Hepatitis

Hepatitis is acute or chronic inflammation of the liver parenchyma. It is caused by a range of agents - most commonly viruses, but also alcohol, drugs/toxins, and autoimmune processes. - Textbook of Family Medicine 9e, p. 1132

Causes

1. Viral Hepatitis (most common)

There are five main hepatitis viruses:

Virus	Transmission	Chronic?	Key Feature
Hep A (HAV)	Fecal-oral route (contaminated food/water)	No	Self-limiting; vaccine available
Hep B (HBV)	Blood, sexual contact, mother-to-child	Yes (10% adults, 90% neonates)	Vaccine available; DNA virus
Hep C (HCV)	Blood (needle sharing, transfusions)	Yes (~70-85%)	Most serious; now curable
Hep D (HDV)	Only infects those with HBV	Yes	Co-infection worsens outcome
Hep E (HEV)	Fecal-oral (like HAV)	Rare (except in immunocompromised)	Dangerous in pregnancy

Other viruses that can cause hepatitis include Epstein-Barr virus (EBV), cytomegalovirus (CMV), and herpes simplex virus (HSV). - Textbook of Family Medicine 9e, p. 1132

2. Non-Viral Causes

Alcoholic hepatitis - from chronic heavy alcohol use
Drug-induced / toxic hepatitis - e.g., acetaminophen (paracetamol) overdose, isoniazid, statins
Autoimmune hepatitis - the immune system attacks liver cells
Metabolic - non-alcoholic fatty liver disease (NAFLD/NASH)

Symptoms

Most people with early viral hepatitis have no symptoms. When present, symptoms include:

Low-grade fever and fatigue
Loss of appetite (anorexia)
Nausea, vomiting, diarrhea
Right upper quadrant (RUQ) abdominal pain
Muscle and joint aches (myalgias, arthralgias)
Jaundice (yellow skin/eyes) and dark urine in more severe cases

Warning signs of severe disease include confusion/mental status changes (hepatic encephalopathy), fluid in the abdomen (ascites), and prolonged clotting times (elevated PT). These require hospitalization. - Textbook of Family Medicine 9e, p. 1133

Lab Tests

Key blood markers used for diagnosis:

Elevated liver enzymes: ALT, AST (transaminases), alkaline phosphatase (ALP)
Elevated bilirubin (causes jaundice)
Serologic markers: specific antibodies and antigens for each hepatitis virus (e.g., HBsAg for Hep B, anti-HCV for Hep C)

Test	What it means
Anti-HAV IgM	Recent/acute Hepatitis A
HBsAg	Active Hepatitis B infection
Anti-HBs	Immunity to Hep B (past infection or vaccination)
Anti-HCV	Exposure to Hepatitis C virus

Source: Textbook of Family Medicine 9e, Table 38-10

Complications

If untreated or chronic, hepatitis can progress to:

Liver fibrosis and cirrhosis (scarring)
Liver failure
Hepatocellular carcinoma (liver cancer) - especially with chronic HBV and HCV
HBV and HCV together are the leading cause of liver cirrhosis and liver cancer worldwide, according to the WHO

Treatment

Type	Treatment
Hepatitis A	Supportive care; resolves on its own; vaccine for prevention
Hepatitis B	Antivirals (tenofovir, entecavir); vaccine available for prevention
Hepatitis C	Direct-acting antivirals (DAAs) - cure rates >95% with 8-12 week courses
Hepatitis D	Difficult to treat; HBV vaccination prevents it
Hepatitis E	Supportive care; usually self-limiting
Autoimmune	Corticosteroids (prednisone) + azathioprine
Acetaminophen toxicity	N-acetylcysteine - must be given promptly to prevent permanent liver damage

According to the CDC, Hepatitis A and B are vaccine-preventable, and Hepatitis C can now be cured.

Prevention

Vaccination: available for Hepatitis A and B
Safe practices: avoid sharing needles, use barrier contraception, safe food/water handling
Screening: all pregnant women should be screened for HBV and HCV; universal infant HBV vaccination has drastically reduced vertical transmission

In summary: Hepatitis ranges from a mild, self-limiting illness (Hepatitis A) to a serious chronic condition (Hepatitis B and C) that can silently progress to cirrhosis and liver cancer over decades. Early detection and treatment are key to preventing severe outcomes.

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