Acute viral hepatitis

Symptoms and signs:

(prodromal phaseà icteric phaseà recovery phase)

malaise, nausea, vomiting, diarrhea, and low-grade fever followed by dark urine, jaundice, and tender hepatomegaly.

EB virus, CMV, coxsackie virus等其他病毒也有可能造成急性肝炎。

Laboratory data:

Hepatitis profile (Anti-HAV IgM, HBsAg, Anti-HBc IgM, Anti-HCV )

Complete LFT, PT/PTT, prothrombin time, Glu

Therapy:

1)      Diet: high calorie, high protein diet,
不需要限制fatty food，除非有nausea, vomiting, or diarrhea

2)      Bed rest and physical isolation

3)      Supportive care

a)      IV volume expansion

b)      Metoclopramide for protracted nausea and vomiting

c)      Multivitamin supplement

d)      Cholestyramine up to 4g po qid for severe pruritus

4)      Avoid narcotics, analgesics, and tranquilizers

5)      Alcohol abstinence

6)      Treatment of acute HCV with IFN-α for 6 months(↑sustained HCV-RNA clearance)

Indication for hospitalization:

1)      prothrombin time > 16 seconds

2)      Encephalopathy

3)      Ascites

4)      Dehydration resulting from nausea and vomiting

5)      Severe jaundice ( total bilirubin > 10 mg/dl )

6)      Elderly patient and those with significant medical problems

Complication and sequelae

1)      relapsing hepatitis(復發)

2)      cholestatic hepatitis(膽汁鬱積)

3)      fulminant hepatitis ( massive hepatic necrosis )

4)      chronic viral hepatitis

5)      enhanced risk of hepatocellular carcinoma

6)    serum sickness-like syndrome