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Acute viral hepatitis consists of hepatocellular necrosis and inflammation caused by A (HAV), B (HBV), C (HCV), D (HDV), or E (HEV). Chronic viral hepatitis is seen with HBV, HCV, and HDV infection. Hepatitis A and hepatitis E virus do not cause a chronic carrier state or chronic liver disease.
I. Clinical Manifestations of Viral Hepatitis
1. Symptoms of acute hepatitis include anorexia, fatigue, myalgias and nausea, developing 1-2 weeks prior to the onset of jaundice. Weight loss and distaste for food and cigarettes may occur early in the illness, followed by headaches, arthralgias, vomiting, and right upper quadrant tenderness.
2. Symptoms of hepatitis A, B and C are indistinguishable, except that patients with hepatitis A are more frequently febrile. Five to 10% of patients will develop a serum-sickness syndrome following infection with HBV, characterized by fever, rash, and arthralgias
. 3. Physical Examination
a. Jaundice occurs in less than one-half of hepatitis patients. Jaundice can be observed when the bilirubin is greater than 2.5 mg/dL and is most easily observed under the tongue or in the sclerae. Hepatomegaly and/or splenomegaly may also occur.
b. Fulminant hepatic failure may result from hepatitis, manifest by signs of severe liver dysfunction associated with encephalopathy, developing within 8 weeks of the acute illness.
B. Chronic Hepatitis
II. Diagnosis of Acute Hepatitis
1. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) enzymes increase during the prodromal phase of hepatitis and may reach 20 times normal. The peak usually occurs when the patients are jaundiced, then rapidly falls during recovery.
2. In icteric patients, the bilirubin continues to increase as the aminotransferases decline and may reach 20 mg/dL. There are equal proportions of direct and indirect bilirubin.
3. The international normalized ratio is usually normal in acute hepatitis, but it can become prolonged in patients with severe