Acute hepatitis Flashcards

1
Q

How common is it?

A

Relatively common

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2
Q

Who does it affect?

A

Viral - IVDU, sexually transmitted

Alcoholic

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3
Q

What causes it?

A

Acute hepatitis is usually cause by viruses: A,B,C,D & E & EBV

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4
Q

What risk factors are there (and how can they be reduced)?

A
Hygiene and sanitation
Unprotected sex
IV drug use
Alcohol abuse
Other drugs
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5
Q

What signs may the patient have on examination?

A

Acute viral hepatitis follows a pattern of infection that involves three distinct phases:

  1. The initial prodromal phase involves non-specific and flu-like symptoms: fatigue, nausea, vomiting, poor appetite, joint pain, and headaches. Late in this phase, people can experience liver-specific symptoms, including choluria and clay-colored stools.
  2. Jaundiced skin/sclera follow prodrome after about 1–2 weeks and can last for up to 4 weeks. The non-specific symptoms seen in the prodromal typically resolve by this time, but people will develop an enlarged liver and right upper abdominal pain or discomfort. 10–20% of people will also experience an enlarged spleen, while some people will also experience a mild unintentional weight loss.
  3. The recovery phase characterized by resolution of the clinical symptoms of hepatitis with persistent elevations in liver lab values and potentially a persistently enlarged liver. All cases of hepatitis A and E are expected to fully resolve after 1–2 months. Most hepatitis B cases are also self-limiting and will resolve in 3–4 months. Few cases of hepatitis C will resolve completely.
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6
Q

Which other conditions might present similarly?

A
Acute Cholangitis
Acute Cholecystitis and Biliary Colic
Blunt Abdominal Trauma
Emergent Management of Pancreatitis
Emergent Treatment of Gastroenteritis
Gallstones (Cholelithiasis)
Intussusception
Pediatric Gastroenteritis in Emergency Medicine
Peptic Ulcer Disease
Small-Bowel Obstruction
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7
Q

How would you investigate this patient?

A

LFTs
Serology
Immunology
USS

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8
Q

What would you tell the patient and how would you explain the condition to them?

A

Hepatitis is the term used to describe inflammation of the liver. It’s usually the result of a viral infection or liver damage caused by drinking alcohol.

Some types will pass without any serious problems, while others can be long-lasting (chronic) and cause scarring of the liver (cirrhosis), loss of liver function and, in some cases, liver cancer.

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9
Q

How do you think the patient and/or family might be affected by the diagnosis? Will it affect their
ability to work/care for themselves?

A

Acute hepatitis is usually self-limiting and will resolve in time.

The exception is with hep C which may develop into a chronic infection.

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10
Q

What questions are they likely to have?

A

Is it treatable?
How long will it take me to get better?
Are there any side effects to the treatment?

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11
Q

What treatment/s (surgical, pharmacological and non-pharmacological) would you discuss with
them? What risks and benefits of treatment are there?

A

Most individuals do not need hospital care. Drugs such as sedatives and narcotics, which are metabolised in the liver, should be avoided. Alcohol should be avoided during the acute illness.

A - Immunoglobulins
B - lamivudine, entecavir, tenofovir, interferon alpha
C - pegylated interferon-alfa + ribavirin + telaprevir or boceprevir
E - similar to A

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