《2008英国国家甲、乙、丙型肝炎病毒管理指南》内容预览

The prodromal illness: flulike symptoms (malaise, myalgia, fatigue), often with right upper abdominal pain. This phase lasts for 310 days. This is followed by
The icteric illness: jaundice (mixed hepatic and cholestatic) associated with anorexia, nausea and fatigue which usually lasts for 13 weeks. It can persist for 12 or more weeks in a minority of patients who have cholestatic symptoms (itching and deep jaundice). Fever is not found in this phase.Signs
None specific in the prodromal phase.
Icteric phase jaundice with pale stools and dark urine. Liver enlargement/tenderness and signs of dehydration are also common. Complications
Acute liver failure (ALF) complicates approximately 0.4% of cases, although 15% of patients may require hospital care, of whom a quarter will have severe hepatitis (Prothrombin time P.T.> 3 seconds prolonged or bilirubin >170mmoles/l) . ALF due to hepatitis A is more common in patients already infected with chronic hepatitis B or C, although studies differ widely in measured rates .
Chronic infection (>6 months) has only been reported in a tiny number of casereports.
The overall mortality is < 0.1% although rises to 40% on those with acute liver failure unless they receive a liver transplant .
Pregnancy The infection does not have any teratogenic effects but there is an increased rate of miscarriage and premature labour, proportional to the severity of the illness . There have been case reports of possible vertical transmission .

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