Synopsis
Recognise enterically transmitted viral hepatitis, diagnose hepatitis A and E accurately, identify acute liver failure, and apply UK prevention and public-health measures.
- Hepatitis A spreads mainly by the faeco-oral route and does not become chronic, although cholestatic or relapsing illness can prolong recovery.
- Hepatitis E in the UK is often zoonotic and linked to undercooked pork or game; absence of foreign travel does not exclude it.
- Test for HAV IgM in compatible acute illness and request HEV serology with RNA testing according to timing and immune status.
- An isolated positive total HAV antibody usually indicates past infection or vaccination and does not diagnose current acute hepatitis.
- Most immunocompetent patients receive supportive care, avoidance of alcohol and careful review of prescribed and non-prescribed hepatotoxic exposure.
- HEV can persist after solid-organ transplantation or other immunosuppression; chronicity requires viral RNA follow-up and specialist management.
- Acute infectious hepatitis is notifiable in the UK jurisdictional framework; contact the local health-protection team for case and contact measures.
- HAV vaccination and post-exposure prophylaxis follow current Green Book and UKHSA risk assessment; there is no routinely available UK HEV vaccine.
Key red flags
Encephalopathy with coagulopathy in a person without established cirrhosis is a transplant emergency, even before bilirubin becomes extreme or a viral result returns.
Acute jaundice after travel or relevant exposure during pregnancy requires immediate obstetric and liver assessment because severe HEV-associated liver failure is possible.
Investigation priorities
Confirm hepatocellular injury, assess cholestasis and detect failing synthetic function.
Management branches
A patient has a hepatitic liver profile, dark urine, jaundice or a compatible exposure history.
- Assess physiological stability, cognition, glucose, INR and medication or toxin exposure before awaiting pathogen tests, and arrange emergency liver-centre discussion if failure features appear.
- Request HAV IgM and HEV testing alongside a broader cause-directed acute-hepatitis screen, explicitly telling the laboratory about immunosuppression, pregnancy, onset and relevant food or travel exposures.
- Use ultrasound when obstruction or another structural cause is possible, then interpret serology and RNA with timing rather than accepting any isolated antibody result uncritically.