Acute hepatitis

Introduction:

·         Acute hepatitis should be reserved for patients who present with a syndrome of anorexia, jaundice and elevated ALT.

·   It is most often caused by viruses that are hepatotropic  ( hepatitis A, B, C, D, and E). Cytomegalovirus (CMV), herpes simplex, coxsackievirus, and adenovirus may also occasionally affect the liver.

Clinical features:

·         Anorexia, Nausea, Vomiting,

·         Jaundice

·         Dark urine,

·         Low grade fever,

·         Tender hepatomegaly

Investigation:

• ·         S. Bilirubin,  ALT
• ·         USG of HBS
• ·         CBC
• ·         Viral Marker-- Anti-HAV ,  Anti HEV, HBsAg
• ·         Prothombin Time

 

N. B. ALP should done in  clinical suspicion of  Obstructive jaundice ( Jaundice, Pale stool and generalized itching)

Management :

·         Supportive:

--Give i.v. fluids- if unable to take per oral

--Anti emetic- if needed

-- Constipation- Lactulose : 20-30 ml per day

--Correct prothombin time-By Vitamin K 10 mg I/V for 3 days

·         Specific :

-- No antiviral for HAV, HEV

--Antiviral for HBV  is be decided by specialist.

·         Stop all OCP, NSAID, Sedatives and Paracetamol. Vitamin supplementation is of no use.

N.B: Look for Altered consciousness, Flaps, Sleep disturbance, Bradycardia and High BP (signs of fulminant hepatic failure) and consider immediate referral.

Indication of hospitalization:

·         Deep jaundice

·         Intractable vomiting

·         High fever

·         Features of encephalopathy (grade I & II)

·         Pregnancy

   Grade I: Changes in behaviour with minimal change in level of consciousness

   Grade II: Disorientation, drowsiness, asterixis, inappropriate behaviour

   Grade III: Marked confusion, incoherent speech, sleeping but rousable

   Grade IV: Comatose, unresponsive, decorticate or decerebrate posturing

Referral to a specialist is recommended under the following circumstances:

·         Gradual deterioration of general condition

·         Progessively increasing prothombin time

·         Signs of encephalopathy (grade III & IV)

·         Pregnancy with HEV infection

HBV for further evaluation and management.