Hepatitis A
Definition of Hepatitis A
- Acute infectious disease of the liver caused by the hepatitis A virus
Epidemiology of Hepatitis A
- Predominantly affects children and young adults
- Worldwide but more common in areas of poor sanitation
- Faeco-oral spread, usually from contaminated water or shellfish
Causes of Hepatitis A
- Hepatitis A virus is a single-stranded RNA picornavirus
- Incubation period 15-50 days
Presentations of Hepatitis A
- Initially
- Generally unwell
- Nausea, anorexia
- After 1-2 weeks
- Transient rash
- Jaundice
- Dark urine/pale stools due to intrahepatic cholestasis
- Hepatomegaly
- Lymphadenopathy
- Splenomegaly in 10%
- Symptoms usually resolve in 3-6 weeks
- Progression to fulminant liver failure occurs in only 0.1% cases
Differential diagnosis of Hepatitis A
- Acute hepatitis B
- Drug induced hepatitis
- Alcoholic hepatiits
- Ischemic hepatitis
Initial management of Hepatitis A
- Bloods
- FBC, U+Es, clotting
- LFTs: often a large transaminase rise (can be >1000)
- Viral screen (including Hep B, Hep C, HIV)
- Hep A IgM indicates acute infection
- Malaria screen if febrile and from affected area
- Ultrasound liver
- Rest and supportive treatment
- Avoid alcohol
Further management of Hepatitis A
- Hepatitis A vaccine is available and is very effective
Complications of Hepatitis A
- Fulminant liver failure is rare: 0.1%
Prognosis of Hepatitis A
- Good unless liver necrosis with fulminant liver failure occurs
- Does not progress to chronic liver disease
Common Hepatitis A exam questions for medical students, finals, OSCEs and MRCP PACES
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