Pathophysiology
1) enterically transmitted hepatitis caused by infection with Alpha-like organism 2) lacks a chronic or carrier state 3) increased incidence in HIV infection
Signs and Symptoms
1) generally mild, self-limited disease but % of cases (10 – 20% in pregnant women) result in fulminant liver failure (massive liver necrosis) 2) prodrome of fatigue, nausea and vomiting, myalgias, and arthralgias 3) fever 4) headache 5) coryza (runny nose) 6) change in taste and smell 7) jaundice 8) symptoms associated with fulminant failure (hepatic encephalopathy, bleeding, etc.)
Characteristic Test Findings
Laboratory – 1) anti-hepatitis E antibodies stay elevated for 9-12 months 2) increased AST and ALT 3) increased bilirubin 4) increased PT
Histology/Gross Pathology
1) single-stranded, linear, nonenveloped RNA virus 2) fulminant hepatitis marked by rapidly shrinking, pale liver
Inheritance/Epidemiology
1) occurs in large-scale contamination of water supplies (flooding, hurricanes) with fecal-oral contaminantion 2) rare in USA; common in Asia, India, Africa, and central America 3) incubation is 2-9 weeks 4) affects mostly young adults
Treatment
1) supportive care 2) in fulminant cases, liver transplantation
Tips for USMLE
1) does not increase the risk of hepatocellular carcinoma 2) if a 30 year old pregnant patient in India survives a flood after a typhoon and 5 weeks later develops fatigue, fever, nausea and vomiting, and jaundice, think hepatitis E
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