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Hepatitis Main Page
Editor-In-Chief: C. Michael Gibson, M.S., M.D. Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. , Usama Talib, BSc, MD 
Hepatitis refers to the inflammation of the liver. The etiologic agent could be infectious (almost always viral) or non-infectious. Hepatitis can be acute and self limiting or can be chronic and progress to cirrhosis or hepatocellular carcinoma (HCC). Most common causes of infectious hepatitis are viral in origin. These include hepatitis A, B, C, D and E . Non infectious causes of hepatitis include autoimmune, alcohol, drugs and toxins. Alcoholic hepatitis and and non alcoholic steatohepatitis (NASH) are the most common non-infectious types of hepatitis.
The common manifestation of acute 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.
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 can be classified according to the causative viral agent in to 7 major categories.
|Alcoholic hepatitis||Non-alcoholic steatohepatitis (NASH)||Alpha 1 antitrypsin deficiency||Autoimmune hepatitis||Obstructive hepatitis||Drug related hepatitis||Toxin related hepatitis||Ischemic hepatitis|
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||---||
|Hepatitis B||+++||++||++||+++||+||+++||HBs Ag, HBc Ab, HBe Ag||---||
|Hepatitis C||+++||++||++||+++||+||+++||HCV Ab||---||
|Hepatitis E||++||++||+/-||++||+||+++||HEV Ab||---||
|CMV hepatitis||+/-||++||-||+||+||++||CMV-specific immunoglobulin (Ig)M antibody||--||
|EBV hepatitis||+/-||++||-||+/-||+||++||Heterophile antibody test, monospot test||--||
|Autoimmune hepatitis||-||+||+/-||++||+||+++||---||ANA, ASMA, anti SLA/LP, ANCA, ALKM-1 antibodies||
|Drug induced hepatitis||+/-||+||-||+||+||++||---||---||
Treatment of hepatitis A and hepatitis E is supportive as they are usually self-limited. Chronic hepatitis E is treated with the antiviral ribavirin.
Hepatitis B infection is treated with pegylated interferon alfa or nucleoside analogs (entecavir, tenofovir) based on the clinical picture including ALT and HBV DNA levels and presence or absence of cirrhosis.
Treatment is indicated in chronic Hepatitis C infection which is defined as the presence of detectable HCV RNA levels for 6 months. The selection of treatment regimen depends on viral genotype, presence or absence of cirrhosis and other patient factors. Some of the commonly used antiviral regimens include sofosbuvir-velpatasvir, glecaprevir-pibrentasvir and ledipasvir-sofosbuvir
Acute hepatitis D has no specific treatment. For chronic hepatitis D infection, treatment is indicated with PEG interferon alfa for patients with detectable HDV RNA, elevated ALT and evidence of active liver disease. Asymptomatic patients can be monitored for development of active disease.
Alcoholic hepatitis is generally treated with alcohol abstinence and supportive care in mild to moderate cases. Severe cases are treated with tapering courses of glucocorticoids.
Autoimmune hepatitis is treated with glucocorticoid mono therapy or combination of glucocorticoid with azathioprine. Treatment decision is based on symptom severity, laboratory and histologic findings.
- Vaccination especially amongst high-risk individuals who were not vaccinated in childhood. These include IV drug users, Chronic liver disease patients, and Men who have sex with men (MSM).
- For individuals at risk of both HAV and HBV, the combined vaccine used as a 3-does series is administered.