Hepatitis A is a contagious disease, and in some jurisdictions, reporting is required. “What is your job?” becomes an important question. Specifically, is the patient involved in food? Another issue is the warning and prophylaxis of household contacts (https://www.cdc.gov/hepatitis/hav/havfaq.htm). In general, a dose of hep A vaccine should be considered for contacts. (On a political note, since cdc is now subject to partisan politics, be wary of their info).
The treatment of Hep A is symptomatic. Rules for admission are similar to other liver diseases – inability to eat and drink, signs of liver failure (high PT, e.g.), treatment (NAC for tylenol). Patients with liver disease are often admitted for work-up if undiagnosed in the ED – weird lab tests, additional imaging (MRCP, e.g.), and biopsy may be required.
In hepatitis, I use a common consideration I use with other diseases as far as dispo – “Is this the beginning, the middle, or the end of the illness?” If this is the beginning and the patient is a little ill, I’m likely to admit the patient (because they may get sicker). If this is nearing the end and the patient is a little ill, I’m likely to send them home (because they’re already getting better). If I send someone home with viral hepatitis, I ask them to follow up the next day (to monitor clinically and maybe repeat labs).
The patient was admitted. I was a little hesitant sending him home though he was only mildly ill. I wasn’t sure what to do with his HIV meds (one was hepatotoxic). He spent two days getting IVF; he didn’t get sicker. His AST/ALT peaked in the 3000s. They didn’t stop his HIV meds upstairs.