DIAGNOSIS AND TREATMENT OF ACUTE VIRAL HEPATITIS A

The clinical picture of viral hepatitis A is extremely variable, ranging from asymptomatic infection without jaundice to fulminating disease. The clinical characteristics of the viral hepatitis A i.e. : infectious, faeca-oral transmission, incubation period 2 to 6 weeks, severity of acute illness mild to moderate, serology IgM-exposure, and immune prophylaxis normal Ig vaccine.

Diagnosis

The key features for diagnosis are :

  • Prodrome of anorexia, nausea, vomiting, malaise, symptoms of upper respiratory infection of flu-like syndrome, aversion to smoking.

  • Fever, enlarged and tender liver, jaundice.
  • Abnormal liver tests, especially markedly elevated aminotransferases early in the course.

  • Liver biopsy will show characteristic hepatocellular necrosis and mononuclear infiltrate. This rarely indicated.

Differential Diagnosis

The overseas traveller presenting with jaundice may have :

  • Infection by any one of the viruses-hepatitis B, C, D or E. All are prevalent in deveploping countries, especially in south-eastern and eastern asia, some Pasific islands and Africa.

  • Other causes to consider are malaria, ascending cholangitis and drug induced hepatic damage due to, for example, the antimalarials, including mefloquine (larium) and Fansidar.

Treatments

  • Bed rest. Advisible during the acute initial phase of the disease, when symptoms are most severe. Return to normal activity during the convalescent period should be gradual.

  • Fluids. If nausea and vomiting are pronounced or if oral intake is substantially decreased, intravenous administration of 10% glucose solution is indicated.

  • Diet. Dietary management consists of giving palatable meals as tolerated, without overfeeding. Patients should avoid alcohol, and hepatotoxic agents.

  • Corticosteroids. In control studies, corticosteroids have demonstrated no benefit in patients with viral hepatitis, including those with fulminant hepatitis. Treatment of patients with acute hepatitis C with alpha interveron appears to decrease the risk of chronic hepatitis.

  • Encephalophalopathy or serve coagulopathy. Suspect fulminant hepatic failure and hospitalization is mandatory.

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