Hepatitis (acute)

Acute Hepatitis of any etiology (from benign Hep A to imminently fatal mushroom poisoning) begins with subtle anorexia, nausea, malaise, & upper abdominal pain/discomfort.

Signs on exam may include:
  • Tenderness to gentle punch-percussion of the liver
  • Jaundice (in acute viral hepatitis, usually occurs as other symptoms begin to subside)

Diagnose:  Elevated LFTs (transaminases ALT & AST)

Identifying the etiology —  Start with antibody tests:
  • Hep A, IgM  [may order Total Hep A, fractionate IgM & IgG if positive)
  • Hep B core Antibody, IgM fraction
  • Hep B surface Antibody (if positive, pt. already immune)
  • Hep B surface Antigen (HBsAg) = if positive, some type of Hep B
  • Hep C Antibody (seroconverts at 8-12 weeks of illness; if positive, acute Sx are something else).
If no Dx with above tests, consider:
  • Monospot or Epstein-Barr Antibody IgM.
  • Hep C RNA by PCR (for acute Hep C; may be expensive).

See posting Acute Hepatitis.