Viral hepatitis - Revision history

Ostermayer: Prepared the page for translation

2026-01-05T00:03:20Z

Prepared the page for translation

← Older revision		Revision as of 00:03, 5 January 2026
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			<languages/>
			<translate>

	==Background==		==Background==

	*Hepatocellular pattern of injury, where AST and ALT are higher than Tbili and Alk Phos; likely to have significantly elevated ALT and AST (20x normal or higher)		*Hepatocellular pattern of injury, where AST and ALT are higher than Tbili and Alk Phos; likely to have significantly elevated ALT and AST (20x normal or higher)
	*Of note, transmission of [[Hepatitis B]] and [[Hepatitis C]] through donated blood, blood products, and organs is rare in the US since blood screening became available in 1992		*Of note, transmission of [[Special:MyLanguage/Hepatitis B\|Hepatitis B]] and [[Special:MyLanguage/Hepatitis C\|Hepatitis C]] through donated blood, blood products, and organs is rare in the US since blood screening became available in 1992


	===Overview of Common Viral Hepatitis Agents===		===Overview of Common Viral Hepatitis Agents===
	*[[Hepatitis A]]
			*[[Special:MyLanguage/Hepatitis A\|Hepatitis A]]
	**Fecal-oral transmission		**Fecal-oral transmission
	**Associated with epidemics linked to a common source (water)		**Associated with epidemics linked to a common source (water)
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	***Whereas ~75% of adults are symptomatic		***Whereas ~75% of adults are symptomatic
	**Incubation period: 15-50d		**Incubation period: 15-50d
	**Prodrome: [[nausea/vomiting]], malaise, [[fever]], [[abdominal pain]]		**Prodrome: [[Special:MyLanguage/nausea/vomiting\|nausea/vomiting]], malaise, [[Special:MyLanguage/fever\|fever]], [[Special:MyLanguage/abdominal pain\|abdominal pain]]
	***1wk later: clay-colored stool, jaundice		***1wk later: clay-colored stool, jaundice
	**Death from [[hepatic failure]] is rare		**Death from [[Special:MyLanguage/hepatic failure\|hepatic failure]] is rare

	*[[Hepatitis B]]		*[[Special:MyLanguage/Hepatitis B\|Hepatitis B]]
	**Transmitted parenterally, blood contact, and unprotected sex		**Transmitted parenterally, blood contact, and unprotected sex
	**90% of exposed infants progress to chronic hepatitis; 10% of exposed adults progress to chronic hepatitis		**90% of exposed infants progress to chronic hepatitis; 10% of exposed adults progress to chronic hepatitis
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	***HBV DNA: Similar to HBe-Ag but more sensitive		***HBV DNA: Similar to HBe-Ag but more sensitive

	*[[Hepatitis C]]		*[[Special:MyLanguage/Hepatitis C\|Hepatitis C]]
	**Blood-borne, in US, most commonly transmitted through [[IV drug use]]. Infrequently transmitted through sexual contact		**Blood-borne, in US, most commonly transmitted through [[Special:MyLanguage/IV drug use\|IV drug use]]. Infrequently transmitted through sexual contact
	**90% of HCV infections progress to chronic hepatitis<ref>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</ref>		**90% of HCV infections progress to chronic hepatitis<ref>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</ref>
	**Unlike Hep A and B, most often asymptomatic in acute phase of infection		**Unlike Hep A and B, most often asymptomatic in acute phase of infection
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	**Active disease identified by reactive HCV ab and positive HCV RNA		**Active disease identified by reactive HCV ab and positive HCV RNA

	*[[Hepatitis D]]		*[[Special:MyLanguage/Hepatitis D\|Hepatitis D]]
	**Transmission similar to Hepatitis B		**Transmission similar to Hepatitis B
	**Can only co-infect patients with Hepatitis B (actively producing HBsAg)		**Can only co-infect patients with Hepatitis B (actively producing HBsAg)
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	**High incidence of cirrhosis		**High incidence of cirrhosis

