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hepatitis
Etiology:
1) viral hepatitis
2) viral infections producing systemic disease [3]
- yellow fever, EBV, CMV, HIV, rubella, rubeolla, coxsackie B, adenovirus, Herpes simplex, Herpes zoster
3) other infections [3]
- leptospirosis, toxoplasmosis
4) alcoholic hepatitis
5) non-alcoholic steatohepatitis (NASH)
6) drug-induced hepatitis
7) autoimmune chronic hepatitis
a) most often affects young women
b) associated symptoms: arthralgias, arthritis, skin rash, fever
8) fatty liver of pregnancy
9) ischemic hepatitis
10) also see chronic hepatitis
Epidemiology:
- 5 cases of adenovirus type 41 infection identified in Alabama in Nov 2021 [5]
Clinical manifestations:
1) malaise
2) nausea/vomiting
3) anorexia
4) fatigue
5) diarrhea
6) low-grade fever
7) hepatomegaly with tenderness
8) jaundice
9) dark urine
Laboratory:
1) liver function tests
a) increased serum transaminases
b) increased serum gamma-glutamyltransferase (serum GGT)
c) increased serum alkaline phosphatase
d) serum bilirubin: hyperbilirubinemia
e) increased lactate dehydrogenase (LDH)
2) markers of viral hepatitis, hepatitis serology
3) markers of autoimmune hepatitis
a) increased erythrocyte sedimentation rate (ESR)
b) positive antinuclear antibody
c) positive LE cell
4) antinuclear nuclear antibody (autoimmune)
5) antimitochondrial antibody
6) eosinophilia in drug-induced hepatitis
7) see ARUP consult [4]
Radiology:
- abdominal ultrasound
Differential diagnosis:
1) acute hepatic congestion
2) disseminated sepsis
3) liver abscess
4) biliary tract disease
5) Wilson's disease
Management:
1) management of viral hepatitis
2) autoimmune chronic hepatitis
- glucocorticoids
- azathioprine
3) indications for hospitalization
a) dehydration with inability to tolerate oral fluids
b) signs of hepatic failure
- prolongation of prothrombin time
- hepatic encephalopathy
Interactions
disease interactions
Related
acute liver failure (ALF)
cirrhosis
Specific
acute hepatitis
alcoholic hepatitis
autoimmune hepatitis
cholestatic hepatitis
chronic hepatitis
drug/toxin-induced hepatitis
non-alcoholic steatohepatitis (NASH); metabolic dysfunction-associated steatohepatitis (MASH)
portal triaditis
viral hepatitis
General
inflammation
liver disease
References
- Saunders Manual of Medical Practice, Rakel (ed),
WB Saunders, Philadelphia, 1996, pg 369-70
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- Ferri's Clinical Advisor, Instant Diagnosis and Treatment,
Ferri FF (ed), Mosby, Philadelphia, 2003
- ARUP Consult: Hepatitis, Acute
deprecated reference
- Hepatitis Virus Screening Algorithm
https://arupconsult.com/algorithm/hepatitis-virus-screening-algorithm
- Centers for Disease Control & Prevention (CDC)
Recommendations for Adenovirus Testing and Reporting of Children with
Acute Hepatitis of Unknown Etiology.
CDC Health Alert Network. April 21, 2022
https://emergency.cdc.gov/han/2022/han00462.asp
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
What Is Viral Hepatitis?
https://www.niddk.nih.gov/health-information/liver-disease/viral-hepatitis/what-is-viral-hepatitis