WHAT GENERAL/FAMILY MEDICINE PRACTITIONER SHOULD KNOW ABOUT VIRAL HEPATITIS

: Viral hepatitis is a systemic disease that predominantly affects the liver. The most common causes of viral hepatitis are fi ve hepatotropic viruses A, B, C, D and E; according to duration, it can be acute or chronic. Although clinical course of all viral hepatitides is similar, particular problem is predisposition of hepatitis B and hepatitis C to cause chronic forms of illness with severe outcome such as cirrhosis, hepatocellular carcinoma and liver failure. Clinical features include malaise, nausea, anorexia, low grade fever, aversion to smoking, and in clinical status usually we can fi nd hepatomegaly, and seldom splenomegaly with adenopathy and jaundice. Generally, symptoms are very variable, from usually asymptomatic to fulminant, which in most cases have lethal outcome. There are three stages in acute phase of viral hepatitis: prodromal, icteric and convalescence. Standard laboratory tests show elevated values of aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase in acute phase of hepatitis and elevated lactate dehydrogenase in chronic phase. Serum protein electrophoresis usually shows decreased albumin fraction and albumin/globulin ratio, as well as increased bilirubin level, positive urobilinogen and disturbance in coagulability factors, i.e. marked prolongation of prothrombin time. For etiology of each virus, series of serologic tests are used. In hepatitis A, acute phase of disease is characterized by IgM anti-HAV and presence of IgG anti-HAV indicates previous exposure. In hepatitis B, appearance of HBsAg in serum is the fi rst evidence of infection and recovery is connected with appearance of anti-HBsAg along with IgG anti HBcAg. Active forms of chronic hepatitis B are characterized by active virus replication, which can be measured with polymerase chain reaction (PCR) HBV DNA. Diagnosis of hepatitis C is based on detection of antibodies to HCV (anti-HCV). Generally, it signifi es that HCV infection is present but that diagnostic tool is poor for the phase of disease. In these circumstances, diagnosis of hepatitis C may be confi rmed by using an assay for HCV RNA. First line therapy in acute phase is mostly supportive, i.e. bed rest, appropriate diet including palatable meals as tolerated, without overfeeding. Alcohol and hepatotoxic agents (for example, paracetamol, amoxicillin, ketoconazole) should be avoided. In cases with increased tendency of developing chronic forms of hepatitis and complications (cirrhosis, hepatocellular carcinoma), immunomodulators should be administered, e.g., interferon and/or antiviral agents. The role of family physician/general practitioner is in maintaining preventive measures (vaccination) and education of general population. Special attention needs to be paid to screening and educating high risk patients with respect to proper diagnostics, laboratory and serologic tests. After establishing the diagnosis, all relevant measures should be taken to avoid chronifi cation of disease. In case of chronic hepatitis, consultation with infectious disease specialist and/or gastroenterologist is needed in the treatment and follow up of the patient.