- Posted on: Aug 12 2020
What is Hepatitis?
Hepatitis is inflammation of the liver usually due to a virus, but other infections, drugs, alcohol, and autoimmune diseases can cause hepatitis as well. There are 5 types of viral hepatitis A, B, C, D, and E.
What is Hepatitis A?
It is transmitted through the fecal-oral route and is associated with contaminated food and water and international travel.
- Patients are usually asymptomatic or mildly symptomatic. Hep A can be associated with spiking fever and on the physical exam there can be malaise, anorexia, nausea, vomiting, abdominal pain.
- No treatment is needed, and Hep A does not progress to chronic hepatitis.
- Hepatitis is best prevented with handwashing and improved sanitation.
What is Hepatitis B?
Transmission is percutaneous, sexual, parenteral, perinatal.
- Most patients present asymptomatically but there are 3 possible states
- Subclinical: constitutional symptoms (malaise, anorexia, nausea, vomiting, abdominal pain) and a decreased desire to smoke in smokers
- Icteric: Jaundice
- Fulminant: Acute hepatic failure
- Diagnosis is made via blood tests and a liver biopsy can be done to assess the extent of the damage.
- The mainstay of treatment is supportive, the majority of patients do not progress to chronic hepatitis. Antivirals can be used for persistent/severe symptoms medications include entecavir and tenofovir.
- The hep B vaccine is administered in 3 doses at 0 1 and 6 months in adults.
What is Hepatitis C?
Transmission is usually parenteral most commonly through IV drug abuse. 85% of patients progress to chronic disease.
- Most patients are asymptomatic but acute Hep C presents with constitutional symptoms (malaise, anorexia, nausea, vomiting, abdominal pain) as well as right upper quadrant pain, dark urine, and clay-colored stool.
- Diagnosis can be made via blood tests for antibodies or HCV RNA which is the most sensitive test.
- There is a wide range of new antiviral treatment options available, including Ledipasvir-Sofosbuvir and Elbasvir-Grazoprevir.
What is Hepatitis D?
A co-infection with hepatitis B that is primarily transmitted parenterally.
- There is currently no FDA approved management, but interferon alpha has been used for chronic hep D.
What is Hepatitis E?
It is transmitted via a fecal-oral route similar to Hep A
- No treatment is needed as it is self-limiting and not associated with a chronic state.
- There is an increased risk of fulminant hepatitis in pregnant women specifically during the 3rd trimester
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