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Hepatitis

Hepatitis is an inflammation of the liver tissue, which can be either acute or chronic. Acute hepatitis resolves within six months, while chronic hepatitis persists longer.

The condition may be asymptomatic or present symptoms such as jaundice, poor appetite, abdominal pain, and fatigue.

Microscopic view of alcoholic hepatitis showing fatty changes, dead liver cells, and Mallory bodies.

Causes

Hepatitis can result from various factors, including viral infections, alcohol, toxins, medications, and autoimmune diseases. The primary viral causes are hepatitis viruses A, B, C, D, and E.

Other infections like cytomegalovirus and Epstein–Barr virus can also cause hepatitis. Hepatitis A and E are mainly spread through contaminated food and water, while hepatitis B, C, and D are transmitted through infected blood and bodily fluids.

Viral Hepatitis

Hepatitis A and E are acute, often resolving on their own. Hepatitis B and C can become chronic, leading to severe complications like cirrhosis and liver cancer.

Hepatitis D requires co-infection with hepatitis B to replicate.

Non-Viral Causes

Excessive alcohol consumption can cause alcoholic hepatitis, leading to liver cirrhosis over time. Medications and toxins can also induce hepatitis through various mechanisms.

Autoimmune hepatitis arises from an abnormal immune response against liver cells.

Signs and Symptoms

Acute Hepatitis

Acute viral hepatitis has three phases:

  1. Prodromal Phase: Flu-like symptoms, fatigue, nausea, and choluria (dark urine).
  2. Icteric Phase: Jaundice, enlarged liver, and right upper abdominal pain.
  3. Recovery Phase: Resolution of symptoms, but liver lab values may remain elevated.
Jaundiced eyes indicative of hepatitis.

Chronic Hepatitis

Chronic hepatitis may be asymptomatic initially but can lead to symptoms like fatigue, jaundice, and joint pain as liver damage progresses. Complications include cirrhosis, liver failure, and liver cancer.

Diagnosis

Diagnosis involves clinical assessment, blood tests, imaging, and sometimes liver biopsy. Blood tests typically show elevated liver enzymes (AST and ALT).

Viral hepatitis is confirmed through specific viral antigens and antibodies in the blood. Imaging can identify liver abnormalities, but liver biopsy remains the definitive test for inflammation and fibrosis.

Histopathology of acute hepatitis showing lobular disarray and lymphocytic inflammation.

Treatment

General Management

Treatment varies based on the type and severity of hepatitis. General recommendations include rest, adequate nutrition, and avoiding liver-metabolised drugs.

Viral Hepatitis

  • Hepatitis A and E: Usually self-limiting; supportive care is provided.
  • Hepatitis B: Acute cases often resolve on their own; chronic cases require antiviral medications like entecavir or tenofovir.
  • Hepatitis C: Treated with direct-acting antivirals aiming for sustained virological response (SVR).
  • Hepatitis D: Difficult to treat; interferon alpha may be used.

Non-Viral Hepatitis

  • Alcoholic Hepatitis: Abstinence from alcohol is very important. Severe cases may require corticosteroids or pentoxifylline.
  • Autoimmune Hepatitis: Treated with corticosteroids and immunosuppressants like azathioprine.

Prevention

Vaccination

Vaccines are available for hepatitis A and B. Hepatitis A vaccination is recommended for children and high-risk adults.

Hepatitis B vaccination is part of routine immunisation in many countries.

WHO-UNICEF estimates of hepatitis B vaccine coverage in Europe (2000-2015).

Lifestyle Modifications

Avoiding excessive alcohol, practising safe sex, and ensuring proper hygiene can prevent hepatitis. Needle exchange programmes and screening blood products are essential in reducing hepatitis B and C transmission.

Hepatitis is a significant global health concern with various causes and manifestations. Early diagnosis, effective treatment, and preventive measures like vaccination can mitigate the impact of hepatitis on affected populations.


Self-assessment MCQs (single best answer)

Which hepatitis virus requires co-infection with another virus to replicate?



What is the primary mode of transmission for hepatitis A and E?



Which phase of acute hepatitis is characterised by jaundice and right upper abdominal pain?



What is the most common cause of cirrhosis in the United States?



Which of the following is NOT a common cause of hepatitis?



Which blood test result is most indicative of alcoholic hepatitis?



What is the treatment goal for chronic hepatitis B?



Which autoimmune marker is most commonly associated with autoimmune hepatitis?



What is the primary preventive measure for hepatitis A?



What is the definitive diagnostic test for assessing inflammation and fibrosis in hepatitis?



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