Hepatitis A, B, C and E in children — branching viva

Opening question

Examiner: Take me through this child. What is the diagnosis, and what is your frame for managing her? ^[1]

Candidate: The leading diagnosis is acute hepatitis A — a returned traveller with the classic prodrome of fever and nausea, then dark urine and jaundice, transaminases in the thousands and a positive hepatitis A IgM, with a normal INR. My frame is to classify her on the two axes that matter: transmission route and chronicity. Hepatitis A is enteric and acute, so it clears without chronicity. The immediate priority is supportive care and the prevention of secondary spread; the prognostic anchor I watch is the INR, because a normal INR with this picture means severe hepatitis but not liver failure. ^[1]

Examiner: Why do you frame the four viruses by those two axes? ^[1]

Candidate: Because the two axes fix the whole approach. Transmission route tells me how the child met the virus — faecal-oral for A and E, blood-borne and perinatal for B and C — which frames the history, the contact tracing and the prevention. Chronicity tells me what happens next — A and E clear, while B and C persist when acquired neonatally. So a single framework, "faecal-oral is A and E, blood-borne and perinatal is B and C, and the chronic divide runs along the same line", organises the whole topic. ^{[1] [6]}