HEPATITIS, ACUTE VIRAL |
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DESCRIPTIONAcute viral hepatitis is inflammation of the liver caused by a virus. Liver cells and bile ducts are involved.
Appropriate health care includes: Self-care after diagnosis (mild cases); physician's monitoring of general condition and medications; and hospitalization (severe cases).
SIGNS & SYMPTOMS
Symptoms vary greatly between children.
Early symptoms are non-specific and include: flu-like symptoms, such as fever, headache, muscle aches, fatigue, nausea, vomiting, diarrhea, loss of appetite, and general ill feeling.
Later symptoms include: abdominal pain; foul breath with a bitter taste; jaundice (yellow eyes and skin) caused by a buildup of bile in the blood; dark urine from bile spilling over into the urine; light, "clay-colored" or whitish stools; swollen, tender liver (sometimes) and spleen (sometimes).
CAUSES
Any of 3 different but related viruses that may infect the liver. All are contagious.
Type A (infectious hepatitis): Usually is spread by person-to-person contact. It also enters the body through water or food, especially raw shellfish, that has been contaminated by sewage.
Type B (serum hepatitis): Usually enters the body through inoculations of serum or blood transfusions contaminated with the virus or from infections with non-sterile needles (frequently used by IV drug abusers) or syringes or from sexual activities with an infected person. Blood-sucking insects are also suspected as sources of Type B.
Type Non-A, Non-B: Usually enters the body by contaminated blood transfusions.
RISK FACTORS
Crowded or unsanitary living conditions or travel to areas with poor sanitation; oral-anal sexual practices; use of intravenous, mind-altering drugs; alcoholism; blood transfusions; volunteering or working in a hospital; kidney-dialysis treatment; homosexual practices; poor nutrition; illness that has lowered resistance; exposure to others in public places.
PREVENTING COMPLICATIONS OR RECURRENCE
Instructions for your child: Avoid risks listed above. Don't eat shellfish from areas with poor sanitation systems. If you are exposed to someone with hepatitis, consult your doctor about receiving gamma-globulin (GG) injections to decrease the risk of hepatitis. (GG can suppress--but not prevent -- infectious hepatitis after exposure.) If you are in a high-risk group, such as hospital workers or volunteers, or male homosexuals, consult your doctor about a vaccine for Type-B hepatitis. (Vaccines are not available for other forms.) If you are traveling where hepatitis is endemic (constantly present), consult your doctor about a vaccine or gamma globulin injection.
BASIC INFORMATION
MEDICAL TESTSMedical history and physical exam by a doctor; laboratory studies of blood, stool, and liver function; urinalysis; special nuclear medicine studies and ultrasonography (See Glossary for all).
POSSIBLE COMPLICATIONSLiver failure in severe cases (very rare).
PROBABLE OUTCOME
In younger children, this is a common infection that is usually mild. It is usually curable in 2 to 3 weeks, but wait 2 more weeks before sending your child to school or other public places. In older children and adolescents, jaundice and other symptoms peak and then gradually disappear over 3 to 16 weeks. Most children in good general health recover fully in 1 to 4 months. A small percentage (1% to 2%) may proceed to chronic hepatitis. Recovery from viral hepatitis usually provides permanent immunity against it.
TREATMENT
HOME CARESee Appendix 12, Care of the Sick Child at Home.
MEDICATION
Your doctor may prescribe cortisone drugs for severe cases to reduce liver inflammation.
ACTIVITY
Bed rest is necessary, except to use the bathroom, until fever is gone, jaundice disappears, and appetite returns. Your child can then sit in a chair, read, or watch TV. Children differ widely in the rate at which they can return to normal activity.
DIET & FLUIDS
Encourage your child to eat, despite a poor appetite, small well-balanced meals to help promote recovery. At least 8 glasses of water are necessary each day. Hard candy may taste good and be nourishing to the liver. Urge your child not to drink alcohol.
OK TO GO TO SCHOOL?When your doctor determines that your child is no longer contagious.
CALL YOUR DOCTOR IF
Your child has symptoms of hepatitis or has been exposed to someone who has it.
The following occurs during treatment: increasing loss of appetite; excessive drowsiness or mental confusion; vomiting, diarrhea, or abdominal pain; deepening jaundice; skin rash or itching.
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