Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • 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 +++ Epidemiology + • 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 +++ Symptoms and Signs + • Right upper quadrant pain• Jaundice• Liver failure• Dark urine• Light colored stools• Hepatomegaly• Spider angiomas +++ Laboratory Findings + • Elevated transaminases• Antihepatitis B core Ab (elevated in chronic also), surface antigen, antihepatitis B early antigen Ab• Antihepatitis C antibodies• Hyperbilirubinemia• Antihepatitis A antibodies +++ Imaging Findings + • Nonspecific, occasional hepatomegaly + • Onset/duration• Family history• Injection drug use• Transfusion history• History of alcoholism• Medications• Travel history +++ Rule Out + • Cholecystitis• Choledocholithiasis• Pancreatitis• Cholangitis + • Transaminases• Hepatitis serologies• Right upper quadrant US• Serum fractionated bilirubin +++ When to Admit + • Liver failure +++ Surgery + • Liver transplantation +++ Indications + • Fulminant liver failure• Cirrhosis• Hepatoma +++ Medications + • Interferon (for hepatitis B and C)• Ribavirin (for hepatitis C)• Antihepatitis A Ig• Lamivudine (for chronic hepatitis B) +++ Treatment Monitoring + • Liver function tests• Hepatitis C viral load (RNA) +++ Complications + • Of liver transplantation:-Primary nonfunction-Rejection-Biliary leak or stricture-Hemorrhage-Hepatic artery thrombosis +++ Prognosis + • 90% remission or recovery (hepatitis B)• 10% have chronic hepatitis B (70-90% as carrier only)• 55-70% chronic hepatitis C +++ Prevention + • Hepatitis B vaccine• Hepatitis A vaccine (endemic areas) +++ References ++Schuppan D, Afdhal NH: Liver cirrhosis. Lancet 2008;371:838. [PubMed: 18328931] Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth