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Acute viral hepatitis dos and don’ts dr. mani singhal
- 1. Dr. Mani Singhal, Resident, Pediatrics TNMC, Mumbai Under the guidance of Dr. Aabha Nagral Acute Viral Hepatitis- dos and don’ts
- 2. Clinical History… 4 yrs old girl child, h/o Nausea, poor appetite – 8-10 days Fever – 5-6 days, high grade, with chills and rigors, 2-3 spikes/day 2 episodes of vomiting – on the first day of fever. Abdominal distension - 4 days, pain in right upper quadrant Passing high colored urine , yellowish discoloration of eyes - 4 days
- 3. Clinical History No h/o: clay colored stools, pedal edema itching bleeding altered sensorium Mixed diet- deficient in calories- 600Kcal and 4g protein/day Developmentally normal, routine immunisation given including hep B. Hep A not given. Poor sanitary hygiene, use tap water for drinking, no known case of jaundice in locality .
- 4. On Examination Conscious, cooperative Vitals stable Icterus+ No edema or skin bleeds, cyanosis, lymphadenopathy Height-97 cm (3rd -50th centile) Weight- 12kgs (3rd -50th centile)
- 5. Systemic examination Liver: 4 cm, palpable below right SCM, tender, soft, span 11 cm, round borders,smooth surface. Spleen – not palpable Shifting dullness + Bowel sounds present Other systems CVS, RS, CNS- normal
- 6. Initial Impression 4 yrs old girl with Febrile illness with jaundice, hepatomegaly, ascitis ; suggestive of acute hepatitis of infective etiology Differential diagnosis- Acute viral hepatitis Malaria/ leptospir al infection Enteri c fever
- 7. • Fever, icterus, vomiting, anorexia seen • Ascitis, pleural effusion rare Acute viral hepatitis • Fever, hepatomegaly , pleural effusion seen • Anicteric illness mostly Malaria / leptospira infection • Fever , hepatomegaly • Frank jaundice is uncommon Enteric fever
- 8. Investigations CBC Hb 8.1 g/dl HCT 23.8% WBC 10,500/ul P/L/E 64/35/01 Plt 216,000/ul MCV 48.3 fl MCHC 34 g/dl RDW 17.2 % ESR 40 LFT T. BILI 7.1 INDIRECT BILI 4.9 T. PROTEIN 5.7 ALBUMIN 2.9 SGOT/PT 122/380 Alk PO4 699 PT/INR 1.2
- 9. Investigations contd… RFT electrolytes BUN 07 CRT 0.5 Na+ 134 K+ 4.1 Ca++ 8.0 PO4- 4.5
- 10. Final Impression Acute viral hepatitis A Ascites and Pleural Effusion Iron deficiency Anemia
- 12. Issues Ascites and pleural effusions in acute Hepatitis ? Viral markers in all? Isolation of the patient? Diet? When to admit a patient with acute hepatitis? Supportive treatment? IV fluids? Specific drugs? Vitamin supplements? Liver tonics? Serial monitoring for liver functions – how often