A 22-year-old student returns from travel with 1 week of nausea, anorexia, malaise and a distaste for cigarettes, then becomes jaundiced with dark urine and pale stools. He ate shellfish abroad. LFTs show ALT over 1000. Anti-HAV IgM is positive. What is the most appropriate management?

Answer: E. Supportive care only, as the illness is self-limiting

Acute hepatitis A: supportive management

The picture - faeco-oral exposure (shellfish), a prodrome with distaste for cigarettes, then jaundice, very high transaminases and anti-HAV IgM positive - is acute hepatitis A.

Key principles

• Hepatitis A is an acute, self-limiting infection spread by the faeco-oral route; there is no carrier state and no progression to chronic liver disease.
• Management is supportive: there is no specific antiviral; corticosteroids have no benefit; most recover within 3-6 weeks.

Serological diagnosis

When to worry

• Persistent vomiting, confusion (encephalopathy) or a rising INR suggests fulminant hepatic failure and warrants hospital assessment - rare but the main cause of death.

Prevention

• Good hygiene and sanitation; the virus is killed by boiling water.
• An inactivated HAV vaccine for travellers and those with chronic liver disease; normal immunoglobulin for post-exposure prophylaxis within 2 weeks.