Thông thường, bệnh nhân có một tập phim của viêm gan cấp tính mà không có triệu chứng, nhưng nếu có, các triệu chứng bao gồm một cảm giác của người khuyết tật nói chung trong một vài ngày liên quan với nhiệt độ nhẹ và đau tổng quát. | 98 JAUNDICE AND LIVER DISEASES ACUTE HEPATITIS Often patients have an episode of acute hepatitis that is asymptomatic but if present symptoms include a feeling of general disability for a few days associated a with a mild temperature and generalized ache. When caused by a virus there may be an episode of cholestasis with pale stools and dark urine which precedes the icteric phase. Patients become jaundiced and stools start to return to normal. Patients are often anorectic and there may be a feeling of nausea with a degree of tenderness over the liver. Examination reveals a generally well individual who is jaundiced and without features of chronic liver disease. The importance of taking a thorough history cannot be overemphasized. History of recent ttavel injections blood transfusions ingestion of foods such as shellfish use of recreational drugs both injected and those taken by alternative routes all medications both prescribed and over-the-counter preparations for the last 3 months and sexual activity particularly homosexual contact should be enquứed about. Early on in the illness the alkaline phosphatase level may be elevated but the most marked feature is a rise in the serum aminotransferase concenttations with values often in the thousands. Serum bilirubin levels vary with the severity of the attack. Changes in the prothrombin time are usually absent or at most minor except in the small proportion of patients who go on to develop fulminant hepatic failure. Many drugs may produce this hepatitic picture but a number produce a pattern of cholestasis with elevation in the bilirubin alkaline phosphatase and gamma glutamyl transpeptidase GGT without particular changes in the aminotransferases. Blood should be drawn for viral studies and a monospot for glandular fever Fig. 1 Source of faecal and oral transmission of hepatitis A a and parenteral sources of hepatitis B and c b . which will allow confirmation of diagnosis at a later date although this has little bearing
