Hepatitis: General principles

• Hepatitis has many causes, and because management differs greatly, depending on the specific diagnosis, clinicians should perform an organized search to identify the responsible disease and initiate treatment. • Before assuming that elevated serum AST and ALT values are hepatic in origin, it is important to verify that serum creatine kinase and aldolase values are within the normal range. • An elevated prothrombin time despite administration of vitamin K and low serum albumin concentrations are the most useful indicators of impaired synthetic function of the liver. • Total serum protein concentration can be in the normal range in spite of a low albumin value when the gamma globulins are increased significantly and the ratio of albumin to gamma globulins is inverted. • Complications of hepatitis can present a medical emergency, as in the case of coagulopathy, esophageal bleeding, or acute encephalopathy. • Based on strong evidence, liver biopsy is the gold standard for the diagnosis of almost all liver diseases. (1) • Based on strong evidence, HAV vaccine is highly recommended for all children who have any chronic liver disease. (2) • Based on strong evidence, breastfeeding does not increase the risk of HBV transmission. (3) • Based on strong evidence, infants born to HCV-infected mothers should be screened by measuring serum anti-HCV antibody at 18 months of age. (4).