Patients with either viral, autoimmune and alcoholic hepatitis may present with a wide variety of symptomatology during their acute and chronic phase of inflammations. The following signs and symptoms are seen in hepatitis:

• Low grade fever
• Anorexia and vomiting
• Dehydration with drying of mucous membranes
• Telangiectasis (spider angiomata) and esophageal varices
• Jaundice
• Ascites
• Utricarial rashes
• Portal Hypertension
• Hepatomegaly and Splenomegaly
• Signs of encephalopathy (i.e. seizure and delirium)
• Malnutrition

• Splenomegaly

  […] signs and symptoms are seen in hepatitis: Low grade fever Anorexia and vomiting Dehydration with drying of mucous membranes Telangiectasis (spider angiomata) and esophageal varices Jaundice Ascites Utricarial rashes Portal Hypertension Hepatomegaly and Splenomegaly [symptoma.com]

  Mild splenomegaly occurs in 15 to 20% of patients. Jaundice usually peaks within 1 to 2 weeks. Recovery phase: During this 2- to 4-week period, jaundice fades. Appetite usually returns after the first week of symptoms. [merckmanuals.com]

  Adjuvant FOLFOX chemotherapy and splenomegaly in patients with stages II-III colorectal cancer. Oncology 2009; 76 (5) 363-368 33 Slade JH, Alattar ML, Fogelman DR, et al. [doi.org]

• Pain

  Pains in the upper part of the abdomen Occasionally the pains in the upper part of the abdomen spread to the rest of the abdomen. This can cause generalised abdominal pains that can result in quite severe discomfort. [hepctrust.org.uk]

  Symptoms include: Fever Fatigue Loss of appetite Vomiting Abdominal pain Dark urine Diarrhea Clay-colored or light stool Joint pain Jaundice Proper handwashing and vaccination are good ways to prevent hepatitis A. Learn more about Hepatitis A. [southernnevadahealthdistrict.org]

  Symptoms & Causes Common symptoms of autoimmune hepatitis include feeling tired, pain in your joints, nausea, poor appetite, pain over your liver, and jaundice. [niddk.nih.gov]

  Those that do have symptoms of hep C infection may experience abdominal pain. fatigue, fever, joint pains, loss of appetite nausea, poor appetite, and vomiting. Is hepatitis C contagious? Hepatitis C is contagious. [medicinenet.com]

• Fever

  Hepatitis secondary to scarlet fever is a rare complication described in adults and even less frequently in children. Our objective was to describe a case of hepatitis secondary to scarlet fever in a pediatric patient. [ncbi.nlm.nih.gov]

  […] in the majority; rash in 50% Acute hepatitis, often severe Yellow fever Jaundice, systemic toxicity, bleeding Liver necrosis with little inflammatory reaction Other Hepatic infection occasionally due to echovirus or coxsackievirus infections, varicella [merckmanuals.com]

  Symptoms include: Fever Fatigue Loss of appetite Vomiting Abdominal pain Dark urine Diarrhea Clay-colored or light stool Joint pain Jaundice Proper handwashing and vaccination are good ways to prevent hepatitis A. Learn more about Hepatitis A. [southernnevadahealthdistrict.org]

• Fatigue

  Chronic fatigue Another common complaint is chronic fatigue. The severity of this fatigue differs from person to person. Some people are able to complete a full day’s work but then feel exhausted in the evening. [hepctrust.org.uk]

  Symptoms include: Fever Fatigue Loss of appetite Vomiting Abdominal pain Dark urine Diarrhea Clay-colored or light stool Joint pain Jaundice Proper handwashing and vaccination are good ways to prevent hepatitis A. Learn more about Hepatitis A. [southernnevadahealthdistrict.org]

  In this report, we present a 19-year-old patient presented with nausea, fatigue and jaundice. Her physical examination and laboratory tests revealed the diagnosis as acute hepatitis due to EBV with cross-reacting antibodies to cytomegalovirus. [ncbi.nlm.nih.gov]

  Acute infection may occur with limited or no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain. [web.archive.org]

