Hepatitis (Acute & Chronic)

• • 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