IM
HEPATITIS A
Key Features
- Most common cause of acute viral hepatitis.
- Causes only acute hepatitis. No carrier state or chronic hepatitis. Usually, does not happen twice.
Transmission
- Fecal-oral route: Contamination of food and water due to poor hygiene by food handlers.
- Saliva of the infected person also contains the virus but in very small amounts.
Clinical Features
Prodromal Phase (Initial 1-2 weeks)
- Anorexia (loss of appetite)
- Nausea
- Malaise (general feeling of discomfort)
- Bad taste in the mouth
- Fever
- Jaundice is absent initially
Icteric Phase (Next 3-6 weeks)
- Jaundice (yellowing of skin and eyes)
- Pain in the right upper quadrant of the abdomen
- Dark urine
- Pale stools
- Tender hepatomegaly (enlarged liver)
Severity of Hepatitis A
- Asymptomatic: Usually in children
- Mild to Moderate Symptoms: Most cases
- Fulminant Hepatic Failure: Rare but serious complication
Investigations
- Liver Function Tests (LFTs):
- High bilirubin (mainly direct bilirubin)
- AST & ALT are very high
- Alkaline Phosphatase slightly high
- Urine: Contains bilirubin
- Diagnostic Test: Hepatitis A antibody (anti-HAV)
Treatment
- No specific drug treatment. The disease is self-limited and usually results in complete recovery within 3 months.
- Strict isolation of the patient is not advised, but they should wash their hands thoroughly after defecation.
- Good nutrition: Eat whatever can be tolerated.
- Vitamin supplements
- Avoid alcohol and hepatotoxic drugs
- Symptomatic treatment
Prevention
- General Measures:
- Good hygiene
- Drink bottled water in high-risk areas
- Avoid risky foods
- Immunization: Hepatitis A vaccine is recommended for:
- Patients with other chronic liver disease
- Patients traveling to a high-risk area for a long time
Rapid Fire Questions (Hepatitis A)
- Mode of transmission of Hep A? fecal oral
- Which test is diagnostic? anti-HAV
- In hepatitis, which type of bilirubin is elevated predominantly? Direct
- Which specific drug is used for Hep A treatment? no specific drug
- Who should get the Hep A vaccine? High risk area for CHD
- How to avoid getting infected? avoid risk factors
- A man tells you that he had Hep A 2 years ago. Now he is jaundiced. The doctor tells him that he has Hep A re-infection. Is the doctor right? no, antibodies protective for life
Thera
Transmission:
- Fecal-oral: contaminated water or food (raw shellfish).
- Anal oral sex.
- Parenteral (not common).
Pathogenesis:
- hepatocytes destruction by the immune system,
- (the virus is not cytopathic).
Clinical features:
- Right upper quadrant pain, tender hepatomegaly, fever, malaise, anorexia, nausea, vomiting, jaundice (dark urine and pale stools), pruritus.
- Mortality rate is 0.1–0.3%.
Diagnoses:
- Antigens detection in stool.
- RNA detection in stool & blood samples by rt-PCR.
- Anti-HAV IgM in serum.
- IgM - Currently infected
- IgG - infected before
Treatment
- Generally self-limited.
- Symptomatic treatment: antiemetics, rehydration.
- Use medications that are metabolized by the liver with caution (e.g., acetaminophen “paracetamol”).
Prevention:
- Inactivated vaccine.