	*[[Hepatitis E]]		*[[Special:MyLanguage/Hepatitis E\|Hepatitis E]]
	**Fecal-oral transmission		**Fecal-oral transmission
	**Usually results in mild illness, but can cause fulminant hepatitis in pregnant women<ref>Rein DB, Stevens GA, Theaker J, Wittenborn JS, Wiersma ST. The Global Burden of Hepatitis E Virus Genotypes 1 and 2 in 2005. Hepatology, Vol. 55, No. 4, 2012: 988-997</ref>		**Usually results in mild illness, but can cause fulminant hepatitis in pregnant women<ref>Rein DB, Stevens GA, Theaker J, Wittenborn JS, Wiersma ST. The Global Burden of Hepatitis E Virus Genotypes 1 and 2 in 2005. Hepatology, Vol. 55, No. 4, 2012: 988-997</ref>
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	***8.5% in second trimester		***8.5% in second trimester
	***21% in third trimester		***21% in third trimester


	==Clinical Features==		==Clinical Features==

			</translate>
	{{Acute hepatitis features}}		{{Acute hepatitis features}}
			<translate>


	==Differential Diagnosis==		==Differential Diagnosis==

			</translate>
	{{Acute hepatitis causes}}		{{Acute hepatitis causes}}
			<translate>


	==Evaluation==		==Evaluation==
	*[[LFTs]]
			*[[Special:MyLanguage/LFTs\|LFTs]]
	*INR		*INR
	**[[liver disease induced coagulopathy\|Coagulopathy]] correlates w/more severe liver dysfunction		**[[Special:MyLanguage/liver disease induced coagulopathy\|Coagulopathy]] correlates w/more severe liver dysfunction
	*Acute hepatitis panel		*Acute hepatitis panel
	**Hep A Ab IgM		**Hep A Ab IgM
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	**Hep C Ab		**Hep C Ab

			</translate>
	{{Acute hepatitis panel}}		{{Acute hepatitis panel}}
			<translate>


	==Management==		==Management==

	*Supportive care		*Supportive care
	**Symptomatic management; [[antiemetics]], [[pain control]], [[IVF\|rehydration]]		**Symptomatic management; [[Special:MyLanguage/antiemetics\|antiemetics]], [[Special:MyLanguage/pain control\|pain control]], [[Special:MyLanguage/IVF\|rehydration]]
	**Manage any complications of [[liver failure\|liver dysfunction]] and/or [[cirrhosis]]		**Manage any complications of [[Special:MyLanguage/liver failure\|liver dysfunction]] and/or [[Special:MyLanguage/cirrhosis\|cirrhosis]]
	**Avoid hepatotoxic meds		**Avoid hepatotoxic meds
	*HepA: Household or close contacts may require IM HepA Ig if within 14 days of exposure		*HepA: Household or close contacts may require IM HepA Ig if within 14 days of exposure
	*See also [[Hepatitis B post-exposure prophylaxis]]		*See also [[Special:MyLanguage/Hepatitis B post-exposure prophylaxis\|Hepatitis B post-exposure prophylaxis]]
	*Outpatient treatments for HCV include [[Interferon-α]], [ribavirin]], and newer direct acting antivirals (e.g. Harvoni)		*Outpatient treatments for HCV include [[Special:MyLanguage/Interferon-α\|Interferon-α]], [ribavirin]], and newer direct acting antivirals (e.g. Harvoni)


	==Disposition==		==Disposition==

	*Admit		*Admit
	**INR >2		**INR >2
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	**Intractable pain		**Intractable pain
	**Bilirubin >30		**Bilirubin >30
	**[[Hypoglycemia]]		**[[Special:MyLanguage/Hypoglycemia\|Hypoglycemia]]
	**Significant comorbidity/immunocompromised		**Significant comorbidity/immunocompromised
	**Age >50 years		**Age >50 years


	==See Also==		==See Also==
	*[[Jaundice]]
	*[[Acute Hepatitis]]		*[[Special:MyLanguage/Jaundice\|Jaundice]]
	*[[Acute hepatic failure]]		*[[Special:MyLanguage/Acute Hepatitis\|Acute Hepatitis]]
			*[[Special:MyLanguage/Acute hepatic failure\|Acute hepatic failure]]


	==References==		==References==

	<references/>		<references/>

	[[Category:GI]]		[[Category:GI]]
	[[Category:ID]]		[[Category:ID]]
			</translate>

