5-72
Plan:
Treatment: Primary: Supportive care
Patient Education
General: Most persons with acute infection will recover within three weeks.
Activity: Bedrest
Diet: Refrain from use of all alcohol products.
Medications: Avoid medications that are cleared by the liver, including acetaminophen.
Prevention and Hygiene: Isolate infected persons up to one week after the onset of jaundice. Appropriate
handwashing, food preparation, waste disposal (feces are highly infective), and water purification. Post-
exposure treatment with immune globulin, 0.02 ml/kg, should be given to close contacts if less than two
weeks from last exposure. Widespread immunization of susceptible people may be effective in stopping
outbreaks.
No Improvement/Deterioration: Evacuate for evaluation of hepatic failure.
Follow-up Actions
Consultation Criteria: Refer cases of HAV that do not improve or that progress to encephalopathy.
ID: Hepatitis B (and Hepatitis D)
LTC Duane Hospenthal, MC, USAIntroduction: Hepatitis B virus (HBV) is spread via sexual intercourse, birthing and exposure to blood
and blood products. HBV can cause both acute and chronic infection. 5-10% of acutely infected adults
develop chronic infection. In contrast, perinatal infection leads to chronic infection in 70-90% of individuals.
Chronically infected persons are the reservoir for this infection and are at risk to develop cirrhosis and
hepatocellular carcinoma (HCC). The highest incidence of chronic disease is in Asia and Africa.
Subjective: Symptoms
Acute infection: See Hepatitis A. 10% of acute HBV infection is symptomatic. If symptoms do occur,
they develop after an incubation period averaging 75 days. Chronic infection is only rarely associated with
nonspecific symptoms such as malaise and fatigue.
Focused History: (for chronic hepatitis): Have you ever been told you had hepatitis or jaundice? (Chronic
hepatitis may occur after acute hepatitis.) How long have you had malaise and/or fatigue? (These symptoms
for greater than a month usually denote a chronic process.)
Objective: Signs
See Hepatitis A for signs of acute hepatitis.
Using Basic Tools (chronic disease):
Vital Signs: Normal
Inspection: Signs of chronic liver disease - telangiectasias (new blood vessel formation in the skin) over the
upper chest, back and arms, reddened palms, gynecomastia, small testes
Assessment:
Differential Diagnosis
Acute hepatitis - same as listed in Hepatitis A
Chronic hepatitis - hepatitis C, autoimmune hepatitis, hemochromatosis, chronic alcoholic liver disease, and
other primary liver disorders.
Plan:
Treatment
Primary: Supportive care for acute hepatitis.