“Inflammation of the liver caused by an infection with the Hepatitis A virus”

Risk Factors
  • Travellers to areas with high prevalence
  • Clotting factor disorders
  • High-risk sexual activities with multiple partners
  • IV drug users
  • Occupational risk- lab or sewage workers
Aetiology
  • Hepatitis A- RNA virus
  • Spread via the faeco-oral route
Pathophysiology
  1. The virus enters the body via faeco-oral route
  2. Replicates in hepatocytes
  3. Interferes with cell function
  4. Causes inflammation of the liver
  • Four clinical phases:
    • Incubation
    • Prodromal
    • Icteric
    • Convalescent
Clinical Presentation
  • Children under 5 frequently asymptomatic
  • Symptoms:
    • Abdominal discomfort
    • Nausea
    • Anorexia
    • Arthralgia
    • Dark urine, pale stool
    • Pruritus
  • Signs:
    • Fever
    • Jaundice
    • RUQ tenderness
    • Hepatomegaly
    • Splenomegaly (15% of cases)
Investigations
  • Hepatitis A IgM antibodies (HAV-IgM)
  • Hepatitis A IgG antibodies (HAV-IgG)
HAV-IgMHAV-IgGIndication
++Acute Infection
+Acute Infection or false positive IgM
+Previous Infection or vaccine-based immunity
No evidence of infection, maybe very early or in incubation
  • LFTs
    • ALT/AST significantly elevated
    • Bilirubin moderately elevated
Management
  • Mild self-limiting disease
  • Notify the Health Protection Unit
  • Conservative:
    • Handwashing and good hygiene to reduce transmission
    • Avoid drinking alcohol during acute illness
    • Avoid work, school, or nursery until no longer infectious
  • Medical:
    • Analgesia (paracetamol, weak opioid if liver impairment mild)
    • Antiemetics- metoclopramide if liver impairment mild; seek specialist advice for those with severe liver impairment
    • Chlorphenamine for itch
  • Surgical:
    • N/A
  • Consider referral to GUM clinic or drug rehabilitation services
  • Vaccination
Complications
  • Fulminant liver failure
  • Prolonged cholestasis
  • Rare:
    • Interstitial nephritis
    • Acute pancreatitis
    • Acalculous cholecystitis
    • Guillan-Barre syndrome

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