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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


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