Acute hepatitis is liver inflammation lasting less than 6 months, caused by viruses (hepatitis A, B, C, E), drugs such as acetaminophen, alcohol or autoimmune disease. Most patients recover, but some progress to acute liver failure.
Key symptoms
- Fatigue and loss of appetite
- Nausea and vomiting
- Right upper abdominal discomfort
- Yellow skin and eyes, dark urine and pale stools
- Fever and joint pain in viral hepatitis
What you find on exam
- Jaundice and yellow sclera
- Tender, enlarged liver
- Mental status to detect encephalopathy
- Bruising or bleeding
- Signs of chronic liver disease
Tests
- Liver tests: ALT and AST often very high, bilirubin
- INR and glucose to judge liver function
- Viral serology: hepatitis A IgM, hepatitis B surface antigen and core IgM, hepatitis C antibody and RNA
- Acetaminophen level, alcohol history and autoimmune markers
- Right upper quadrant ultrasound with Doppler
Treatment basics
- Supportive care: rest, fluids and nutrition
- Stop alcohol and liver-toxic drugs
- N-acetylcysteine for acetaminophen toxicity
- Antivirals for selected hepatitis B or C
- Vaccinate contacts and report to public health
Red flags
- Confusion or drowsiness (hepatic encephalopathy)
- INR above 1.5 or bleeding
- Low blood sugar, kidney failure or rapidly rising bilirubin
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.