Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:12

684 Hepatitis A and E

differential diagnosis

■Nonspecific symptoms (malaise, anorexia, nausea, vomiting): many

other causes, including EBV infection, flu syndromes, depression

■Other acute liver diseases: acute HBV or HCV infection; drug-

induced hepatitis, especially acetaminophen hepatotoxicity; auto-

immune hepatitis; alcoholic hepatitis

management

What to Do First

■Confirm diagnosis

■Assess severity of acute liver disease

General Measures

■Outpatient care unless persistent vomiting, severe anorexia or dehy-

dration

■Maintenance of adequate calorie and fluid intake

■No specific dietary recommendations

■All nonessential drugs discontinued

■Limitation of daily activities and rest periods as needed

specific therapy

■No specific therapy for usual acute HAV and HEV infection

■Corticosteroids of no value

■Liver transplantation for FHF

follow-up

■Serial LFTs to confirm early peak of illness and improvement

■Serial visits to ensure adequate nutrition and hydration

■Urgent visits or hospitalization for mental status changes, raising

concern for FHF

complications and prognosis

Complications

■Vomiting with dehydration

■Severe anorexia with inadequate nutrition

■FHF

Prognosis

■Complete clinical, histologic, and biochemical recovery within 3–6

months

■Occasional FHF, with greatest mortality in individuals >40 years of

age

■Increased risk of FHF in pregnant women with HEV infection