Viral hepatitis This must be considered in anyone presenting with hepatitic liver blood tests (high transaminases). All these viruses cause illnesses that have similar clinical and pathological features and are frequently anicteric or even asymptomatic. They differ in their tendency to cause acute and chronic infections. Therapeutic developments for viral hepatitis, in paicular hepatitis C, are evolving veryrapidly, with several new classes of drugs entering clinicalpractice Clinical features of acute infection A non-specific prodromal illness characterised by headache, myalgia, ahralgia, nausea and anorexia usually precedes the development of jaundice by a few days to 2 weeks. Vomiting and diarrhoea may follow and abdominal discomfo is common. Dark urine and pale stools may precede jaundice. There are usually few physical signs. The liver is often tender but only minimally enlarged. Occasionally, mild splenomegaly and cervical lymphadenopathy are seen. These features are more frequent in children or those with Epstein-Barr virus (EBV) infection. Symptoms rarely last longer than 3-6 weeks. Complications may occur but are rare . Investigations A hepatitic pattern of LFTs develops, with serum transaminases typically between 200 and 2000 U/L in an acute infection (usually lower and fluctuating in chronic infections). The plasma bilirubin reflects the degree of liver damage. The ALP rarely exceeds twice the upper limit of normal. Prolongation of the PT indicates the severity of the hepatitis but rarely exceeds 25 seconds, except in rare cases of acute liver failure. The white cell count is usually normal with a relative lymphocytosis. Serological tests confirm the aetiology of the infection. Management Most individuals do not need hospital care. Drugs such as sedatives and narcotics, which are metabolised in the liver, should be avoided. No specific dietary modifications are required. Alcohol should not be taken during the acute illness. Elective surgery should be avoided in cases of acute viral hepatitis, as there is a risk of post-operative liver failure. Liver transplantation is very rarely indicated for acute viral hepatitis complicated by liver failure, but is commonly performed for complications of cirrhosis resulting from chronic hepatitis B and C infection. Ref Davidson edition23rd pg 872