Acute hepatitis: Difference between revisions
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==Background== | <languages/> | ||
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==Background== <!--T:1--> | |||
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{{Acute hepatitis causes}} | {{Acute hepatitis causes}} | ||
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{{Drug or Toxin Related Liver Disease}} | |||
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==Clinical Features== <!--T:2--> | |||
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{{Acute hepatitis features}} | {{Acute hepatitis features}} | ||
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==Differential Diagnosis== <!--T:3--> | |||
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{{DDX RUQ}} | {{DDX RUQ}} | ||
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==Evaluation== <!--T:4--> | |||
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*[[LFTs]] | *[[Special:MyLanguage/LFTs|LFTs]] | ||
**AST, ALT > 1000s | **AST, ALT > 1000s | ||
**Elevated bilirubin | **Elevated bilirubin | ||
**Elevated alk phosphatase | **Elevated alk phosphatase | ||
*INR | *INR | ||
**[[liver disease induced coagulopathy|Coagulopathy]] | **[[Special:MyLanguage/liver disease induced coagulopathy|Coagulopathy]] | ||
*Consider acetaminophen level | *Consider acetaminophen level | ||
*Acute [[viral hepatitis|hepatitis panel]] | *Acute [[Special:MyLanguage/viral hepatitis|hepatitis panel]] | ||
**Hep A Ab IgM | **Hep A Ab IgM | ||
**Hep B cAb IgM | **Hep B cAb IgM | ||
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**Hep C Ab | **Hep C Ab | ||
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{| class="wikitable" | {| class="wikitable" | ||
! Anti-hepatitis A, IgM | ! Anti-hepatitis A, IgM | ||
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==Management== | |||
==Management== <!--T:7--> | |||
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*Treat underlying cause | *Treat underlying cause | ||
==Disposition== | |||
==Disposition== <!--T:9--> | |||
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Consider admission for: | Consider admission for: | ||
*Bilirubin > 20 | *Bilirubin > 20 | ||
*PT 50% above normal | *PT 50% above normal | ||
*[[Hypoglycemia]] | *[[Special:MyLanguage/Hypoglycemia|Hypoglycemia]] | ||
*[[Hypoalbuminemia]] | *[[Special:MyLanguage/Hypoalbuminemia|Hypoalbuminemia]] | ||
*Any [[GI bleeding]] | *Any [[Special:MyLanguage/GI bleeding|GI bleeding]] | ||
==See Also== <!--T:11--> | |||
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*[[Special:MyLanguage/Jaundice|Jaundice]] | |||
*[[Special:MyLanguage/Viral Hepatitis|Viral Hepatitis]] | |||
*[[Special:MyLanguage/Acute hepatic failure|Acute hepatic failure]] | |||
== | ==References== <!--T:13--> | ||
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<references/> | <references/> | ||
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[[Category:GI]] | [[Category:GI]] | ||
[[Category:ID]] | [[Category:ID]] | ||
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Latest revision as of 17:02, 6 January 2026
Background
Causes of acute hepatitis
- Acetaminophen toxicity (most common cause of acute liver failure in the US[1])
- Viral hepatitis
- Toxoplasmosis
- Acute alcoholic hepatitis
- Toxins
- Ischemic hepatitis
- Autoimmune hepatitis
- Wilson's disease
Drug or Toxin Related Liver Disease
- Liver damage from drugs or toxins may be cytotoxic from the primary drug or its metabolites, or may be caused by veno-occlusive disease or hypersensitivity disease[2]
- Common Drugs and Toxins
- Acetaminophen
- Amiodarone
- Amphotericin
- Anabolic steroids
- Azathioprine
- Carbamazepine
- Chlorpromazine
- Cisplatin
- Contraceptives
- Cyclophosphamide
- Erythromycin
- Gold salts
- Haloperidol
- Isoniazid
- Ketoconazole
- Lovastatin
- Methotrexate
- Methoxyflurane
- Methyldopa
- Phenobarbital
- Phenytoin
- Quinidine
- Salicylates
- Tetracycline
- Valproic acid
- Verapamil
Clinical Features
Acute Hepatitis Features
- Nausea/Vomiting
- RUQ pain
- Enlarged, tender liver
- Fever
- Jaundice
- Bilirubinuria
Differential Diagnosis
RUQ Pain
- Gallbladder disease
- Pancreatitis
- Acute hepatitis
- Pancreatitis
- GERD
- Appendicitis (retrocecal)
- Pyogenic liver abscess
- Bowel obstruction
- Cirrhosis
- Budd-Chiari syndrome
- GU
- Other
- Hepatomegaly due to CHF
- Peptic ulcer disease with or without perforation
- Pneumonia
- Herpes zoster
- Myocardial ischemia
- Pulmonary embolism
- Abdominal aortic aneurysm
Evaluation
- LFTs
- AST, ALT > 1000s
- Elevated bilirubin
- Elevated alk phosphatase
- INR
- Consider acetaminophen level
- Acute hepatitis panel
- Hep A Ab IgM
- Hep B cAb IgM
- Hep B sAg
- Hep B sAb
- Hep C Ab
| Anti-hepatitis A, IgM | Hepatitis B surface antigen | Anti-hepatitis B core, IgM | Anti-hepatitis C | Interpretation |
|---|---|---|---|---|
| Positive | Negative | Negative | Negative | Acute hepatitis A |
| Negative | Positive | Positive | Negative | Acute hepatitis B |
| Negative | Positive | Negative | Negative | Chronic hepatitis B infection |
| Negative | Negative | Positive | Negative | Acute hepatitis B; quantity of hepatitis B surface antigen is too low to detect |
| Negative | Negative | Negative | Positive | Acute or chronic hepatitis C; additional tests are required to make the determination |
Management
- Treat underlying cause
Disposition
Consider admission for:
- Bilirubin > 20
- PT 50% above normal
- Hypoglycemia
- Hypoalbuminemia
- Any GI bleeding
See Also
References
- ↑ Ostapowicz G, Fontana RJ, Schiodt FV, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med. 2002 Dec 17; 137(12): 947-54.
- ↑ Oyama, LC: Disorders of the Liver and Biliary Tractin Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2014, (Ch) 107: p 1186-1204