What are the relevant history points, examination, investigations, and treatment for a 21-year-old female with viral hepatitis?

Management of Viral Hepatitis in a 21-Year-Old Female

The comprehensive evaluation of a 21-year-old female with viral hepatitis should include specific history points, targeted physical examination, appropriate laboratory investigations, and treatment based on the type of viral hepatitis identified. 1

Relevant History Points

• Risk factors for viral hepatitis acquisition:

  • Sexual history (multiple partners, unprotected sex) 1
  • History of injection drug use 1
  • Blood transfusion history 1
  • Travel to endemic areas 1
  • Family history of HBV infection and liver cancer 1
  • Occupational exposures (healthcare workers) 1

• Symptoms assessment:

  • Duration and severity of jaundice 1
  • Fatigue and malaise 1
  • Abdominal pain (especially right upper quadrant) 1
  • Nausea and vomiting 1
  • Fever 1
  • Dark urine or clay-colored stools 1

• Other important history:

  • Alcohol consumption (can worsen liver damage) 1
  • Current medications (including over-the-counter and herbal supplements) 1
  • Previous liver disease 1
  • Coexisting medical conditions 1

Physical Examination

• General appearance: Signs of acute or chronic illness 1

• Vital signs: Fever may indicate active infection 1

• Skin examination:

  • Jaundice (scleral and skin) 1
  • Spider angiomas (suggest chronic liver disease) 1
  • Palmar erythema 1

• Abdominal examination:

  • Hepatomegaly (liver tenderness, size) 1
  • Splenomegaly 1
  • Ascites (suggests advanced liver disease) 1
  • Caput medusae (dilated periumbilical veins suggesting portal hypertension) 1

• Other systems:

  • Lymphadenopathy 1
  • Signs of encephalopathy (in severe cases) 1

Investigations

Initial Laboratory Tests

• Complete blood count with platelets 1

• Liver function tests:

  • AST/ALT (aminotransferases) 1
  • Alkaline phosphatase 1
  • Gamma-glutamyl transpeptidase (GGT) 1
  • Total and direct bilirubin 1
  • Albumin 1
  • Prothrombin time/INR 1

• Viral hepatitis markers:

  • Hepatitis A: Anti-HAV IgM (acute infection) 1
  • Hepatitis B: HBsAg, anti-HBc IgM (acute), HBeAg, anti-HBe, HBV DNA 1
  • Hepatitis C: Anti-HCV, HCV RNA 1
  • Hepatitis D: Anti-HDV (if HBsAg positive) 1
  • Hepatitis E: Anti-HEV IgM 1

• Other tests:

  • HIV testing (coinfection increases morbidity) 1
  • Autoimmune markers (to rule out autoimmune hepatitis) 2
  • Serum alpha-fetoprotein (baseline for HCC risk) 1

Imaging Studies

• Abdominal ultrasound (evaluate liver size, texture, and rule out complications) 1
• Transient elastography (FibroScan) to assess liver fibrosis non-invasively 1

Additional Tests (as indicated)

• Liver biopsy (to assess inflammation and fibrosis, especially if diagnosis unclear) 1
• HBV genotype testing (if considering interferon therapy) 1
• HBV DNA quantification (for chronic HBV) 1
• HBsAg quantification (useful for HBeAg-negative chronic HBV) 1

Treatment

Treatment depends on the specific viral etiology and disease phase:

Acute Viral Hepatitis

• Supportive care:

  • Adequate hydration 1
  • Nutritional support 1
  • Avoidance of hepatotoxic medications 1
  • Abstinence from alcohol 1

• Hospitalization criteria:

  • Signs of acute liver failure (encephalopathy, coagulopathy) 1
  • Inability to maintain hydration 1
  • Severe symptoms 1

Chronic Hepatitis B

• Treatment indications based on:

  • HBeAg status 1
  • HBV DNA levels 1
  • ALT elevation 1
  • Evidence of liver fibrosis 1

• Treatment options:

  • Nucleos(t)ide analogues (entecavir, tenofovir) 1, 3
  • Pegylated interferon in selected cases 1, 3

• Monitoring:

  • ALT every 3-6 months 1
  • HBV DNA levels 1
  • HBeAg/anti-HBe status 1
  • Ultrasound for HCC surveillance 1

Chronic Hepatitis C

• Direct-acting antivirals based on genotype 3
• Monitor for sustained virologic response 3

Hepatitis D (with HBV coinfection)

• Pegylated interferon or newer agents like bulevirtide 3

Preventive Measures

• Hepatitis A vaccination for patients with chronic liver disease 1
• Counseling on preventing transmission to others 1
• Avoidance of alcohol 1

Follow-up

• Regular monitoring of liver function tests 1
• Periodic assessment of viral markers 1
• HCC surveillance in high-risk patients 1
• Evaluation for complications of chronic liver disease 1