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Hepatitis A, B, C - Coggle Diagram
Hepatitis A, B, C
HEP B
Can be acute self limiting, presentation similar to Hep A. Can also be chronic where the body fails to clear the virus, which can be due to issues with the immune system, dependant on strain of the virus. Can lead to liver damage, cirrhosis or hepatocellular cancer.
Identify at risk patients who may be asymptomatic but have known contact with a positive case, HIV positive, People from areas of high pervalence.
Symptomatic patients may present with fever, arthralgia, rash, non specific malaise, nausea, RUQ pain, jaundice.
Chronic infection, patients may present with signs of liver disease inc-spider navei, jaundice, finger clubbing, thin skin, bruising, hepatoslpenomegaly, liver flap and ascites.
INVESTIGATION: check liver function, results likly elevated in positive cases. ALT and AST liklely significantly elevated. Bilirubin elevated. Alkaline phosphatase generally x2 the upper limit.
DIFFERENTIALS: Possible other strains of hepatitis. Alcohol or drug induced hepatitis. Autoimmune. Similar to those of HEP A.
MANAGEMENT: Primary care of confirmed case. Those positive of HBsAG refer to specialist clinic as per current guidance and local provisions. Phone call to specialist service to discuss urgency.
TREATMENT: treat for symptom management and self care advice while awaiting review. Offer paracetamol, possible codeine, anti emetic or ibuprofen as indicated and in line with liver function. Consult GP, BNF and NICE Guidance.
Hep C
Slow progressive liver disease caused by the Hep C virus. Acute infection can often be asymptomatic and clear without treatment. Chronic infection follows acute, if virus remains for 6 months or more and can lead to complications of the liver.
Testing: consider for those in high risk groups who may be asymptomatic or for those who present non specific symptoms. Also view LFT results, consider HVC for those with significanlty elevated ALT levels.
Discuss exposure risks prior to testing and advice to reduce risk of spread of infection.
Patients should be referred and managed under specialist hepatologist or gastroenterologist. While awaiting review, obtain bloods inc FBC, U&Es, LFTs, Clotting screen, TFTs, ferritin, Hep A and Hep B testing and HIV. Conisder STI screening.
Give advice to reduce disease progression inc smoking cessation, reduce alcohol intake.
Advise on measures to reduce the spread of infection inc not sharing toothbrushes, razors, toiletries or other items that may be contaminated with blood. Advise on risk of sexual transmission. Advise on partner notification and contact tracing.
Investigations: state suspicion of Hepatitis on request. Most sesnitive test is PCR but not widely available.
Test RNA for both HAV-IgG and HAV-IgM. If possible, confirms likely diagnosis.
If test obtained in first 7-10 days, may give false negative, can recheck after 2 weeks.
LFTs-may be elevated on positive cases.
DIFFERENTIALS: viral hepatitis, B or C. Alcohol or drug induced. Acute HIV. Autoimmune disease. Granulomatous Disorders or Wilsons Disease.
Hep A: non enveloped, single stranded RNA. Replicates in liver cells, affects function and causes inflammation of liver.
Usually self limiting with good prognosis. Adults present as clinical illness, children asymptomatic.
4 phases: Incubation, prodromal, icteric, convalescent. Can be spread through person to person.
Diagnosis: Patient with acute illness, discrete onset and jaundice or aminotransferese levels.
Diagnose if known contact with confirmed case or IgM antibody to Hep A virus.
Management: Admit if severly unwell. Provide self care advice if can be managed in primary care, rest, regular paracetamol and/or ibuprofen for symptom management. Can issue anti emetic if required.
Advise to avoid work, school or nursery for first week of symptoms until no longer infectious. Avoid alcohol to reduce further risk of damage to liver.
Review 2 weekly, recheck bloods and refer to specialist clinic if further intervention indicated.
Contact HPU for advise on management and offer Hep A vaccine to patient if not already received.
S&S: Flu like symptoms, GI symptoms, itch or urticaria, jaundice, pale stools or dark urine. Possible presents in hepatomegaly, splenomegaly, lymphadenopathy and hepatic tenderness on examination likley.
Sign post to local sources of support and information.
HEP A