Differential diagnosis
Infectious
Viral*
- A: shellfish
- B: IVDU, sexual, vertical
- C: IVDU, blood transfusion
- D: only ?HBV
- E: Eastern A
- G: better prognosis if HIV +ve
Others: EBV, CMV, HSV, flavivirus (yellow fever)
Bacterial
- Leptospirosis: Weil’s disease
- Treponema: syphilis
- Coxiella burnetii: Q fever
Toxic
- EtOH **
Drugs
- paracetamol od
- NSAIDs: idiosyncratic
- halothane
- anti-TB
Toxins
- Amanita phalloides - mushrooms
- CCl4
- ethylene glycol
- glue sniffing
Rare
- pregnancy
* viral hepatitis: ALT > AST
** EtOH hepatitis: AST > ALT
Viral Hepatitis
HAV
- incubation period: 2 – 6 weeks
- clinical features: subclinical infection common, acute hepatitis
- outcome: resolves
- management: avoid EtOH
HBV
- incubation period: 2 – 6 months
- clinical features: acute hepatitis in 15% (+/- arthralgia, urticaria...), fulminant liver failure in 1 % (if co-infection with HCV, HDV, HIV)
- outcome: chronic in 5 % (but 90 % of neonates), HCC (hepatocellular carcinoma)´ 10%
- management: avoid EtOH, lamivudine (if fulminant liver failure), IFN-alpha (if chronic infection)
- prevention: safe sex / immunisation
- HCC screening: USS, AFP (alpha-foeto protein, a tumour marker)
HCV
- clinical features: an acute hepatitis = v. rare, asymptomatic carriage, chronic liver disease in 20 % (accelerated if concurrent EtOH+++)
- outcome: chronic viraemia in 85 %, HCC
- management: IFN-a, ribavirin, liver transplant (but may recur in transplanted organ)
