable?
How long will it take me to get better?
Are there any side effects to the treatment?

Question 11

What treatment/s (surgical, pharmacological and non-pharmacological) would you discuss with
them? What risks and benefits of treatment are there?

Answer 11

Most individuals do not need hospital care. Drugs such as sedatives and narcotics, which are metabolised in the liver, should be avoided. Alcohol should be avoided during the acute illness.

A - Immunoglobulins
B - lamivudine, entecavir, tenofovir, interferon alpha
C - pegylated interferon-alfa + ribavirin + telaprevir or boceprevir
E - similar to A