Acute Viral Hepatitis can be well managed by pediatrician. However, patients should be referred to the higher center or a pediatric gastroenterologist in the following situations –
Any complication of Hepatitis like intra-vascular hemolysis, prolonged cholestasis(>12 weeks), acute liver failure, pancreatitis, etc.
Deterioration of LFTs like poor synthetic function – hypoalbuminemia, deranged Prothrombin Time/INR
Suspicion of underlying chronic liver disease – firm irregular liver, splenomegaly, palpable liver with deranged INR, negative viral markers, recurrent jaundice and family history of chronic liver disease, ascites etc.
Clinical deterioration of patients like – persistent vomiting, irritability, hypoglycemia, rapidly reducing liver size or non-palpable liver etc.