• Weight Loss

  Treatment Doctors recommend weight loss to treat nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). Weight loss can reduce fat in the liver, inflammation, and fibrosis. [niddk.nih.gov]

  A major attempt should be made to lower body weight into the healthy range. Weight loss can improve liver tests in patients with NASH and may reverse the disease to some extent. [web.archive.org]

  Fever Weight loss Arthralgias Hair loss Headache Itching 56 50 47 47 41 38 38 12 Gaudin 1995 Flu‐like symptoms Leukopoenia Thrombocytopoenia Hyperthyroidism Death (by suicide) 100 100 100 10 10 Figures and Tables - Table 2. [doi.org]

• Sepsis

  Despite advances in intensive care management, mortality continues to be high (40–80%) and is partly related to ALF's complications, such as cerebral edema, sepsis, hypoglycemia, gastrointestinal bleeding, and acute renal failure. [doi.org]

  Such conditions may include: Abnormal heart rhythms Dehydration Heart failure Infection, especially sepsis Severe bleeding Other causes may include: Blood clots in the main artery to the liver (hepatic artery) after a liver transplant Swelling of blood [nlm.nih.gov]

  Vibrio vulnificus may cause sepsis, cellulitis, and necrotizing fasciitis, a “flesh-eating” infection. Listeria species may cause sepsis and meningitis, and are a risk from unpasteurized dairy products and salty processed meats. [medicinenet.com]

  […] and 0.1%. 14 The puncture of lung, colon, kidney and gall bladder together with pneumothorax, pleural effusion, and subcutaneous emphysema are well recognised complications, which rarely require intervention. 21 Other recognised complications include sepsis [gut.bmj.com]

• Nausea

  Those that do have symptoms of hep C infection may experience abdominal pain. fatigue, fever, joint pains, loss of appetite nausea, poor appetite, and vomiting. Is hepatitis C contagious? Hepatitis C is contagious. [medicinenet.com]

  In this report, we present a 19-year-old patient presented with nausea, fatigue and jaundice. Her physical examination and laboratory tests revealed the diagnosis as acute hepatitis due to EBV with cross-reacting antibodies to cytomegalovirus. [ncbi.nlm.nih.gov]

  Symptoms include an enlarged liver, fever, nausea, vomiting, abdominal pain, and dark urine Disease of the liver causing inflammation. Symptoms include an enlarged liver, fever, nausea, vomiting, abdominal pain, and dark urine Hepatitis. [icd9data.com]

  Acute infection may occur with limited or no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain. [web.archive.org]

• Abdominal Pain

  Symptoms include: Fever Fatigue Loss of appetite Vomiting Abdominal pain Dark urine Diarrhea Clay-colored or light stool Joint pain Jaundice Proper handwashing and vaccination are good ways to prevent hepatitis A. Learn more about Hepatitis A. [southernnevadahealthdistrict.org]

  Those that do have symptoms of hep C infection may experience abdominal pain. fatigue, fever, joint pains, loss of appetite nausea, poor appetite, and vomiting. Is hepatitis C contagious? Hepatitis C is contagious. [medicinenet.com]

  Acute infection may occur with limited or no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain. [web.archive.org]

  Pains in the upper part of the abdomen Occasionally the pains in the upper part of the abdomen spread to the rest of the abdomen. This can cause generalised abdominal pains that can result in quite severe discomfort. [hepctrust.org.uk]

  Common symptoms include jaundice, nausea, chills, rigors, diaphoresis, fatigue, and abdominal pain. Laboratory investigations often reveal profound elevations in AST, ALT, GGT, and conjugated bilirubin. [ncbi.nlm.nih.gov]

• Abdominal Tenderness

  Other signs and symptoms of rejection may include fatigue, loss of appetite, nausea, abdominal tenderness or pain, fever, jaundice, dark-colored urine, or lightcolored stools. [web.archive.org]

• Hypertension

  […] pressure only in patients with clinical signs or evidence of evolving intracranial hypertension. [doi.org]

