Clinical features
- Asymptomatic
- Classic form: fever, fatigue, malaise, abdominal discomfort (right upper quadrant), nausea, diarrhoea, anorexia, followed by jaundice, dark urine and more or less clay coloured stool
- Fulminant form: acute liver failure due to massive liver necrosis, often It is more common in HepB patients with secondary infection with D virus and pregnant women who get hepatitis E in their third trimester
Differential diagnosis
- Other causes of hepatitis, e.g. drugs, herbs, tumours, and autoimmune diseases
- Gastroenteritis, relapsing fever
- Pancreatitis
- Malaria, leptospirosis, yellow fever
- Haemorhagic fevers, e.g. Marburg and Ebola
Investigations
- Complete blood count
- Slide or RDT for malaria parasites
- Liver function tests
- Viral antigens and antibodies: Hepatitis B, Hepatitis C, and HIV serology
ManagementTreatment
- Supportive management
- Rest and hydration
- Diet: high in carbohydrates and vitamins and vegetable proteins. Avoid animal proteins e.g. meat
- Avoid any drug – they may aggravate symptoms.
- Refer if patient has features of liver failure or decompensated liver disease
Caution
- Avoid drugs generally but especially sedatives and hepatotoxic drugs
- Ensure effective infection control measures e.g. institute barrier nursing, personal hygiene
- Patient isolation is not necessary unless there is high suspicion of viral haemorrhagic fevers
Prevention
- Hygiene and sanitation
- Immunization against hepatitis B (all children, health workers, household contacts of people with chronic hepatitis B, sex workers and other populations at risk)
- Safe transfusion practices
- Infection control in health facilities
- Screening of pregnant women
- Safe sexual practices (condom use)