Acute Hepatitis

1.  Common Sx:  anorexia, nausea, vomiting, fever, malaise.  Maybe jaundice
2.  Dx by increased ALT & AST, often >1,000 IU
  • If AlkPhos ↑ disproportionately to ALT/AST, suspect Biliary Disease (get image)
  • Acute Pancreatitis can mimic hepatitis: order serum Lipase
  • If painless jaundice, consider pancreatic cancer (CT), hemolytic anemia (CBC)
3.  Prothrombin Time defines severity (≤1.3 OK;   ≥1.6 severe)
Hepatitis A
  • HepA IgM Antibody = Acute Hep A
    1. Total Hep A Ab pos, IgM neg = already immune
Hepatitis B  —  Both of the following tests should be positive
  • HepB surface Antigen  (HBsAg)
  • HepB core IgM Antibody
    1. Only HBsAg Pos = Chronic Hep B
      Only HepB core IgM AB Pos = tail end Acute Hep B
Hepatitis C
  • Hep C Viral Load (HCV RNA)  [esp. if risk factors]
  • HepC Antibody: 50% Pos; others convert by 12 wks
    1. Only HCV RNA Pos = Acute Hep C for sure
      Both pos. could be acute or chronic
Hepatitis D
  • Only in pt. w/ Chronic HepB.  Hep D rare in US.
  • HepD Antibody  (rarely ordered)
Hepatitis E
  • 3rd World Travel; no commercial test available
  • 25% mortality in pregnancy (call CDC for test kit)
  • Epstein-Barr IgM Antibody
  • Heterophile (Monospot) may take weeks to convert
Other Microbes
  • Self- limiting (e.g. CMV, Toxo, Herpesvirus-6, -7, etc.)
  • Don’t Test
Alcoholic Hepatitis
  • History of recent binge
  • AST > ALT, usually in 200-300 IU range
  • History: Meds, Environmental, Lead, Mushrooms, etc.
Wilson’s Disease  (very rare)
  • Low serum ceruloplasmin