Rossdonaldson1: /* Overview of Common Viral Hepatitis Agents */

2020-06-04T18:11:41Z

Overview of Common Viral Hepatitis Agents

← Older revision		Revision as of 18:11, 4 June 2020
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	**Most common risk factor is travel outside of the US <ref>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.</ref>		**Most common risk factor is travel outside of the US <ref>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.</ref>
	**Not associated with chronic carrier state; incubation period is approximately 30 days, and infectivity usually resolved prior to symptom onset		**Not associated with chronic carrier state; incubation period is approximately 30 days, and infectivity usually resolved prior to symptom onset
	*Most common form of transmission occurs from asymptomatic children to adults		**Most common form of transmission occurs from asymptomatic children to adults
	**Approximately only 5% of infected children symptomatic		***Approximately only 5% of infected children symptomatic
	**Whereas ~75% of adults are symptomatic		***Whereas ~75% of adults are symptomatic
	*Incubation period: 15-50d		**Incubation period: 15-50d
	*Prodrome: [[nausea/vomiting]], malaise, [[fever]], [[abdominal pain]]		**Prodrome: [[nausea/vomiting]], malaise, [[fever]], [[abdominal pain]]
	**1wk later: clay-colored stool, jaundice		***1wk later: clay-colored stool, jaundice
	*Death from [[hepatic failure]] is rare		**Death from [[hepatic failure]] is rare

	*[[Hepatitis B]]		*[[Hepatitis B]]
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	**90% of exposed infants progress to chronic hepatitis; 10% of exposed adults progress to chronic hepatitis		**90% of exposed infants progress to chronic hepatitis; 10% of exposed adults progress to chronic hepatitis
	**Serology<ref> www.cdc.gov/hepatitis </ref>		**Serology<ref> www.cdc.gov/hepatitis </ref>
	*Incubation period: 1-3 months		**Incubation period: 1-3 months
	*Presentation is similar to hep A		**Presentation is similar to hep A
	*Lab tests:		**Lab tests:
	**HBsAg: + implies infection		***HBsAg: + implies infection
	**Anti-HBs: implies clearance or vaccination		***Anti-HBs: implies clearance or vaccination
	**Anti-HBc: Implies prior infection; IgM = acute & in flares; only marker in window period; IgG always present		***Anti-HBc: Implies prior infection; IgM = acute & in flares; only marker in window period; IgG always present
	**HBe-Ag: Implies active viral replication & infectivity		***HBe-Ag: Implies active viral replication & infectivity
	**Anti-HBe: low infectivity		***Anti-HBe: low infectivity
	**HBV DNA: Similar to HBe-Ag but more sensitive		***HBV DNA: Similar to HBe-Ag but more sensitive

	*[[Hepatitis C]]		*[[Hepatitis C]]
	**Blood-borne, in US, most commonly transmitted through [[IV drug use]]. Infrequently transmitted through sexual contact		**Blood-borne, in US, most commonly transmitted through [[IV drug use]]. Infrequently transmitted through sexual contact
	**90% of HCV infections progress to chronic hepatitis<ref>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</ref>		**90% of HCV infections progress to chronic hepatitis<ref>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</ref>
	*Unlike Hep A and B, most often asymptomatic in acute phase of infection		**Unlike Hep A and B, most often asymptomatic in acute phase of infection
	*>75% of patients advance to chronic stage		**>75% of patients advance to chronic stage
	*Active disease identified by reactive HCV ab and positive HCV RNA		**Active disease identified by reactive HCV ab and positive HCV RNA

	*[[Hepatitis D]]		*[[Hepatitis D]]
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	**Can only co-infect patients with Hepatitis B (actively producing HBsAg)		**Can only co-infect patients with Hepatitis B (actively producing HBsAg)
	**Presentation can range from acute self-limited disease to fulminant hepatitis or chronic infection		**Presentation can range from acute self-limited disease to fulminant hepatitis or chronic infection
	*Only occurs with comorbid hepatitis B		**Only occurs with comorbid hepatitis B
	*High incidence of cirrhosis		**High incidence of cirrhosis

