Acute viral hepatitis is caused by hepatitis virus A, E (faeco-orally transmission) or B, C (parenteral transmission).
SALIENT FEATURES
Clinically, the onset is with a prodromal phase (nausea, vomiting, anorexia, fever, dull aching pain in upper right abdomen followed by icteric phase (appearance of jaundice in 3-7 days of onset, associated with improvement in nausea and return of appetite) followed by convalescent phase, when jaundice gradually settles.
The total duration of episode usually lasts for 2-6 weeks. Convalescent phase may be complicated by cholestatic phase, when levels of conjugated bilirubin may increase and may take several weeks to improve.
Diagnosis can be confirmed by detection of IgM antibodies to different viruses (A, E and B) or detection of HCV RNA.
Treatment
Nonpharmacological
During prodromal phase, adequate intake of fluids should be maintained. Once the appetite improves, patient should be advised to take normal diet (fat restriction or giving high carbohydrate has no advantage).
Indications for hospitalization are—severe prodromal symptoms causing dehydration, presence of early signs of hepatic encephalopathy (e.g. altered sensorium, disturbed sleep pattern, flapping tremors), decreased liver span on examination.
Pharmacological
If patient has severe nausea or vomiting.
1. Tab. Domperidone 10 mg as and when required (maximum 3 times a day). Or
Tab. Mosapride 5 mg as and when required (maximum 3 times a day). Or
Inj. Metoclopramide 10 mg 3 times a day IM or IV.
2. IV fluids as required in case of uncontrolled nausea or vomiting. Follow-up/monitoring
Repeat LFT at weekly interval.
Patient can resume activity, when the enzyme levels come down to less than 3-5 times normal.
In patient with HBV infection, check for disappearance of HBsAg at 3-6 months. Hepatitis B and hepatitis C virus infections warrant long-term follow-up. Patient education
Explain the relatives to report and hospitalize the patient, if there is alteration in behaviour or sensorium of patient.
There is no need to isolate the patient.
Patient should avoid taking alcohol for 4-6 months after recovery.
Spouse of the patient with acute viral hepatitis B, should use barrier method to prevent sexual transmission and vaccinated against hepatitis B.