Episode one of the Viral Hepatitis chapter builds the acute-hepatitis framework and covers the two fecal-oral viruses, hepatitis A and hepatitis E. The organizing idea: acute viral hepatitis looks the same no matter which virus caused it, so you read the virus off the serology, not the symptoms. It walks the four clinical phases, the four-test acute panel with its two named traps, and then hepatitis A as a post-exposure-prophylaxis decision that splits by age and host. Hepatitis E closes it with its two high-yield scenarios: twenty to thirty percent mortality in third-trimester pregnancy and chronic infection in the immunocompromised. Topics covered The acute-hepatitis mechanism and its four phases The four-test first-line serologic panel Serology interpretation rules and two named traps Differential, alarm features, and treatment by virus Hepatitis A course, risk factors, and atypical variants Hepatitis A vaccine and post-exposure prophylaxis Hepatitis E genotypes and when to test Hepatitis E in pregnancy and chronic infection with ribavirin Key decisions The first move on any acute hepatitis stem is the serologic panel, not the history, because the clinical phases are identical across viruses. The first-line acute panel is four tests, hepatitis B surface antigen, hepatitis B core IgM, hepatitis C antibody with reflex to RNA, and hepatitis A IgM, adding hepatitis E IgM in the returning traveler or when the panel is negative. Surface antigen positive with core IgM positive is acute hepatitis B, while surface antigen positive with core IgM negative but total core positive is chronic hepatitis B. A high-suspicion hepatitis C patient with a negative antibody is not cleared, because the antibody lags viremia by a couple of months, so the RNA closes the question. Post-exposure prophylaxis splits by host: immunocompetent persons aged twelve months to forty get a single vaccine dose within two weeks, while those over forty, the immunocompromised, chronic liver disease patients, and infants under twelve months get immunoglobulin. Vaccinate all patients with chronic liver disease of any cause against hepatitis A, because a superimposed acute hepatitis A decompensates them at a much higher rate. Chronic hepatitis E is defined by persistent RNA beyond three to six months in an immunocompromised host, diagnosed by RNA not IgM, and treated by reducing immunosuppression first, then ribavirin for three months. For the full chapter with MCQs, tables, and primary-guideline references, visit www.boardpearls.com. Questions or feedback: [email protected]. (00:00) - Introduction and the organizing idea (00:28) - Mechanism and the four phases of acute hepatitis (02:32) - The serologic panel and its two named traps (04:54) - Differential, alarm features, and treatment by virus (06:25) - Hepatitis A: course and atypical variants (08:09) - Hepatitis A vaccine and post-exposure prophylaxis (09:26) - Hepatitis E: genotypes and when to test (11:53) - Hepatitis E treatment by host

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“What did the council decide on item 42?” — answered with the speaker and the moment.

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