eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Hepatitis A: Differential Diagnoses & Workup

Author: Nicholas John Bennett, MB, BCh, PhD, Fellow in Pediatric Infectious Disease, Department of Pediatrics, State University of New York Upstate Medical University
Coauthor(s): Joseph Domachowske, MD, Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York-Upstate Medical University; Lisa C Turner, MD, Clinical Instructor, Departments of Pediatrics and Communicable Diseases, University of Michigan Medical Center
Contributor Information and Disclosures

Updated: Jun 2, 2009

Differential Diagnoses

Enteroviral Infections
Gallbladder Disease
Gastroenteritis
Hepatitis B
Hepatitis C

Other Problems to Be Considered

Drug-induced hepatotoxicity
Hepatitis E

Workup

Laboratory Studies

  • Liver function tests
    • Liver inflammation during hepatitis A virus (HAV) infection can be identified by elevations in alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltranspeptidase (GGTP) levels. Increases in ALT and AST levels are seen most consistently, and the values are usually 4-100 times the normal levels. Elevations in ALT and AST levels may precede the onset of symptoms by a week or more and usually peak within 3-10 days after onset of clinical illness.
    • Serum bilirubin levels, although elevated, usually remain below 10 mg/dL and peak after 1-2 weeks of illness.
    • Prolongation of the prothrombin time (PT) and a significant decrease in the albumin level suggest a more severe course.
  • Anti–hepatitis A virus antibody tests
    • Specific antibody tests for hepatitis A virus confirm infection.
    • Anti–hepatitis A virus immunoglobulin (Ig)M is present at the onset of symptoms, and its level remains high for 4-8 weeks. It usually disappears by 4-6 months, but, occasionally, it persists longer.
  • Anti–hepatitis A virus immunoglobulin G (IgG) becomes detectable shortly after the IgM titer appears and usually increases as the IgM level decreases.
  • IgG persists for life and provides ongoing immunity against reinfection.

Imaging Studies

  • Imaging studies are generally not necessary. The history and physical examination and laboratory findings are used to establish the diagnosis in most cases of hepatitis A virus.
  • Ultrasonography of the liver may be helpful when cholelithiasis is a consideration.

Histologic Findings

  • Histologic findings are similar to those in other forms of acute viral hepatitis and include inflammatory cell infiltration, hepatocellular necrosis, and liver cell regeneration.
  • Liver biopsy is not indicated because of the self-limited nature of hepatitis A virus and lack of chronic infection.

More on Hepatitis A

Overview: Hepatitis A
Differential Diagnoses & Workup: Hepatitis A
Treatment & Medication: Hepatitis A
Follow-up: Hepatitis A
Multimedia: Hepatitis A
References
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References

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Further Reading

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Keywords

hepatitis A, hepatitis A virus, HAV, viral hepatitis, catarrhal jaundice, epidemic jaundice, infectious hepatitis, viral hepatitis type A, virus A hepatitis, Picornaviridae, picornavirus, cholestasis, fulminant hepatitis, splenomegaly, fulminant hepatitis, abdominal pain, diarrhea, treatment, diagnosis

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Contributor Information and Disclosures

Author

Nicholas John Bennett, MB, BCh, PhD, Fellow in Pediatric Infectious Disease, Department of Pediatrics, State University of New York Upstate Medical University
Nicholas John Bennett, MB, BCh, PhD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Pediatrics
Disclosure: Nothing to disclose.

Coauthor(s)

Joseph Domachowske, MD, Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York-Upstate Medical University
Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Lisa C Turner, MD, Clinical Instructor, Departments of Pediatrics and Communicable Diseases, University of Michigan Medical Center
Lisa C Turner, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Medical Editor

Rosemary Johann-Liang, MD, Medical Officer, Infectious Diseases and Pediatrics, Division of Special Pathogens and Immunological Drug Products, Center for Drug Evaluation and Research, Food and Drug Administration
Rosemary Johann-Liang, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Leslie L Barton, MD, Professor, Program Director, Department of Pediatrics, University of Arizona School of Medicine
Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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