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- Hepatitis A: Old and New

No specific management is necessary for most patients with uncomplicated HAV infection. Common sense prescribes appropriate rest (when necessary) and diet (avoiding foods that may cause digestive discomfort, such as fatty food). In the past, however, strict bed rest until complete resolution of all symptoms was common. Hoagland and Shank analyzed the relationship between the length of time from onset of symptoms until hospitalization and the average duration of illness 113. They found that when hospitalization was delayed for 30 or more days, the illness lasted an average of 81 days. In contrast, when the patient was hospitalized within the first 14 days, the illness lasted for an average of 46 days. Their conclusions were that prompt hospitalization and freedom from activity were important. An alternative explanation is that a slower, more subfulminant course was associated with a longer period until complete resolution and that the degree of bed rest (or need for hospitalization) was unproven. In 1969, a randomized study that compared "early and vigorous exercise" with traditional rest was published 207. No difference in the duration of illness was observed with the institution of a deliberate exercise program. Early, however, was defined as when symptoms (anorexia and malaise) and signs (liver tenderness) were graded as slight or 2+ (on a 1+ to 4+ scale). Nevertheless, this study led to the abandonment of strict bed rest in the management of acute hepatitis.

In hepatitis complicated by fulminant hepatic failure, management is determined by the complications that develop and the availability of transplantation. Similarly, extrahepatic manifestations such as renal failure and pancreatitis are managed in a routine manner. The expectation for all patients is for complete recovery without sequelae, which occurs in the vast majority.

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