ABC of diseases of liver, pancreas, and biliary system

Acute hepatitis

BMJ 2001; 322 doi: http://dx.doi.org/10.1136/bmj.322.7279.151 (Published 20 January 2001)
Cite this as: BMJ 2001;322:151

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  1. S D Ryder,
  2. 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.

    View this table:

    Liver enzyme activity in liver disease

    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

    • Myalgia

    • 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)

    View this table:

    Types and modes of transmission of human hepatitis viruses

    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 …

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