Case: Acute viral hepatitis- dos and don’ts Presenter: Mani Singhal Moderator: John Matthai Panelists: Shakuntala Prabhu, S K Yachha, Aabha Nagral

1. Dr. Mani Singhal,
Resident, Pediatrics
TNMC, Mumbai
Under the guidance of Dr. Aabha Nagral
Acute Viral Hepatitis-
dos and don’ts

2. Clinical History…
4 yrs old girl child, h/o
Nausea, poor appetite – 8-10 days
Fever – 5-6 days, high grade, with chills and
rigors, 2-3 spikes/day
2 episodes of vomiting – on the first day of fever.
Abdominal distension - 4 days, pain in right
upper quadrant
Passing high colored urine , yellowish
discoloration of eyes - 4 days

3. Clinical History
No h/o:
clay colored
stools,
pedal edema
itching
bleeding
altered sensorium
Mixed diet- deficient in
calories- 600Kcal and 4g
protein/day
Developmentally normal,
routine immunisation
given including hep B.
Hep A not given.
Poor sanitary hygiene,
use tap water for
drinking, no known case
of jaundice in locality .

4. On Examination
Conscious,
cooperative
Vitals stable
Icterus+
No edema or skin
bleeds, cyanosis,
lymphadenopathy
Height-97
cm (3rd -50th
centile)
Weight-
12kgs
(3rd -50th
centile)

5. Systemic examination
Liver:
4 cm, palpable below
right SCM, tender,
soft, span 11 cm,
round borders,smooth
surface.
Spleen – not palpable
Shifting dullness +
Bowel sounds present
Other systems
CVS, RS, CNS-
normal

6. Initial Impression
 4 yrs old girl with Febrile illness with jaundice,
hepatomegaly, ascitis ; suggestive of acute
hepatitis of infective etiology
Differential diagnosis-
Acute
viral
hepatitis
Malaria/
leptospir
al
infection
Enteri
c
fever

7. • Fever, icterus, vomiting,
anorexia seen
• Ascitis, pleural effusion
rare
Acute viral
hepatitis
• Fever, hepatomegaly ,
pleural effusion seen
• Anicteric illness mostly
Malaria /
leptospira
infection
• Fever , hepatomegaly
• Frank jaundice is
uncommon
Enteric fever

8. Investigations
CBC
Hb 8.1 g/dl
HCT 23.8%
WBC 10,500/ul
P/L/E 64/35/01
Plt 216,000/ul
MCV 48.3 fl
MCHC 34 g/dl
RDW 17.2 %
ESR 40
LFT
T. BILI 7.1
INDIRECT BILI 4.9
T. PROTEIN 5.7
ALBUMIN 2.9
SGOT/PT 122/380
Alk PO4 699
PT/INR 1.2

9. Investigations contd…
RFT
electrolytes
BUN 07
CRT 0.5
Na+ 134
K+ 4.1
Ca++ 8.0
PO4- 4.5

10. Final Impression
Acute viral hepatitis A
Ascites and Pleural
Effusion
Iron deficiency Anemia

12. Issues
Ascites and pleural effusions in acute Hepatitis
?
Viral markers in all?
Isolation of the patient?
Diet?
When to admit a patient with acute hepatitis?
Supportive treatment? IV fluids?
Specific drugs? Vitamin supplements? Liver
tonics?
Serial monitoring for liver functions – how often