Hepatitis (Acute/Chronic)

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management

Definition

Hepatitis refers to inflammation of the liver, which can be acute (lasting less than six months) or chronic (persisting beyond six months). It can result from viral infections, toxins, autoimmune conditions, or metabolic diseases.

Aetiology

  • Viral Hepatitis: hepatitis A, B, C, D, and E.
  • Alcohol-related hepatitis: due to excessive alcohol intake.
  • Autoimmune hepatitis: immune-mediated liver inflammation.
  • Drug-induced hepatitis: caused by medications like paracetamol overdose, methotrexate, or isoniazid.
  • Metabolic disorders: wilson’s disease, haemochromatosis.
  • Non-alcoholic fatty liver disease (NAFLD): associated with obesity and metabolic syndrome.

Pathophysiology

  • Hepatitis leads to hepatocyte injury through direct viral replication, immune-mediated attack, or toxic damage.
  • Inflammation causes liver cell apoptosis, necrosis, and fibrosis in chronic cases.
  • Progression to cirrhosis can occur in chronic hepatitis.

Risk factors

  • Unprotected sexual contact (for hepatitis B and C).
  • Intravenous drug use (hepatitis B and C).
  • Alcohol consumption (alcoholic hepatitis).
  • Obesity and metabolic syndrome (NAFLD).
  • Autoimmune conditions.
  • Exposure to hepatotoxic drugs.

Signs and symptoms

Acute Hepatitis:

  • Jaundice (yellowing of skin and eyes).
  • Dark urine and pale stools.
  • Fatigue and malaise.
  • Right upper quadrant pain.
  • Nausea, vomiting, and anorexia.
  • Fever (in viral hepatitis).

Chronic Hepatitis:

  • Often asymptomatic in early stages.
  • Persistent fatigue.
  • Hepatomegaly (enlarged liver).
  • Signs of liver fibrosis or cirrhosis (spider naevi, ascites, splenomegaly).

Investigations

  • Blood tests:
    • Liver function tests (ALT, AST, ALP, bilirubin).
    • Coagulation profile (prolonged PT in severe cases).
    • Hepatitis serology (HAV IgM, HBsAg, anti-HCV antibodies).
    • Autoimmune markers ( for example. ANA).
    • Metabolic screening (serum ferritin for haemochromatosis, ceruloplasmin for Wilson’s disease).
  • Imaging:
    • Ultrasound liver (assess for cirrhosis or fatty liver).
    • Fibroscan (to assess liver fibrosis).
  • Liver biopsy: considered if diagnosis is unclear or to assess fibrosis stage.

Management

Acute Hepatitis:

  • Supportive care: hydration, rest, and nutritional support.
  • Avoid hepatotoxic drugs: stop alcohol, paracetamol, or NSAIDs.
  • Hepatitis A and E: usually self-limiting; symptomatic management.
  • Hepatitis B: consider antiviral therapy if severe.
  • Hepatitis C: early antiviral treatment may be indicated.
  • Alcoholic hepatitis: abstinence, corticosteroids in severe cases.

Chronic Hepatitis:

  • Antiviral therapy: mainly for hepatitis B and hepatitis C (follow local/NICE guideline) .
  • Lifestyle modifications: weight loss and diet for NAFLD.
  • Immunosuppression: for autoimmune hepatitis (steroids, azathioprine).
  • Surveillance: regular monitoring for liver fibrosis, cirrhosis, and hepatocellular carcinoma.
  • Referal to hepatology.
GastroenterologymypanotesHepatitis (Acute/Chronic)