1. HAV
   1. Single stranded positive sense linear RNA
      1. single-stranded, positive-sense, linear RNA enterovirus Most deaths occur in > 50 years old patients Anorexia, nausea, vomiting and jaundice Stool excression 2 weeks before and 1 week after onset
         1. Order CBC, LFTs, HAV IgM/IgG, PT/PTT, CBC
2. HBV
   1. Hepadnaviridae Double stranded DNA virus
      1. CBC. Leukopenia, lymphocytosis & ↑ESR are the MC findings LFTs, ALT>AST. (in the 1000s). ALP 3x the normal. PT/PTT. Prolonged PT CBC. Anemia HBV serology, US/CT/MRI to exclude biliary obstruction AFP is chronic for HCC surveillance
         1. SEROLOGY HbsAg HbsAb HBc Ab HBeAg Acute + - IgM + Chronic + - IgG + Carrier + - IgG - Past infxn - + IgG - Vaccine - + - -
            1. ACUTE
            2. CHRONIC
3. HCV
   1. single-stranded RNA Flaviviridae major cause of chronic hepatitis in the US 20% of all cases of acute hepatitis 40% of all referrals to liver clinic
      1. CBC. LFTs, ALT to monitor therapy. A normal ALT does not prove cure PT/PTT HCV Ab test for screening Recombinant immunoblot assay to confirm infection Qualitative and quantitative HCV RNA HCV genotyping Liver biopsy
         1. LOW RISK PATIENT
            1. RULE OUT OTHER CAUSES OF INCREASED ALT
            2. PCR
            3. TREAT
            4. ACUTE
            5. CHRONIC
            6. BIOPSY
            7. NO INFLAMMATION-->NO TREATMENT
            8. INFLAMMATION-->TREATMENT
            9. END STAGE CIRRHOSIS-->TRANSPLANT
            10. KNODELL Histological Activity Index I. Periportal ± bridging necrosis Score
         2. HIGH RISK PATIENT
4. HDV
   1. RNA virus Associated with HBV infection Fulminant form in 1%.
      1. HDV serology HDV RNA Rule out HBV coinfection Imaging studies
         1. Treat with αIFN for 1 year
5. HEV
   1. RNA Hepevirus Self limited infection No chronic form reported
      1. HEV serology HEV RNA LFTs CBC
         1. Supportive therapy