Jaundice.

Abstract

Always take a full travel, drug and contact history in any patient presenting with jaundice. All drugs should be suspected as potential hepatotoxins. With hepatitis A the presence of IgM antibodies reflects recent infection, and IgG antibody indicates past infection and lifelong immunity. There is no chronic carrier state of hepatitis A and E. All patients with jaundice should be tested for hepatitis B surface antigen (HBsAg). Hepatitis B infection is usually benign and short lived, but it can be fatal if chronic hepatitis develops, which may lead later to cirrhosis and hepatocellular carcinoma. Up to 5 to 10 per cent of patients with hepatitis B will become chronic carriers (especially drug addicts and homosexuals). Such carriers are identified by persistent titres of HBsAg and possibly HBeAg, the latter indicating the presence of the whole virus and active replication and high infectivity. A raised gamma glutamyl transferase accompanied by a raised MCV is a good screening test for alcohol abuse.