	*[[Hepatitis E]]		*[[Hepatitis E]]
	**Fecal-oral transmission		**Fecal-oral transmission
	**Usually results in mild illness, but can cause fulminant hepatitis in pregnant women<ref>Rein DB, Stevens GA, Theaker J, Wittenborn JS, Wiersma ST. The Global Burden of Hepatitis E Virus Genotypes 1 and 2 in 2005. Hepatology, Vol. 55, No. 4, 2012: 988-997</ref>		**Usually results in mild illness, but can cause fulminant hepatitis in pregnant women<ref>Rein DB, Stevens GA, Theaker J, Wittenborn JS, Wiersma ST. The Global Burden of Hepatitis E Virus Genotypes 1 and 2 in 2005. Hepatology, Vol. 55, No. 4, 2012: 988-997</ref>
	*Fecal-oral transmission		**Fecal-oral transmission
	*No carrier state		**No carrier state
	*High associated mortality		**High associated mortality
	*Common in Southeast Asia, but different genotypes found globally across Asia, Africa, Latin America<ref>Chaudhry SA et al. Hepatitis E infection during pregnancy. Can Fam Physician. 2015 Jul; 61(7): 607–608.</ref>		**Common in Southeast Asia, but different genotypes found globally across Asia, Africa, Latin America<ref>Chaudhry SA et al. Hepatitis E infection during pregnancy. Can Fam Physician. 2015 Jul; 61(7): 607–608.</ref>
	*Mortality in pregnancy dependent on trimester<ref>Ranger-Rogez S, Alain S, Denis F. Hepatitis viruses: mother to child transmission [article in French] Pathol Biol (Paris) 2002;50(9):568–75.</ref>		**Mortality in pregnancy dependent on trimester<ref>Ranger-Rogez S, Alain S, Denis F. Hepatitis viruses: mother to child transmission [article in French] Pathol Biol (Paris) 2002;50(9):568–75.</ref>
	**1.5% in first trimester		***1.5% in first trimester
	**8.5% in second trimester		***8.5% in second trimester
	**21% in third trimester		***21% in third trimester

	==Clinical Features==		==Clinical Features==

Rossdonaldson1 at 18:10, 4 June 2020

2020-06-04T18:10:40Z

← Older revision		Revision as of 18:10, 4 June 2020
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	**Most common risk factor is travel outside of the US <ref>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.</ref>		**Most common risk factor is travel outside of the US <ref>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.</ref>
	**Not associated with chronic carrier state; incubation period is approximately 30 days, and infectivity usually resolved prior to symptom onset		**Not associated with chronic carrier state; incubation period is approximately 30 days, and infectivity usually resolved prior to symptom onset
	*[[Hepatitis B]]
	**Transmitted parenterally, blood contact, and unprotected sex
	**90% of exposed infants progress to chronic hepatitis; 10% of exposed adults progress to chronic hepatitis
	**Serology<ref> www.cdc.gov/hepatitis </ref>

	*[[Hepatitis C]]
	**Blood-borne, in US, most commonly transmitted through [[IV drug use]]. Infrequently transmitted through sexual contact
	**90% of HCV infections progress to chronic hepatitis<ref>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</ref>
	*[[Hepatitis D]]
	**Transmission similar to Hepatitis B
	**Can only co-infect patients with Hepatitis B (actively producing HBsAg)
	**Presentation can range from acute self-limited disease to fulminant hepatitis or chronic infection
	*[[Hepatitis E]]
	**Fecal-oral transmission
	**Usually results in mild illness, but can cause fulminant hepatitis in pregnant women<ref>Rein DB, Stevens GA, Theaker J, Wittenborn JS, Wiersma ST. The Global Burden of Hepatitis E Virus Genotypes 1 and 2 in 2005. Hepatology, Vol. 55, No. 4, 2012: 988-997</ref>

	~~===[[Hepatitis A]]===~~
	*Most common form of transmission occurs from asymptomatic children to adults		*Most common form of transmission occurs from asymptomatic children to adults
	**Approximately only 5% of infected children symptomatic		**Approximately only 5% of infected children symptomatic
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	*Death from [[hepatic failure]] is rare		*Death from [[hepatic failure]] is rare

	~~===~~[[Hepatitis B]]~~===~~		*[[Hepatitis B]]
			**Transmitted parenterally, blood contact, and unprotected sex
			**90% of exposed infants progress to chronic hepatitis; 10% of exposed adults progress to chronic hepatitis
			**Serology<ref> www.cdc.gov/hepatitis </ref>
	*Incubation period: 1-3 months		*Incubation period: 1-3 months
	*Presentation is similar to hep A		*Presentation is similar to hep A
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	**HBV DNA: Similar to HBe-Ag but more sensitive		**HBV DNA: Similar to HBe-Ag but more sensitive

