Editing Hepatitis (section)

== Acute hepatitis ==

** Aetiology
*** Viral hepatitis (see below)
*** Drugs - including paracetamol overdose (can occur with small amounts in alcoholics)
*** Acute alcoholic hepatitis
*** Gallstones
*** Wilson's disease, especially in childhood
*** In pregnancy - acute viral hepatitis is most common, but consider acute fatty liver
** Symptoms:
*** Nausea +/- vomiting
*** RUQ pain
*** Weakness/fatigue
*** Fever
*** Pruritis
*** Jaundice 
** Examination
*** Tender hepatomegaly often seen
*** Check for complications such as encephalopathy
** Investigation
*** Transaminase usually >5x ULN
*** Moderate ALP elevations can occur
*** USS - look at liver and spleen and exclude biliary disease
** Management
*** Viral hepatitis - supportive, ensure they don't develop fulminant liver failure, or develop chronic disease
*** Withdraw offending drugs
*** Alcoholic hepatitis - supportive, nutritional supplementation, thiamine, corticosteroids if encephalopathy
*** Acute autoimmune hepatitis - corticosteroids (e.g. prednisolone 30-60mg daily then taper)