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Hepatitis B - Management
When should I suspect acute hepatitis B?

  • Acute hepatitis B cannot easily be distinguished from other forms of acute hepatitis either by history or examination, or through routine biochemistry.
  • Acute hepatitis B:
    • Is asymptomatic in around 50% of adults and in most infants and young children.
    • Has an incubation period of generally 60–90 days (but this ranges from 40–160 days).
    • Can present as a serum sickness-like prodromal illness (in 10% of people).
      • Fever, arthralgia, or a rash may appear about 2 weeks prior to the onset of jaundice; such symptoms usually subside when the jaundice appears.
    • Often presents with symptoms that are ill-defined and have an insidious onset. These include:
      • Nonspecific malaise — which may be profound, with disinclination to smoke or to drink alcohol.
      • Fever — if present, it is usually mild.
      • Nausea and poor appetite.
      • Pain in the right upper abdominal quadrant.
      • Jaundice — occurs in only about 10% of younger children and 30–50% of adults. Urine becomes darker, and the stools paler, in cholestasis.
      • Fulminant hepatitis — occurs in less than 1% of people.
      • Extrahepatic manifestations — such as glomerulonephritis, vasculitis, and polyarteritis.
  • In the absence of clinical features of hepatitis, suspect acute hepatitis B if the person has:
    • Altered liver function tests.
      • In acute hepatitis B, ALT (alanine transaminase) and AST (aspartate transaminase) levels typically reach 1000–2000 IU/L (with ALT being higher than AST).
    • Characteristic serological markers of acute hepatitis B infection.
  • If hepatitis B is suspected, confirm the diagnosis by serology.

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