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  • • Viral etiology most common cause

    • Most common viral etiologies: Hepatitis B, C, and A

    • Other viral etiologies include:

    • -Hepatitis D and E

      -Cytomegalovirus (CMV)

      -Epstein-Barr

      -HIV

      -Herpes simplex virus

    • Other nonviral etiologies include:

    • -Alcoholic

      -Drug side effects

      -Environmental toxicity

      -Ischemia

      -Idiopathic

      -Autoimmune

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Epidemiology

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  • • Hepatitis B and C most endemic in Asia and Africa

    • Hepatitis A most frequent in areas of poor sanitation

    • In 40% of hepatitis C cases, no is source identified

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Symptoms and Signs

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  • • Right upper quadrant pain

    • Jaundice

    • Liver failure

    • Dark urine

    • Light colored stools

    • Hepatomegaly

    • Spider angiomas

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Laboratory Findings

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  • • Elevated transaminases

    • Antihepatitis B core Ab (elevated in chronic also), surface antigen, antihepatitis B early antigen Ab

    • Antihepatitis C antibodies

    • Hyperbilirubinemia

    • Antihepatitis A antibodies

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Imaging Findings

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  • • Nonspecific, occasional hepatomegaly

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  • • Onset/duration

    • Family history

    • Injection drug use

    • Transfusion history

    • History of alcoholism

    • Medications

    • Travel history

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Rule Out

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  • • Cholecystitis

    • Choledocholithiasis

    • Pancreatitis

    • Cholangitis

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  • • Transaminases

    • Hepatitis serologies

    • Right upper quadrant US

    • Serum fractionated bilirubin

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When to Admit

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  • • Liver failure

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Surgery

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  • • Liver transplantation

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Indications

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  • • Fulminant liver failure

    • Cirrhosis

    • Hepatoma

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Medications

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  • • Interferon (for hepatitis B and C)

    • Ribavirin (for hepatitis C)

    • Antihepatitis A Ig

    • Lamivudine (for chronic hepatitis B)

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Treatment Monitoring

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  • • Liver function tests

    • Hepatitis C viral load (RNA)

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Complications

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  • • Of liver transplantation:

    • -Primary nonfunction

      -Rejection

      -Biliary leak or stricture

      -Hemorrhage

      -Hepatic artery thrombosis

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Prognosis

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  • • 90% remission or recovery (hepatitis B)

    • 10% have chronic hepatitis B (70-90% as carrier only)

    • 55-70% chronic hepatitis C

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Prevention

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  • • Hepatitis B vaccine

    • Hepatitis A vaccine (endemic areas)

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References

Schuppan D, Afdhal NH: Liver cirrhosis. Lancet 2008;371:838.  [PubMed: 18328931]

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