Hepatitis aguda
Antecedentes
Causes of acute hepatitis
- Acetaminophen toxicity (most common cause of acute liver failure in the US[1])
- Viral hepatitis
- Toxoplasmosis
- Acute alcoholic hepatitis
- Toxins
- Ischemic hepatitis
- Autoimmune hepatitis
- Wilson's disease
Drug or Toxin Related Liver Disease
- Liver damage from drugs or toxins may be cytotoxic from the primary drug or its metabolites, or may be caused by veno-occlusive disease or hypersensitivity disease[2]
- Common Drugs and Toxins
- Acetaminophen
- Amiodarone
- Amphotericin
- Anabolic steroids
- Azathioprine
- Carbamazepine
- Chlorpromazine
- Cisplatin
- Contraceptives
- Cyclophosphamide
- Erythromycin
- Gold salts
- Haloperidol
- Isoniazid
- Ketoconazole
- Lovastatin
- Methotrexate
- Methoxyflurane
- Methyldopa
- Phenobarbital
- Phenytoin
- Quinidine
- Salicylates
- Tetracycline
- Valproic acid
- Verapamil
Características Clínicas
Acute Hepatitis Features
- Nausea/Vomiting
- RUQ pain
- Enlarged, tender liver
- Fever
- Jaundice
- Bilirubinuria
Diagnóstico Diferencial
RUQ Pain
- Gallbladder disease
- Pancreatitis
- Acute hepatitis
- Pancreatitis
- GERD
- Appendicitis (retrocecal)
- Pyogenic liver abscess
- Bowel obstruction
- Cirrhosis
- Budd-Chiari syndrome
- GU
- Other
- Hepatomegaly due to CHF
- Peptic ulcer disease with or without perforation
- Pneumonia
- Herpes zoster
- Myocardial ischemia
- Pulmonary embolism
- Abdominal aortic aneurysm
Evaluación
- LFTs
- AST, ALT > 1000s
- Bilirrubina elevada
- Fosfatasa alcalina elevada
- INR
- Considerar nivel de paracetamol
- Panel de hepatitis viral aguda
- Hep A Ab IgM
- Hep B cAb IgM
- Hep B sAg
- Hep B sAb
- Hep C Ab
| Anti-hepatitis A, IgM | Antígeno de superficie de hepatitis B | Anti-hepatitis B core, IgM | Anti-hepatitis C | Interpretación |
|---|---|---|---|---|
| Positivo | Negativo | Negativo | Negativo | Hepatitis A aguda |
| Negativo | Positivo | Positivo | Negativo | Hepatitis B aguda |
| Negativo | Positivo | Negativo | Negativo | Infección crónica por hepatitis B |
| Negativo | Negativo | Positivo | Negativo | Hepatitis B aguda; la cantidad de antígeno de superficie de hepatitis B es demasiado baja para detectar |
| Negativo | Negativo | Negativo | Positivo | Hepatitis C aguda o crónica; se requieren pruebas adicionales para hacer la determinación |
Manejo
- Tratar la causa subyacente
Disposición
Considerar ingreso para:
- Bilirrubina > 20
- TP 50% por encima de lo normal
- Hipoglucemia
- Hipoalbuminemia
- Cualquier hernorragia GI
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Referencias
- ↑ Ostapowicz G, Fontana RJ, Schiodt FV, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med. 2002 Dec 17; 137(12): 947-54.
- ↑ Oyama, LC: Disorders of the Liver and Biliary Tractin Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2014, (Ch) 107: p 1186-1204