  BACKGROUND: Nifedipine is a generic, well-known and commonly-prescribed dihydropyridine calcium channel blocker used in the treatment of hypertension and Prinzmetal's angina. [ncbi.nlm.nih.gov]

  On the other hand, people with cirrhosis need to be regularly screened for liver cancer and portal hypertension. [health.clevelandclinic.org]

  Chronic hepatitis can result in cirrhosis with portal hypertension and liver failure. A biopsy is done to confirm the diagnosis. [msdmanuals.com]

• Jaundice

  […] infection Systemic symptoms, hepatomegaly, sometimes jaundice *Differentiate from amebiasis with serologic tests for amebas and direct percutaneous abscess aspiration. [merckmanuals.com]

  No other medication was reported in the previous 6 months of the onset of jaundice. Liver biopsy showed a cholestatic hepatitis with mild biliary damage. Liver enzymes normalized within 2 weeks as well as jaundice. [ncbi.nlm.nih.gov]

  jaundice) are generally attributed to Hippocrates. [about-hepatitis.com]

• Liver Fibrosis

  Non-invasive algorithm of enhanced liver fibrosis and liver stiffness measurement with transient elastography for advanced liver fibrosis in chronic hepatitis B. Aliment Pharmacol Ther 2014;39:197-208. 24261924. 75. [doi.org]

  Clearing the hepatitis C virus from the body halts the progression of liver fibrosis and leads to regression of fibrosis in most cases. Side effects from the medication, when they happen at all, are minimal. [newsnetwork.mayoclinic.org]

  PMID: 24720679 13 Evolution of noninvasive tests of liver fibrosis is associated with prognosis in patients with chronic hepatitis C. [infmed.dk]

• Hepatomegaly

  Selected Infections With Liver Involvement Disease or Organism Manifestations Viruses Cytomegalovirus In neonates: Hepatomegaly, jaundice, congenital defects In adults: Mononucleosis-like illness with hepatitis; may occur posttransfusion Epstein-Barr [merckmanuals.com]

  Findings include: hepatomegaly >15.5 cm at the midclavicular line 4 possible decreased attenuation around the portal system and at the hepatic hilum (periportal edema) possible diffusely decreased parenchymal attenuation on noncontrast CT diffuse edematous [radiopaedia.org]

  The following signs and symptoms are seen in hepatitis: Low grade fever Anorexia and vomiting Dehydration with drying of mucous membranes Telangiectasis (spider angiomata) and esophageal varices Jaundice Ascites Utricarial rashes Portal Hypertension Hepatomegaly [symptoma.com]

  Typical signs and symptoms of hepatitis include: jaundice (yellow discolouration of the skin and sclera of the eyes, dark urine and pale stools); anorexia (loss of appetite); an enlarged, tender liver (hepatomegaly); abdominal pain and tenderness; nausea [web.archive.org]

• Arthralgia

  […] tool=bestpractice.com Infection may present as an acute illness (e.g., fatigue, arthralgia, jaundice) in approximately one third of patients; however, the majority of patients are asymptomatic. [bestpractice.bmj.com]

  Urticaria and arthralgias occasionally occur, especially in HBV infection. Icteric phase: After 3 to 10 days, the urine darkens, followed by jaundice. Systemic symptoms often regress, and patients feel better despite worsening jaundice. [merckmanuals.com]

  Arthralgia involving small joints is common, and inflammatory arthritis may be particularly troublesome. One presentation of AIH is in the setting of medications, or herbal agents, used for other diseases. [doi.org]

• Yellow Discoloration of the Skin

  Signs and symptoms include: Bleeding easily Bruising easily Fatigue Poor appetite Yellow discoloration of the skin and eyes (jaundice) Dark-colored urine Itchy skin Fluid buildup in your abdomen (ascites) Swelling in your legs Weight loss Confusion, drowsiness [mayoclinic.org]

  A hepatitis infection is also associated with jaundice, a yellow discoloration of the skin and a yellowish color to the whites of the eyes. [healthychildren.org]

  The most notable symptom of acute viral hepatitis is jaundice, which is a yellow discoloration of the skin and the whites of the eyes. Patients also usually complain of vague upper abdominal pain. [patients.gi.org]