	~~===~~[[Hepatitis C]]~~===~~		*[[Hepatitis C]]
			**Blood-borne, in US, most commonly transmitted through [[IV drug use]]. Infrequently transmitted through sexual contact
			**90% of HCV infections progress to chronic hepatitis<ref>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</ref>
	*Unlike Hep A and B, most often asymptomatic in acute phase of infection		*Unlike Hep A and B, most often asymptomatic in acute phase of infection
	*>75% of patients advance to chronic stage		*>75% of patients advance to chronic stage
	*Active disease identified by reactive HCV ab and positive HCV RNA		*Active disease identified by reactive HCV ab and positive HCV RNA

	~~===~~[[Hepatitis D]]~~===~~		*[[Hepatitis D]]
			**Transmission similar to Hepatitis B
			**Can only co-infect patients with Hepatitis B (actively producing HBsAg)
			**Presentation can range from acute self-limited disease to fulminant hepatitis or chronic infection
	*Only occurs with comorbid hepatitis B		*Only occurs with comorbid hepatitis B
	*High incidence of cirrhosis		*High incidence of cirrhosis

	~~===~~[[Hepatitis E]]~~===~~		*[[Hepatitis E]]
			**Fecal-oral transmission
			**Usually results in mild illness, but can cause fulminant hepatitis in pregnant women<ref>Rein DB, Stevens GA, Theaker J, Wittenborn JS, Wiersma ST. The Global Burden of Hepatitis E Virus Genotypes 1 and 2 in 2005. Hepatology, Vol. 55, No. 4, 2012: 988-997</ref>
	*Fecal-oral transmission		*Fecal-oral transmission
	*No carrier state		*No carrier state

Rossdonaldson1: /* Background */

2020-06-04T18:09:09Z

Background

← Older revision		Revision as of 18:09, 4 June 2020
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	*Of note, transmission of [[Hepatitis B]] and [[Hepatitis C]] through donated blood, blood products, and organs is rare in the US since blood screening became available in 1992		*Of note, transmission of [[Hepatitis B]] and [[Hepatitis C]] through donated blood, blood products, and organs is rare in the US since blood screening became available in 1992

			===Overview of Common Viral Hepatitis Agents===
	*[[Hepatitis A]]		*[[Hepatitis A]]
	**Fecal-oral transmission		**Fecal-oral transmission

Rossdonaldson1: /* Evaluation */

2020-06-04T18:07:51Z

Evaluation

@@ Line 74: / Line 74: @@
 *INR
 **[[liver disease induced coagulopathy|Coagulopathy]] correlates w/more severe liver dysfunction
 *Acute hepatitis panel
 **Hep A Ab IgM
@@ Line 84: / Line 81: @@
 **Hep C Ab
-{| class="wikitable"
+{{Acute hepatitis panel}}
 ==Management==

Rossdonaldson1: /* Evaluation */

2020-06-04T18:07:15Z

Evaluation

← Older revision		Revision as of 18:07, 4 June 2020
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	*INR		*INR
	**[[liver disease induced coagulopathy\|Coagulopathy]] correlates w/more severe liver dysfunction		**[[liver disease induced coagulopathy\|Coagulopathy]] correlates w/more severe liver dysfunction

			{{Acute hepatitis panel}}

	*Acute hepatitis panel		*Acute hepatitis panel
	**Hep A Ab IgM		**Hep A Ab IgM

Rossdonaldson1: /* Evaluation */

2020-06-04T18:06:45Z

Evaluation

@@ Line 117: / Line 117: @@
 | Positive
 | Acute or chronic hepatitis C; additional tests are required to make the determination
 |}

Rossdonaldson1: /* Evaluation */

2020-06-04T18:06:04Z

Evaluation

@@ Line 117: / Line 117: @@
 | Positive
 | Acute or chronic hepatitis C; additional tests are required to make the determination
 |}

Rossdonaldson1: /* Background */

2020-06-04T18:05:50Z

Background

@@ Line 13: / Line 13: @@
 **90% of exposed infants progress to chronic hepatitis; 10% of exposed adults progress to chronic hepatitis
 **Serology<ref> www.cdc.gov/hepatitis </ref>
-{| {{table}}
 *[[Hepatitis C]]
 **Blood-borne, in US, most commonly transmitted through [[IV drug use]]. Infrequently transmitted through sexual contact

Rossdonaldson1: /* See Also */

2020-06-04T18:04:59Z

← Older revision		Revision as of 18:04, 4 June 2020
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	*[[Jaundice]]		*[[Jaundice]]
	*[[Acute Hepatitis]]		*[[Acute Hepatitis]]
			*[[Acute hepatic failure]]

	==References==		==References==