Management of Viral Hepatitis

Diagnosis and Evaluation

The American Association for the Study of Liver Diseases recommends a comprehensive evaluation of patients with viral hepatitis, including specific history points, targeted physical examination, and laboratory investigations 1, 2
Risk factors for viral hepatitis acquisition include sexual history, history of injection drug use, blood transfusion history, travel to endemic areas, family history of HBV infection and liver cancer, and occupational exposures 2, 3, 4, 5, 6
Symptoms assessment should include duration and severity of jaundice, fatigue and malaise, abdominal pain, nausea and vomiting, fever, and dark urine or clay-colored stools 1, 5
Physical examination should include general appearance, vital signs, skin examination, abdominal examination, and other systems 1, 5
Initial laboratory tests should include complete blood count with platelets, liver function tests, viral hepatitis markers, and other tests as indicated 1, 5, 8

The Centers for Disease Control and Prevention recommends treatment for chronic hepatitis B based on HBeAg status, HBV DNA levels, ALT elevation, and evidence of liver fibrosis 1, 8
Treatment options for chronic hepatitis B include nucleos(t)ide analogues and pegylated interferon in selected cases 6, 7
Monitoring for chronic hepatitis B should include ALT every 3-6 months, HBV DNA levels, HBeAg/anti-HBe status, and ultrasound for HCC surveillance 1, 3
Preventive measures include hepatitis A vaccination for patients with chronic liver disease, counseling on preventing transmission to others, and avoidance of alcohol 3, 5, 6

Regular monitoring of liver function tests and periodic assessment of viral markers are recommended 1, 8
HCC surveillance is recommended in high-risk patients 3, 8
Evaluation for complications of chronic liver disease should include assessment for signs of liver failure, portal hypertension, and other complications 5, 7