### Date : 2024-11-20 15:35 ### Topic : Hepatitis #gastroenterology ---- ### **Hepatitis** **Hepatitis** refers to **inflammation of the liver**, which can result from infections, toxins, autoimmune conditions, or other diseases. It can lead to liver dysfunction, ranging from mild, reversible inflammation to severe liver failure or chronic liver disease. --- ### **Causes of Hepatitis** #### **1. Infectious Causes** - **Viral Hepatitis**: - **Hepatitis A (HAV)**: Fecal-oral transmission; self-limiting. - **Hepatitis B (HBV)**: Bloodborne, sexual, and perinatal transmission; may lead to chronic hepatitis. - **Hepatitis C (HCV)**: Bloodborne transmission; high risk of chronic infection. - **Hepatitis D (HDV)**: Requires co-infection with HBV. - **Hepatitis E (HEV)**: Fecal-oral transmission; common in resource-limited areas. - **Non-Hepatitis Viruses**: - Epstein-Barr virus (EBV), cytomegalovirus (CMV), herpes simplex virus (HSV). #### **2. Non-Infectious Causes** - **Alcoholic Hepatitis**: - Chronic alcohol use damages hepatocytes, leading to inflammation. - **Drug-Induced Hepatitis**: - Acetaminophen overdose or long-term use of hepatotoxic drugs. - **Autoimmune Hepatitis**: - Immune system attacks liver cells; associated with other autoimmune conditions. - **Non-Alcoholic Steatohepatitis (NASH)**: - Related to metabolic syndrome, obesity, diabetes. #### **3. Other Causes** - Toxins (e.g., aflatoxins). - Ischemic hepatitis (due to hypoperfusion). - Wilson’s disease (copper overload), hemochromatosis (iron overload). --- ### **Types of Hepatitis** | **Type** | **Transmission** | **Acute/Chronic** | **Notes** | |--------------------|-----------------------------|-------------------------|------------------------------------------| | **Hepatitis A** | Fecal-oral | Acute only | Vaccine available; self-limiting. | | **Hepatitis B** | Bloodborne, sexual, perinatal | Both acute and chronic | Vaccine available; chronic infection risk. | | **Hepatitis C** | Bloodborne | Primarily chronic | High chronicity; curable with antivirals. | | **Hepatitis D** | Bloodborne | Chronic (needs HBV) | Requires HBV co-infection. | | **Hepatitis E** | Fecal-oral | Acute (chronic rare) | Severe in pregnancy; common in outbreaks.| --- ### **Clinical Presentation** #### **Symptoms**: 1. **Acute Hepatitis**: - Fatigue, malaise, anorexia, nausea, vomiting. - **Jaundice**: Yellowing of skin and eyes due to hyperbilirubinemia. - Dark urine, pale stools, pruritus. - Right upper quadrant abdominal pain. 2. **Chronic Hepatitis** (lasting >6 months): - Often asymptomatic in early stages. - May progress to signs of **cirrhosis** or **liver failure**: - Ascites, encephalopathy, bleeding, spider angiomas. #### **Physical Exam**: - Hepatomegaly, jaundice, tenderness in the right upper quadrant. --- ### **Diagnosis** #### **1. Laboratory Tests** - **Liver Function Tests (LFTs)**: - Elevated **ALT** and **AST**: Indicate hepatocyte injury. - Elevated **bilirubin**: Jaundice and cholestasis. - Elevated alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT): Suggest cholestasis. - **Serologic Markers** (for viral hepatitis): - **HAV IgM**: Acute hepatitis A. - **HBsAg**: Hepatitis B surface antigen (active infection). - **Anti-HCV** and **HCV RNA**: Hepatitis C. - **Autoimmune Markers**: - Antinuclear antibody (ANA), anti-smooth muscle antibody. - **Coagulation Tests**: - Prolonged prothrombin time (PT) indicates liver dysfunction. #### **2. Imaging Studies** - **Ultrasound**: - Detects hepatomegaly, fatty liver, or fibrosis. - **CT/MRI**: - Used for complications like tumors or abscesses. #### **3. Liver Biopsy** - Confirms diagnosis and assesses severity (e.g., fibrosis, cirrhosis). --- ### **Treatment** #### **1. Supportive Care**: - For acute hepatitis (e.g., HAV, HEV): Rest, hydration, nutrition. - Avoid hepatotoxic substances (e.g., alcohol, certain drugs). #### **2. Antiviral Therapy**: - **HBV**: - Chronic infection: Tenofovir, entecavir. - **HCV**: - Direct-acting antivirals (DAAs) like sofosbuvir, ledipasvir (high cure rates). - **HDV**: - Interferon-based therapy (limited efficacy). #### **3. Autoimmune Hepatitis**: - Corticosteroids (e.g., prednisone) and/or azathioprine. #### **4. Alcoholic Hepatitis**: - Stop alcohol intake. - Severe cases: Corticosteroids or pentoxifylline. #### **5. Liver Transplantation**: - For end-stage liver disease or fulminant hepatic failure. --- ### **Complications** 1. **Acute Complications**: - Fulminant hepatitis: Rapid liver failure with encephalopathy and coagulopathy. 2. **Chronic Complications**: - **Cirrhosis**: Irreversible scarring of the liver. - **Hepatocellular Carcinoma (HCC)**: - Particularly in chronic HBV and HCV. - Portal hypertension, ascites, variceal bleeding. --- ### **Prevention** #### **1. Vaccination**: - **Hepatitis A and B vaccines** are highly effective. - No vaccines currently for HCV, HDV, or HEV. #### **2. Lifestyle and Precautions**: - Avoid contaminated food and water (HAV, HEV). - Safe sex practices, proper needle disposal, and blood safety (HBV, HCV). - Limit alcohol intake to prevent alcoholic hepatitis. --- ### **Key Points** - Hepatitis involves liver inflammation with diverse etiologies including viruses (HAV, HBV, HCV), alcohol, and autoimmune diseases. - **Acute hepatitis** may resolve completely, while **chronic hepatitis** can progress to cirrhosis and liver failure. - Diagnosis relies on serologic tests, liver function tests, and imaging. - Treatment is tailored to the cause, ranging from supportive care to antivirals or immunosuppressive therapy. - Prevention through **vaccination** and lifestyle measures is critical. ### Reference: - ### Connected Documents: -