0071643192.pdf

DIAGNOSIS

■ Screening: HCV antibody ⊕4–6 weeks after infection) and qualitative

PCR (in acute infection; can be ⊕ 1–2 weeks after infection); screen

patients with risk factors or persistently elevated transaminases

■ Confirmatory: Qualitative PCR or recombinant immunoblot assay

(RIBA)

TREATMENT

■ No vaccine available

■ Acute infection/needlestick prophylaxis: Currently not recommended

■ Chronic HCV:Interferon alfa and ribavirin for selected patients with

chronic disease can be curative.

HEPATITISD

Defective RNA virus; cotransmitted with hepatitis B or superinfection in

chronic hepatitis B carriers (associated with high mortality); diagnosed by

positive anti-HDV; treat HDV by treating HBV

HEPATITISE

Rarely seen in the USA, but consider in your differential for patients returning

from endemic areas, high mortality rate in pregnant patients (10–20%); illness

is self-limited; no vaccine available; diagnosed by positive anti-HEV IgM

(acute infection) and anti-HEV (prior exposure)

DRUG-INDUCEDHEPATITIS

Ranges from subclinical disease with abnormal LFTs to fulminant hepatic

failure; accounts for 40% of acute hepatitis cases in U.S. adults >50 years of

age; for 25% of cases of fulminant hepatic failure; and for 5% of jaundice

cases in hospitalized patients; can be characterized as intrinsic (direct toxic

effect) or idiosyncratic (immunologically mediated injury) and as necroin-

flammatory (hepatocellular), cholestatic, or mixed; see Table 11.13 for a list

of common toxins that cause liver injury; risk factors include advanced age,

female gender, use of an increasing number of prescription drugs, underlying

liver disease, renal insufficiency, and poor nutrition

AUTOIMMUNEHEPATITIS

Insidious onset, more common in young females

SYMPTOMS/EXAM

■ Fatigue, anorexia, arthralgias

■ Pruritus suggests an alternate diagnosis: Jaundice, hepatomegaly; spider

angiomas

■ 40% follow hepatitis A or other viral infections

■ Extrahepatic features common: Coombs+ hemolytic anemia, arthritis,

Sjögren syndrome, thyroiditis

ABDOMINAL AND GASTROINTESTINAL

EMERGENCIES