• Pruritus

  When they persist, they cause prolonged jaundice, elevated alkaline phosphatase, and pruritus, despite general regression of inflammation. [merckmanuals.com]

  The adverse events observed in the milk thistle group encompassed impotence (one patient), pruritus (four patients), cephalea (three patients), and nausea and epigastric discomfort (one patient). [doi.org]

  […] however, occur in many liver conditions and are therefore not a reliable clinical feature to distinguish obstruction from liver causes of jaundice.[22] People also can present with elevated serum cholesterol, and often complain of severe itching or "pruritus [en.wikipedia.org]

• Kidney Failure

  The following children are at risk for hepatitis C: Children born to mothers who have the virus Children who have a blood clotting problem, such as hemophilia Children who need dialysis for kidney failure Teens who do high-risk activities. [urmc.rochester.edu]

  Hepatitis B can also cause kidney problems, and infected adults are more likely than children to experience kidney failure. Both hepatitis A and E do not lead to chronic infections, according to the CDC. [livescience.com]

• Encephalopathy

  In patients with subacute presentations, even low-grade encephalopathy indicates an extremely poor prognosis, whereas in hyperacute disease, high grades of encephalopathy may clearly indicate a poor prognosis. [doi.org]

  Specific entities addressed in this chapter include hepatic-related coagulopathy, ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, and hepatic encephalopathy. [web.archive.org]

  Treating hepatic encephalopathy involves taking drugs to help the body eliminate the toxic substances that can cause the brain function to deteriorate. [merckmanuals.com]

• Headache

  […] raw produce, contaminated drinking water, uncooked foods and cooked foods that are not reheated after contact with an infected food handler Incubation Period 28 days average (ranges from 15 to 50 days) Symptoms Diarrhea, dark urine, jaundice, fever, headache [foodsafety.gov]

  Less common side effects include: a slightly raised temperature feeling unwell tiredness a headache feeling sick loss of appetite Page last reviewed: 11 March 2019 Next review due: 11 March 2022 [nhs.uk]

  Symptoms may be very mild and flu-like: nausea, fatigue, loss of appetite, fever, headaches, and abdominal pain. Most people do not have jaundice although jaundice can sometimes occur along with dark urine. [hepfi.org]

  The side effects of antiviral medications may include flu-like symptoms, anemia, fever, fatigue, headaches, weight loss, nausea, skin rashes, and muscle or bone pain. [medbroadcast.com]

The following diagnostic modalities and tests are used in patients with hepatitis:

• Qualitative and quantitative analysis of immunoglobulins for infectious hepatitis
• Liver biopsy will reveal the histologic state of the liver
• Autoimmune assay like Anti-nuclear antibodies (ANA) and anti-smooth muscle antibodies (ASMA).
• Blood tests (Liver enzymes, C-reactive proteins, etc.)
• Imaging studies of the liver

• Candida

  Keep reading… 7/11 Thrush (Candidiasis) is an infection caused by yeast called Candida Albicans. Keep reading… 8/11 Chlamydia is a bacterial infection that can infect the mucous lining of the penis, anus or eyes. [nzaf.org.nz]

  Clonorchis sinensis[45] Dicrocoelium dendriticum[53] Echinococcus[45] Fasciola hepatica[45] Fasciolopsis buski[54] Metorchis[55] Necator[50] Opisthorchis[45] Paragonimus[56] Strongyloides stercoralis[57] Schistosoma[58] Toxocara[59] Fungal Aspergillus[60] Candida [tr.wikipedia.org]

• Coxiella Burnetii

  burnetii[28] Ehrlichia[29] Leptospira Listeria[30] Mycobacterium tuberculosis[31] Nocardia[32] Novosphingobium aromaticivorans[33][34][35][36] Orientia tsutsugamushi[37][38][39] Rickettsia[39] Rhodococcus[40] Salmonella[41] Streptococcus pyogenes[42] [tr.wikipedia.org]

  burnetii, and rickettsia species.[30] Metabolic[edit] Alcoholic hepatitis[edit] Excessive alcohol consumption is a significant cause of hepatitis and is the most common cause of cirrhosis in the U.S.[28] Alcoholic hepatitis is within the spectrum of [en.wikipedia.org]

