Codes

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

• Cytomegalovirus
• Epstein-Barr virus
• Herpes simplex virus
• Varicella virus
• Coxsackie virus
• Toxoplasmosis
• Histoplasmosis
• Leptospirosis
• Alcoholic hepatitis – Serum AST levels rarely rise above 300 units/L, and typically serum AST levels exceed serum ALT levels.
• Drug-induced liver injury – Careful medication history should be obtained.
• Ischemic hepatitis ("shock liver") – Usually in the setting of cardiogenic or septic shock (see bacterial sepsis).
• Severe autoimmune chronic active hepatitis – Young females; positive auto-antibodies and other systemic auto-immune manifestations.
• Acute Budd-Chiari syndrome – Associated primarily with aminotransferase elevations, not alkaline phosphatase, and increased lactate dehydrogenase levels.
• Wilson's disease – This metabolic disorder rarely mimics acute viral hepatitis. Look for Kayser-Fleischer rings and history of psychiatric disorder.
• Acute fatty liver of pregnancy – It is potentially fatal and most common in third trimester. Liver biopsy shows characteristic steatosis.
• The syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome) – Common in third trimester; presents with eclampsia, right upper quadrant pain, hypertension, and edema.

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Management Pearls

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Therapy

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References

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