Hepatitis

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Patient Information

Overview

Classification

Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E
Alcoholic Hepatitis
Autoimmune Hepatitis

Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2], Usama Talib, BSc, MD [3]

Overview

Hepatitis refers to the inflammation of the liver. The etiologic agent could be infectious (almost always viral) or non-infectious. Depending on the disease course various kinds of hepatitis may be classified as acute or chronic. Acute viral hepatitis is a spectrum of systemic inflammatory conditions that predominantly involves the liver. Hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), the HBV-associated delta agent or hepatitis D virus (HDV), and hepatitis E virus (HEV) are the most common viruses that may cause acute viral hepatitis. Alcoholic hepatitis and and non alcoholic steatohepatitis (NASH) are the most common non-infectious types of hepatitis. Many drugs and toxins may also result in hepatic injury. The common manifestation among the patients of hepatitis are fever, jaundice, fatigue, abdominal pain, and hepatomegaly. Diagnosis of hepatitis is based on the clinical manifestations and laboratory findings. In rare conditions liver biopsy is required for either the diagnosis or formulating a treatment plan. In some cases disease may become chronic and result in multiple complications such as, hepatocellular carcinoma (HCC), cirrhosis, or hepatorenal syndrome. In such conditions liver transplantation is the definitive treatment option.

Classification

Hepatitis may be classified depending on the duration of the disease into the following types:

  • Acute hepatitis
  • Chronic hepatitis

Hepatitis may also be classified on the basis of various causes into the following types:

  • Infectious hepatitis
  • Non-infectious hepatitis

Infectious Hepatitis

Infectious hepatitis can be classified according to the causative viral agent in to 7 major categories.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
Viral Hepatitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hepatitis A
 
Hepatitis B
 
Hepatitis C
 
Hepatitis D
 
Hepatitis E
 
Hepatitis F
 
Hepatitis G
 
Other
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
EBV hepatitis
CMV hepatitis
HSV hepatitis
Coxsackie B virus hepatitis



Non-Infectious Hepatitis



 
 
 
 
 
 
 
 
 
 
 
 
Non-infectious Hepatitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Alcoholic hepatitis
 
Non-alcoholic steatohepatitis (NASH)
 
Alpha 1 antitrypsin deficiency
 
Autoimmune hepatitis
 
Obstructive hepatitis
 
Drug related hepatitis
 
Toxin related hepatitis
 
Ischemic hepatitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Gallstones
Tumors
 
Isoniazid
NSAIDs
•Beta-lactam antibiotics
•Sulfa-containing drugs
HAART
 
Chemicals
 
 
 
 
 



Differential diagnosis

Hepatitis must be differentiated from other conditions that may cause fever, fatigue, nausea and vomiting, and elevated liver enzymes.

Disease Clinical manifestations Laboratory findings Additional findings
Symptoms Signs Transaminitis (elevated AST and ALT) Viral markers Autoimmune markers
Nausea & vomiting Abdominal pain Arthralgia Jaundice Hepatomegaly
Acute viral hepatitis Hepatitis A +++ ++ + +++ + +++ HAV Ab ---
  • Fecal-oral transmission
  • Usually acute and self limit
  • Fever usually present
Hepatitis B +++ ++ ++ +++ + +++ HBs Ag, HBc Ab, HBe Ag ---
  • Percutaneous transmission most common
  • May cause acute hepatic failure or may become chronic
  • Fever usually present
Hepatitis C +++ ++ ++ +++ + +++ HCV Ab ---
Hepatitis E ++ ++ +/- ++ + +++ HEV Ab ---
  • Fecal-oral transmission
  • May cause fulminant disease in pregnancy
  • Fever usually present
CMV hepatitis +/- ++ - + + ++ CMV-specific immunoglobulin (Ig)M antibody --
  • Usually manifests as mononucleosis syndrome
  • fever usually present
EBV hepatitis +/- ++ - +/- + ++ Heterophile antibody test, monospot test --
  • Systemic manifestations as mononucleosis syndrome
  • Fever usually present
Autoimmune hepatitis - + +/- ++ + +++ --- ANA, ASMA, anti SLA/LP, ANCA, ALKM-1 antibodies
  • Liver biopsy may be required for diagnosis
Alcoholic hepatitis +/- + - + - AST>ALT --- ---
  • History of alcohol intake
Drug induced hepatitis +/- + - + + ++ --- ---
  • May cause either cholestatic or hepatocellular injury

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