Viral Hepatitis

Hepatitis A - HAV

• picornavirus

Epidemiology

• faecal-oral - contaminated food or water
• overcrowding and poor sanitation
• no carrier state
• notifiable

Clinical Features

• non-specific symptoms - nausea, anorexia, distaste for cigarettes - early recovery
• after 1-2/52 - jaundice occurs with symptom improvement
• jaundice deepens with dark urine and pale stools (intrahepatic cholestasis)
• hepatomegaly (moderate); palpable spleen (10%)
• occ tendor lymphadenopathy; transient rash
• jaundine and illness recedes in 3-6/52
• extrahepatic compx: arthritis, vasculitis, myocarditis, renal failure

Investigations

LFT -

• Prodrome - serum bil normal; bilirubinuria and inc urinary urobilinogen
• Raised AST or ALT, preceding jaundice (AST reaching max 1-2d after jaundice)
• Icteric stage - serum bilirubin reflects level of jaundice
• After jaundice subsides, aminotransferases may remain elevated for wks to 6/12.

FBC - leucopenia, relative lymphocytosis

PT - prolonged in severe cases

ESR - raised

Viral markers

• IgG common over 50yrs
• anti-HAV IgM = acute infx