Etiology:
• The most important cause of both acute and chronic hepatitis are hepatitis viruses.
• Apart from viruses, drugs, alcohol, ischemia, autoimmune, metabolic and genetic diseases can cause acute or chronic hepatitis.
Etiology:
• Important viruses that cause hepatitis are A, B, C, D and E (These are mainly liver specific. Therefore, they are defined as hepatitis viruses).
• Apart from these, Epstein-Barr, CMV, Herpes, Yellow fever, Rubella and some exotic viruses can also cause hepatitis.
Clinic:
• Patients with acute hepatitis may show an asymptomatic, subclinical/subicteric, icteric/cholestatic or fulminant course.
• Symptomatic cases usually present to the clinic with jaundice, nausea-vomiting, dark urine and right upper quadrant pain.
Lab:
• First of all, liver enzymes, bilirubin levels and PTZ measurements are made in the patient who comes with the suspicion of acute hepatitis.
• AST and ALT are generally increased more than 10 times the upper limit.
• PTZ (INR) and aPTT may be prolonged due to decreased synthesis of coagulation factors.
• Since factor 8 is especially synthesized in the vascular endothelium, its level is normal (differentiation of liver failure from DIC).
• PTZ prolongation is the parameter most closely associated with prognosis.
• Albumin is expected to be normal, especially in the early period.
Diagnosis:
• Definitive diagnosis is made with viral serological markers to be detected in the blood according to the factor.
• The first serological tests to be requested in a patient with suspected acute viral hepatitis are as follows:
Anti-HAV IgM
HBsAg
Anti-HBc IgM
Anti-HCV
Follow up and treatment
• Acute hepatitis resolves spontaneously at a high rate and does not require medical intervention other than follow-up.
• Treatment is generally supportive treatment. No antiviral therapy is required (except for acute hepatitis C and severe acute hepatitis B).
Acute liver failure is the most important complication of acute hepatitis. Therefore, patients whose PTZ tends to increase and who develop encephalopathy and coagulopathy symptoms should be followed up in a hepatology center as soon as possible.
• Treatment of patients with fulminant failure is emergency liver transplantation.
Complications and Sequelae: The most important risk of acute viral hepatitis is fulminant course and chronicity.