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Hepatitis A - Coggle Diagram
Hepatitis A
Follow-Up and Referral
Usually do not require follow up
Patient education
Household contacts and sexual contacts should be given passive immunity as well as active immunization
Do not share personal items during infective periods
Toothbrushes
Razors
Eating utensils
Patient resources
American Liver Foundation
Rarely require hospitilization
Information technologies
Local health dep. sends report through the National Notifiable Disease Surveillance System
Hepatitis A surveillance data can be used to inform and improve public health interventions
Healthcare providers notify their local health dep. of Hep A case
Go to ER if persistent vomiting or anorexia leading to dehydration
Refer to hepatology if liver failure occurs or other comorbidities present
Epidemiology
Endemic in US with periodic outbreaks
CDC reports 12,474 new cases of HAV in 2018 with an estimated 24,900 acute infections
This was an 850% increase from 2014 to 2018
Risk factors
Crowded conditions
Prisons
Nursing homes
Day-care centers
Poor sanitations
45% of US population has antibodies
Vaccine available
Mortality rate 0.0%-0.2%
Pathophysiology
Average incubation period of 28 days (15 to 50 days)
Blood and stool remain infectious throughout incubation period
Aminotransferase levels peak
Person is most infectious 2 weeks before and during the first week that symptoms appear
Liver acini cells affected by patchy cell dropout, acidophilic hepatocellular necrosis, scarring, Kupffer cell hyperplasia and mononuclear inflammatory infiltrate.
Degree of cellular change is proportional to the severity of infection.
Fosters development of hepatocellular necrosis
Normally, reticulin network is preserved, allowing for complete histological recovery
Inflammatory processes can damage and obstruct the bile canaliculi
Chronic cholestasis and obstructive jaundice
Infectious source
Blood Tranfusion (rare
Raw shellfish
Uncooked produce that may be contaminated when handling
Fecal Oral Route
oral-anal sex
Ingestions of food or water contaiminated by an infected person
Management
Diagnostics
Anti-HAV IgM (Gold standard for acute)
Appears 4 weeks after exposure, disappears in 3-6 months
Anti-HAV IgG (resolving)
Peaks after 1 month of disease
Persists for more than 10 years and provides immunity
Urine bilirubin
Elevated ALT and AST
Elevated LDH, bilirubin and alkaline phosphatase
HPI
Extremely variable
Prodromal
Fever, anorexia, nausea, vomiting, malaise, URI, myalgia, arthralgia, easily fatigued, abdominal pain
Onset abrupt or insidious
Asymmptomatic
Icteric
Jaundice, dark urine, light-colored stools
Convalescent
Increased sense of well-being
Appetite returns
Jaundice, abdominal pain and fatigue resolve
Differential diagnoses
Cytomegalovirus infection
Herpes simplex virus
Infectious mononucleosis
Toxin-induced liver damage
Prevention of Transmission
Adequate supplies for clean drinking water
Proper disposal of sewage
Personal Hygiene and regular handwashing
Safe sex practices including condoms
Treatment
Symptom relief
Balanced nutrition
Adequate hydration
Avoidance of alcohol
Activity restricted during acute phase and relapse
Avoiding hepatotoxic medications
Immunity
HAV vaccination
Everyone 1 year or older
Travel to countries with high rates of Hep A
Men who have sex with men
People who use injectable drugs
Persons with chronic liver disease
Occupational risk factors
Pharmacologic Therapy
There is no specific antiviral treatment
Avoid unnecessary medications that affect the liver
Steroids
Some antibiotics
Acteaminophen