Hepatitis

Symptoms

Because the initial symptoms of viral hepatitis are similar to influenza, the initial diagnosis may be that of the flu. The following symptoms are most commonly seen in individuals who have one of the conditions known as viral hepatitis

• Fatigue or malaise
• Loss of appetite
• Nausea
• Vomiting
• Low-grade fever
• Headache
• Diarrhea
• Abdominal pain
• Jaundice (sclera and/or skin)
• Generalized skin itching
• Clay-colored stools
• Weight loss

Diagnosis

The diagnosis of any of the viral hepatitis conditions generally consists of several blood tests and may [Page 489]include a complete blood count (CBC) and a battery of liver function tests (LFTs) including the following

• Serum albumin
• Alkaline phosphatase (ALP)
• Alanine transaminase (ALT); also known as serum pyruvate transaminase (SGPT)
• Aspartate aminotransferase (AST); also known as serum glutamic-oxaloacetic transaminase (SGOT)
• Gamma-GT (GGTP or GGT)
• Prothrombin time (PT or pro-time)
• Total bilirubin; direct and indirect bilirubin; also known as conjugated or unconjugated bilirubin
• Urine bilirubin

The three most common virally caused hepatitis conditions are hepatitis A (HepA), hepatitis B (HepB), and hepatitis C (HepC). In diagnosing viral hepatitis, serum will also be collected to determine the presence of antibodies for each of these three types of hepatitis. IgM antibodies generally appear in the serum approximately 3 to 4 weeks after exposure and return to normal levels within approximately 8 weeks. IgG antibodies generally appear in the serum approximately 2 weeks after the IgM antibodies increase and may be perpetually present. A normal test for any of these indicates lack of viral exposure.

Causation and Risk Factors

Each of the three types of hepatitis is caused by a specific virus. In addition, mode of transmission and associated risk factors may be disease specific. HepA is transmitted through contaminated water or food and contact with the stool, blood, or other body secretions of an infected person during the 15to 45-day incubation period before symptoms are present and during the first 7 days of illness. HepA is considered an acute disease; it does not become chronic and is rarely fatal. The risk factors include communal living, for example, nursing homes, close contact with a recently infected person, intravenous drug use, and travel or recent immigration from endemic areas such as South or Central America or many Asian countries.

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