Hepatitis A

Last reviewed: 2 Jun 2022
Last updated: 19 May 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • fever
  • malaise
  • nausea and vomiting
  • jaundice
  • hepatomegaly
  • right upper quadrant pain
  • clay-coloured stools
More key diagnostic factors

Other diagnostic factors

  • fatigue
  • headache
  • dark urine
  • pruritus
  • arthralgias and myalgias
  • cough
  • diarrhoea
  • constipation
  • splenomegaly
  • posterior cervical lymphadenopathy
  • evanescent rash
  • bradycardia
Other diagnostic factors

Risk factors

  • living in endemic region
  • travel to endemic region
  • close personal contact with an infected person
  • men who have sex with men
  • known foodborne outbreak
  • illegal drug use
  • homelessness
  • occupational exposure
More risk factors

Diagnostic investigations

1st investigations to order

  • serum transaminases
  • serum bilirubin
  • blood urea
  • serum creatinine
  • prothrombin time
  • IgM anti-hepatitis A virus (HAV)
More 1st investigations to order

Investigations to consider

  • IgG anti-hepatitis A virus (HAV)
  • hepatitis A virus RNA detection
More investigations to consider

Treatment algorithm

INITIAL

unvaccinated people with recent exposure to hepatitis A (<2 weeks)

ACUTE

confirmed hepatitis A

Contributors

Authors

Musaddiq Waheed, MD

Hospitalist Physician

Archbold Memorial Hospital

Thomasville

GA

Assistant Clinical Professor

Florida State University School of Medicine

Tallahassee

FL

Disclosures

MW declares that he has no competing interests.

Acknowledgements

Dr Musaddiq Waheed would like to gratefully acknowledge the late Dr Fida A. Khan for his contribution to this topic.

Disclosures

FAK declared that he has no competing interests.

Peer reviewers

Howard J. Worman, MD

Professor of Medicine and Cell Biology

Columbia University College of Physicians and Surgeons

New York

NY

Disclosures

HJW declares that he has no competing interests.

Srikrishna Nagri, MD

Gastroenterologist

Dartmouth-Hitchcock Nashua

Nashua

NH

Disclosures

SN declares that he has no competing interests.

George Y. Wu, MD, PhD

Professor of Medicine

University of Connecticut Health Center

Farmington

CT

Disclosures

GYW is on the medical advisory boards of the following: Gilead Sciences, Bristol-Myers Squibb, AbbVie, and Intercept.

Kittichai Promrat, MD

Assistant Professor

Division of Gastroenterology

Department of Medicine

Brown University

RI

Disclosures

KP declares that he has no competing interests.

Pierre Van Damme, MD, PhD

Professor

Director of Vaccine & Infectious Disease Institute

University of Antwerp

Antwerp

Belgium

Disclosures

PVD has been and still is principal investigator of vaccine trials for several vaccine manufacturing companies, from which the university obtained and obtains research contracts and funds for conducting such vaccine trials.

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