Any evidence for severe disease should prompt hospitalization. These include persistent nausea and vomiting, prolonged prothrombin time, low serum albumin level, hypoglycemia, high serum bilirubin level, or central nervous system symptoms. In most cases, however, clinical and biochemical recovery is complete within 1 to 2 months in all cases of hepatitis A, in most cases of hepatitis B, but in only a small proportion of cases of hepatitis C.
When patients are hospitalized, their feces, secretions, bedpans, and other articles in contact with the intestinal tract should be handled with glove-protected hands. Extra precautions, such as double gloving during delivery and surgical procedures, are recommended. Due to significant exposure of health-care personnel to hepatitis B, the Centers for Disease Control and Prevention (CDC) (2016a) recommend active and passive vaccination, described later. There is no vaccine for hepatitis C, so recommendations are for postexposure serosurveillance only.
Acute hepatitis has a case-fatality rate of 0.1 percent. For patients ill enough to be hospitalized, it may reach 1 percent. Most fatalities are due to fulminant hepatic necrosis, which in later pregnancy may resemble acute fatty liver. In these cases, hepatic encephalopathy is the usual presentation, and the mortality rate is 80 percent. Approximately half of patients with fulminant disease have hepatitis B infection, and co-infection with the delta agent is common.
Hepatic, Biliary, and Pancreatic Disorders 1063
The CDC (20 16b) estimated that more than 4 million Americans were living with chronic viral hepatitis. Although most chroniclly infected persons are asymptomatic, approximately 20 percent develop cirrhosis within 10 to 20 years (Dienstag, 2015b). When present, symptoms are nonspecific and usually include fatigue. In some patients, cirrhosis with liver failure or bleeding varices may be the presenting inding. Indeed, asymptomatic chronic viral hepatitis as a group remains the leading cause of liver cancer and the most frequent reason for liver transplantation.
Chronic viral hepatitis is usually diagnosed serologically (Table 55-3). With persistently abnormal biochemical tests, liver biopsy usually discloses active inlammation, continuing necrosis, and fibrosis that may lead to cirrhosis. Chronic hepatitis is classiied by cause; by grade, defined by histological activity; and by stage, which is the degree of progression (Dienstag, 2015b).
Most young women with chronic viral hepatitis either are asymptomatic or have only mild liver disease. For seropositive asymptomatic women, there usually are no problems with pregnancy. With symptomatic chronic active hepatitis, pregnancy outcome depends primarily on disease and ibrosis severity, and especially on the presence of portal hypertension. he few women whom we have managed have done well, but their long-term prognosis is poor. Accordingly, they should be counseled regarding possible liver transplantation as well as abortion and sterilization options.