Acute Hepatitis for Healthcare Professionals:

Acute hepatitis is a rapid onset of liver enzyme derangements that can lead to organ failure and death. It requires urgent medical attention when discovered. The following is a guide to assess an individual with acute hepatitis: 

 

   1. Take a detailed medical history:

Does the patient have any history of autoimmune disorders? Does the patient have any recent viral illness? Is the patient using any new medications, or herbal remedies or over-the-counter weight loss medications?

 

It is important in order to obtain information that can help with diagnosis of the patient’s condition.

 

   2. Obtain urgent blood tests:

A liver panel should be sent to include ALT, ALP, and AST. Measures of liver synthetic function should be ordered such as Bilirubin, Platelets, International normalized ratio (INR), and albumin. Further investigations should be sent for etiologies such as an ultrasound with doppler to rule out a clot, viral hepatitis panel, autoimmune panel, and metabolic panel to include Wilson’s disease and Hemochromatosis. 

 

Specific tests are listed as follows: HCV Ab, HBsAb, HBsAg, HBcAb, Hepatitis A IgM, HEV IgM, CMV, HSV, EBV, CK, Anti-TTG, Ceruloplasmin, Immunoglobulin, ANA, ASMA, AMA, Alpha-1-anti-trypsin, proBNP, Iron, Ferritin, Doppler with ultrasound.

 

   3. Counselling

Patients should be counselled to avoid Tylenol, Advil, and alcohol

 

   4. Follow up

Depending on patient condition, this could be followed up as an outpatient with blood tests every 4 weeks for the next 3 months. 

 

If the liver enzymes are worsening or not improving, a referral to Hepatology will be warranted. 

If there is an elevation of IgG >22, or viral panel is positive, a referral to Hepatology is warranted for further care. 

 

Emergent medical attention is required if blood tests show INR >1.5 and confusion suggestive of encephalopathy. This is because it may be a sign of liver failure. 

 

References: 

Kwo, Paul Y MD, FACG, FAASLD1; Cohen, Stanley M MD, FACG, FAASLD2; Lim, Joseph K MD, FACG, FAASLD3. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. American Journal of Gastroenterology 112(1):p 18-35, January 2017. DOI: 10.1038/ajg.2016.517