GASTROENTEROLOGY

ACUTE VIRAL

except for hep B: DNA virus but

replicates like a retrovirus.

II. HEPATITIS VIRUSES

Please see appendix I for the features of the

hepatitis viruses.
Please see appendix II for the clinical &
epidemiologic features of viral hepatitis.
Prophylaxis & t herapeutics included on the table
as well.

III. SIGNS & SYMPTOMS

A. Incubation Period

Hepatitis
Hepatitis
Hepatitis
Hepatitis

A: 1545 days, mean, 4 weeks

B & D: 30180 days, mean, 812 weeks
C 15160 days, mean, 7 weeks
E 1460 days, mean, 56 weeks

B. Prodromal Symptoms

1-2 weeks before jaundice

o Constitutional symptoms: anorexia,
nausea and vomiting (associated with
alterations in olfaction and taste),
fatigue, malaise, arthralgias, myalgias,
headache, photophobia, pharyngitis,
cough, and coryza
o low-grade fever between 38-39C
(100-102F) is more often present in
hepatitis A & E than in hepatitis B or C,
except when hepatitis B is heralded by a
serum sicknesslike syndrome
o rarely, fever of 39.540C (103104F)
15 days before the onset of clinical
jaundice
o Dark urine and clay-colored stools may
be noticed

B. Clinical Jaundice

OUTLINE
I. Introduction
IV. Laboratory Findings
II. Hepatitis Viruses
A. First Subtopic
III. Signs & symptoms
B. Second Subtopic
A. Incubation Period
C. Third Subtopic
B. Prodromal Symptoms
D. Fourth Subtopic
C. Clinical Jaundice
IV. Serologic Markers &
D. Recovery Phase
Scheme
V. Treatment
VI. Complications

I. INTRODUCTION

Acute viral hepatitis- a systemic infection

affecting the liver predominantly.
Almost all cases of acute viral hepatitis are
caused by one of five viral agents
o HAV, HBV, HCV, HBV-associated delta
agent or HDV, & HEV.
All are RNA viruses

constitutional prodromal symptoms usually

diminish
in some, mild weight loss (2.55 kg) is common
and may continue during the entire icteric phase
liver becomes enlarged and tender and may be
associated with RUQ pain and discomfort.
present with a cholestatic picture, suggesting
extrahepatic biliary obstruction (infrequent)
splenomegaly and cervical adenopathy (in 10
20%)
spider angiomas appear during the icteric phase
and disappear during convalescence (rare)

C. Recovery Phase

constitutional symptoms disappear

usually some liver enlargement and
abnormalities in liver biochemical tests are still
evident.
duration of the posticteric phase is variable (2-12
weeks)
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usually more prolonged in acute
hepatitis B & C
Complete clinical and biochemical recovery:
o 12 months after hepatitis A and E
o 34 months after the onset of
jaundice in of uncomplicated, selflimited cases of hepatitis B (95-99%)
and C (~15%).
o biochemical recovery may be
delayed
o

A. Hepatitis (General)

III. LABORATORY FINDINGS

AST & ALT

o during prodromal phase of acute
viral hepatitis & precede the rise in
bilirubin
o however, rise does not correlate well
with the degree of liver cell damage.
o Peak levels: 4004000 IU or more

usually reached at the time

the patient is clinically
icteric

diminish progressively
during recovery
o diagnosis of anicteric hepatitisbased on clinical features and on
aminotransferase elevations
Bilirubin
o Jaundice is usually visible in the
sclera or skin when s >43 mol/L
(2.5 mg/dL)
o continue to rise despite falling
serum aminotransferase levels.
o usually the total bilirubin is equally
divided between the conjugated and
unconjugated fractions

B. Hepatitis A

C. Hepatitis B

Transiet neutropenia & lymphopenia

followed by relative lymphocytosis.
Prolonged PT
o may reflect a severe hepatic
synthetic defect, signify extensive
hepatocellular necrosis, and indicate
a worse prognosis
Hypoglycemia
o In severe cases
o d/t nausea &vomiting, inadequate
carbohydrate intake, & poor hepatic
glycogen reserves may contribute to
hypoglycemia noted occasionally
Alkaline phosphatas- normal or mildly
elevated
In some patients:
o mild and transient steatorrhea
o slight microscopic hematuria
o Minimal proteinuria

IV. SEROLOGIC MARKER & SCHEME

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V. TREATMENT

Only supportive measures

For acute HCV- PEG Interferon plus ribavirin
for 24 weeks

Relapsing Hepatitis A
Cholestatic Hepatitis A
Fulminant Hepatitis most feared; rare
o seen primarily in hepatitis B, D, and
E, but rare
o fulminant cases of hepatitis A
Chronic hepatitis
o important late complication of acute
hepatitis B
o in small proportion of patients with
acute disease but more common in
those who present with chronic
infection withouthaving experienced
an acute illness, as occurs typically
after neonatal infection or after
infection in an immunosuppressed
host
Rare complications: pancreatitis,
myocarditis, atypical pneumonia, aplastic
anemia, transverse myelitis, and peripheral
neuropathy.

VI. COMPLICATIONS

D. Hepatitis C

III. APPENDIX

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