Pediatric emergency medicine trisk 2091 2091
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (70.54 KB, 1 trang )
Clinically, the effect of HDV appears to worsen the course of HBV. Hepatitis
E is an enterically transmitted virus responsible for large epidemics of acute
hepatitis in Asia, the Middle East, and parts of Africa. Mortality as high as
10% is reported worldwide in pregnant women. Supportive care is the only
available treatment. Hepatitis G virus (HGV) is known to infect humans but
has not been definitively shown to cause disease. A variety of nonhepatotropic
viruses that cause systemic disease are known to cause a number of systemic
viral infections that may cause hepatitis, the most common of which are
Epstein–Barr virus (EBV) and cytomegalovirus (CMV).
Clinical Considerations
Clinical Recognition
The majority of patients who are diagnosed with hepatitis present with
nonspecific symptoms and clinically may appear jaundiced. Symptoms may
include nausea, vomiting and anorexia, or may include flu-like symptoms of
cough, pharyngitis, rhinorrhea, headache, or myalgias. A history of
immigration or adoption from high prevalence countries, such as those from
Eastern Europe, Asia, Sub-Saharan Africa, Northern South America, or
family/personal history of high-risk exposures, such as IV drug use, multiple
sexual partners, unregulated tattoo parlors, should prompt screening HBV and
HCV even if liver transaminases are only mildly elevated.
Triage
The basic tenets of contact transmission apply, thus encourage patients and
providers to wash hands after using the bathroom and before fixing food or
eating.
Initial Assessment/H&P
Most childhood cases of acute hepatitis produce minimal symptoms, are
anicteric, and, unless suspected by palpation of tender hepatomegaly, are
usually confused with a GI flu–like illness. Clinical hepatitis classically
consists of a 5- to 7-day prodrome of variable constitutional symptoms (lowgrade fever, anorexia, nausea, vomiting, malaise, fatigue, and epigastric or
right upper quadrant abdominal pain), followed by acute onset of scleral
icterus, jaundice, and passage of dark urine. Pruritus and diarrhea are rare.
Physical examination after the onset of jaundice may reveal tender
hepatomegaly. Mild splenomegaly is present in 25% to 50% of patients. HBV
