Presentation: The classic presentation of acute viral hepatitis is a prodrome of fever, vomiting and malaise followed by onset of jaundice and right upper quadrant pain. The fever classically disappears with the onset of jaundice.
Approach: Any child with the aforementioned presentation should get the following tests done: CBC, LFT and PT/INR, in addition to clinical examination to document the liver span.
Abdominal ultrasound and viral markers are not necessary to make a diagnosis. Infact, viral markers are only required to confirm the etiology. G6PD level should be done in children with high bilirubin level (>10mg/dl) especially if there is evidence of peripheral hemolysis.
Management: Patients with a poor oral intake, persistent vomiting and dehydration need admission. Children who have an altered sleep wake cycle, disorientation or those with an INR>1.5 also requires urgent admission and care. Rest of the children can be managed on outpatient basis. The child should be on a normal diet; there is no role of fat or protein restriction. Rapidly rising INR, steep fall in the liver enzymes with a rising bilirubin level, decrease liver span on clinical examination and worsening encephalopathy are poor prognostic markers.
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