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Hepatitis, Emergency Medicine

Jason Koob and Christopher T. Richards Reviewed 06/2017
 


Basics

Description

  • Inflammation of the liver owing to infectious, toxic, and autoimmune disorders

    • Progression from hepatocellular injury (hepatitis) to scarring (cirrhosis)

  • Infectious causes are the most...

Diagnosis

Signs and Symptoms

  • Often asymptomatic

  • Preicteric phase:

    • Often misdiagnosed as a nonspecific viral syndrome or gastroenteritis

  • Icteric phase:

    • Present in 70% of HAV, 30% of HBV, and 20% of HCV

  • FHF:

    • C...

Treatment

Initial Stabilization/Therapy

ABCs and IV fluid resuscitation for FHF and severe hepatic encephalopathy. 

Ed Treatment/Procedures

  • Treat hypovolemia judiciously with isotonic fluids

  • Correct elect...

Follow-Up

Disposition

Admission Criteria

  • Intractable vomiting, dehydration, or electrolyte imbalance not responding to ED treatment

  • ICU and consider transfer to transplant center for FHF and acute hepati...

Pearls and Pitfalls

  • Acute hepatitis is often misdiagnosed as a nonspecific viral syndrome—screen with urinalysis or serum LFTs

  • ED treatment is primarily supportive

  • Ask detailed social and travel history

  • ...

Additional Reading

  • Falade-Nwulia  O, Seaberg  EC, Rinaldo  CR, et al. Comparative risk of liver-related mortality from chronic hepatitis B versus chronic hepatitis C virus infection. Clin Infect Dis. ...

Codes

ICD9

  • 070.1 Viral hepatitis A without mention of hepatic coma

  • 070.30 Viral hepatitis B without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta

  • 573.3 Hepatitis, unsp...

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