- S D Ryder,
- I J Beckingham
Acute hepatic injury is confirmed by a raised serum alanine transaminase activity. The activity may be 100 times normal, and no other biochemical test has been shown to be a better indicator. Alkaline phosphatase and γ-glutamyltransferase activities can also be raised in patients with an acute hepatic injury, but their activites are usually proportionately lower than that of alanine transaminase.
Acute viral hepatitis
Hepatitis can be caused by the hepatitis viruses A, B, C, D, or E. The D and E forms are rare in the United Kingdom. A large proportion of infections with hepatitis viruses of all types are asymptomatic or result in anicteric illnesses that may not be diagnosed as hepatitis. Hepatitis A virus causes a typically minor illness in childhood, with more than 80% of cases being asymptomatic. In adult life infection is more likely to produce clinical symptoms, although only a third of patients with acute hepatitis A infections are jaundiced. Infections with hepatitis B and C viruses are also usually asymptomatic except in intravenous drug users, in whom 30% of hepatitis B infections are associated with jaundice.
Common symptoms of acute viral hepatitis
Nausea and vomiting
Fatigue and malaise
Change in sense of smell or taste
Right upper abdominal pain
Coryza, photophobia, headache
Diarrhoea (may have pale stools and dark urine)
In the preicteric phase, patients often have non-specific systemic symptoms together with discomfort in the right upper quadrant of the abdomen. An illness resembling serum sickness occurs in about 10% of patients with acute hepatitis B infection and 5-10% of patients with acute hepatitis C infection. This presents with a maculopapular rash and arthralgia, typically affecting the wrist, knees, elbows, and ankles. It is due to formation of immune complexes, and patients often test positive for rheumatoid …