Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Viral Hepatitis

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In one line

·A virus sneaks into liver cells, your immune system fights back hard, and the battle makes you tired, yellow, and sick—but most people win and heal completely.

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Normal physiology

·The liver is a chemical factory the size of a football, sitting under your right ribs. Every minute, about a quarter of your blood flows through it to get cleaned, restocked, and balanced before heading back to your heart.

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What goes wrong

·A hepatitis virus invades liver cells, your immune system attacks the infected cells to kill the virus, and that battle damages the liver's ability to filter blood and make proteins.

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Hallmark signs

·Feeling tired all the time, even after rest
·Yellow skin and eyes (jaundice)
·Dark urine, like cola or strong tea
·Pale or clay-colored stools
·Nausea, loss of appetite, or feeling sick to the stomach
·Pain or tenderness in the upper right belly, just below the ribs
·Mild fever and body aches, like a flu
·Confusion, sleepiness, or trouble thinking clearly

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Red flags · escalate now

·Confusion, extreme sleepiness, or slurred speech (sign the liver is failing and toxins are reaching the brain)
·Vomiting blood or black, tarry stools (sign of bleeding from swollen veins in the esophagus or stomach)
·Severe belly pain with rapid swelling (could mean infection of fluid in the belly, called spontaneous bacterial peritonitis)
·Trouble breathing or very fast heart rate with yellowing of the skin and eyes (jaundice) (sign of liver failure affecting the whole body)
·New bruising, nosebleeds, or bleeding gums without injury (sign clotting factors are dangerously low)

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Workup

·Alanine aminotransferase (ALT) and aspartate aminotransferase (AST)
·Total and direct bilirubin
·Hepatitis A IgM antibody
·Hepatitis B surface antigen (HBsAg), core IgM antibody (anti-HBc IgM), and surface antibody (anti-HBs)
·Hepatitis C antibody (anti-HCV) and HCV RNA by PCR
·Prothrombin time (PT) and INR
·Albumin
·Hepatitis D antibody (anti-HDV) and HDV RNA (if HBV is positive)

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Treatment

·Supportive care: rest, hydration, nutrition, and serial liver function tests every few days to weeks
·Hepatitis A vaccine and hepatitis B vaccine for unvaccinated close contacts within 2 weeks of exposure
·Hepatitis B immune globulin (HBIG) within 24 hours of exposure (e.g., needle stick, newborn of HBsAg-positive mother)
·Antiviral therapy for chronic hepatitis B: entecavir or tenofovir daily, often for years or lifelong
·Direct-acting antivirals for hepatitis C: sofosbuvir/velpatasvir or glecaprevir/pibrentasvir for 8–12 weeks
·Pegylated interferon-alpha or bulevirtide for chronic hepatitis D (in people with HBV co-infection)
·Liver transplant for acute liver failure (INR > 6.5, encephalopathy, multi-organ failure) or end-stage cirrhosis from chronic viral hepatitis

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NCLEX trap

·Viral hepatitis is caused by a virus, not bacteria. Antibiotics do NOT kill viruses and will NOT help. Order viral hepatitis panels (anti-HAV IgM, HBsAg, anti-HCV, anti-HEV) to find the virus, then give supportive care: rest, fluids, and avoid medicines that stress the liver (like acetaminophen).
·Yellowing of the skin and eyes (Jaundice) (yellow skin and eyes) happens when bilirubin builds up. Viral hepatitis damages liver cells (hepatocytes) so they can't process bilirubin. Ask about needle exposure, travel, shellfish, unprotected sex, and tattoos — all can spread hepatitis viruses. Check hepatitis labs first.
·Most adults with acute hepatitis B clear it on their own in 6 months. Give supportive care and watch closely. Only start antivirals for acute HBV if the patient has severe liver failure (rising INR, confusion, bleeding) or is immunocompromised. Antivirals ARE standard for chronic HBV (infection lasting >6 months).
·Hepatitis C is CURABLE. Direct-acting antivirals (DAAs) like sofosbuvir/velpatasvir cure over 95% of patients in 8–12 weeks with almost no side effects. All patients with HCV should be offered treatment. Cure stops liver damage and prevents cirrhosis and liver cancer.
·Each hepatitis virus needs a different plan. Hepatitis A: supportive care, it clears on its own. Hepatitis B acute: supportive care (antivirals only if severe). Hepatitis B chronic: long-term antivirals. Hepatitis C: cure with DAAs. Hepatitis D: pegylated interferon or bulevirtide (only happens with HBV). Hepatitis E: supportive care (ribavirin if pregnant or immunocompromised and severe).
·Hepatitis D (HDV) can ONLY infect someone who already has hepatitis B (it needs HBV to survive). When both viruses are present together, liver damage gets much worse and cirrhosis happens faster. Test for anti-HDV and HDV RNA in anyone with chronic HBV who has worsening liver disease or new symptoms. Treat with pegylated interferon alfa or bulevirtide.

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