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Patient Education
General: Most adults recover from acute hepatitis within 4 weeks. Over 90% become immune and do not
develop chronic infection.
Activity: Bedrest
Diet: Refrain from use of all alcohol products
Prevention and Hygiene: Sexual partners and children should be tested. Consider HBV immunization of
close contacts if not immune. Patient should not donate blood, tissues or semen. Condom use decreases
sexual transmission. Avoid sharing toothbrushes and razors.
No Improvement/Deterioration: Evacuate for evaluation of hepatic failure.
Follow-up Actions
Return evaluation/ Consultation Criteria: All patients suspected to have chronic hepatitis B should be
referred to a specialist.
NOTES: Hepatitis D or delta hepatitis (HDV) is caused by a defective virus that only causes disease in the
presence of HBV. HDV disease is similar to HBV, occurring in persons previously or concurrently infected with
HBV. Found worldwide, endemic pockets occur in South America, Africa, the Middle East, and in the Pacific
islands. HDV is often diagnosed when a person with known HBV infection is noted to have a flare up of
disease or a second course of acute hepatitis.
ID: Hepatitis C
LTC Duane Hospenthal, MC, USAIntroduction: Hepatitis C virus (HCV) is a common cause of chronic hepatitis. This virus is transmitted by
exposure to blood and blood products and less frequently, perinatally or by sexual intercourse. Acute infection
(incubation period 6-7 weeks) is rarely diagnosed, but chronic disease develops in more than 60% of those
infected. Persons with chronic disease are at risk to develop cirrhosis and hepatocellular carcinoma (HCC).
Subjective: Symptoms
Acute infection is asymptomatic or associated with nonspecific symptoms in most patients. Typical symptoms
associated with hepatitis A virus (HAV) infection are only rarely present and then usually to milder degree.
Chronic infection is only rarely associated with nonspecific symptoms such as malaise and fatigue.
Focused History Questions: 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
Jaundice may be seen in 20-30% of acutely infected individuals.
Using Basic Tools (chronic disease):
Vital Signs: Normal
Inspection: Stigmata 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 B, autoimmune hepatitis, hemochromatosis, chronic alcoholic liver disease, and
other primary liver disorders.