Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Escalate
Confusion, asterixis, hypoglycaemia, rising INR, bleeding, severe vomiting, haemodynamic instability or rapidly deepening jaundice during acute hepatitis suggests acute liver failure or another major complication. Admit, stop non-essential hepatotoxic medicines, monitor glucose and coagulation closely, and discuss early with a regional liver-transplant centre rather than waiting for established coma. Pregnant patients with suspected hepatitis E and immunosuppressed people with persistent HEV require especially prompt specialist input.
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.
Key red flags
Acute liver failure
Encephalopathy with coagulopathy in a person without established cirrhosis is a transplant emergency, even before bilirubin becomes extreme or a viral result returns.
Investigation priorities
01
Liver profile and coagulationFirst step
Confirm hepatocellular injury, assess cholestasis and detect failing synthetic function.
Management branches
DiagnoseInvestigate acute jaundice
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.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.