• Toxoplasma Gondii

  Seroprevalence of cytomegalovirus, toxoplasma gondii, syphilis, and hepatitis B and C virus infections in a regional population seropositive for HIV infection. Can J Infect Dis 1998 ; 9: 209 – 214. Google Scholar | Crossref | Medline 37. [doi.org]

The following treatment approaches are done in all cases of hepatitis among patients:

• Antiviral therapy for viral Hepatitis (nucleoside analogs)
• Interferon therapy for infectious hepatitis
• Autoimmune hepatitis is treated with intravenous corticosteroids
• Cyclosporine and azathioprine
• Naltrexone and acomprosate
• Liver transplantation may be indicated for end stage liver disease cases

In viral hepatitis, the prognosis is primarily dependent on the causative agents. Hepatitis A is usually self-limiting and benign while hepatitis B is insidious and chronic in nature which may lead to hepatocellular carcinoma in 10-15% of cases. Autoimmune hepatitis outlook is gravely dependent on the extent of inflammation. In severe cases, patients usually die within 10 years, those without treatment will usually die within 5 years from diagnosis [9].

The long term outlook of patients with alcoholic hepatitis is dependent whether they are continually on alcohol and whether cirrhosis has already developed. In general, the mortality rate of patients with severe alcoholic hepatitis reaches 66% in most cases [10].

Hepatitis may be clinically caused by infectious agents which commonly involves hepatitis A, hepatitis B, and hepatitis C virus. Less common infectious causes includes cytomegalovirus infections, leptospirosis, malaria, infectious mononucleosis, yellow fever and tuberculosis. Autoimmune hepatitis disease usually follows a hepatitis virus or Epstein Barr virus infection. Some cases of autoimmune hepatitis are caused by drugs like minocycline, methyldopa, nitrofurantoin, and infliximab [1]. Drug induced hepatitis may resolve with the immediate cessation of drugs, but some cases may persist even after drug withdrawal [2]. The most common toxin involved in hepatitis is alcohol. Alcoholic hepatitis usually progresses to cirrhosis and liver failure if heavy alcohol intake is continued.

In the United States, it was estimated that there are 25,000 new hepatitis A infection as of 2007 [3]. The new cases recorded for hepatitis B reached 43,000 as of 2007 in the US. On a worldwide scale, hepatitis A numbers up to 1.5 million infected individuals while those with hepatitis B infections reaches 4 million in numbers [4].

Autoimmune hepatitis occurs in 1-1.2 cases per 100,000 individuals as its global incidence rate. This type of hepatitis accounts for 6% of all liver transplantation done in the United States. In Japan, autoimmune hepatitis has been identified as one of the major causative agent in the development of liver cirrhosis [5].

The relationship of alcohol to the development of severe liver inflammation has been established since antiquity. Genetic polymorphism has been postulated to play a great role in the development of alcoholic damage to the liver cells [6]. Majority of patients who develop alcoholic hepatitis have some degree of malnutrition.

At the incubation period of the hepatitis virus, the host remains asymptomatic but viral shedding are passed out to the stools which potentially infective. After several weeks of unexplained malaise and weakness, patient will develop a cholestasis that leads to generalized hepatic inflammation marked by alalnine aminotransferase (ALT) and alkaline phosphatase elevation. In hepatitis B infection, liver damage is immune mediated and directly cytotoxic at the same time. In some patients, hepatitis undergoes an immune tolerant phase where viral DNA is abundant in the serum while ALT remains normal [7].

The pathogenesis of autoimmune hepatitis is an active interplay of genetic factors and environmental factors in a patient. Genetic predisposition makes the host more susceptible to hepatic insults from foreign antigens and antibodies. Environmental antigens trigger an autoimmune response and a necroinflammatory response in the hepatocytes which causes direct damage, fibrosis and eventually cirrhosis.

The precise mechanism in the pathogenesis of alcoholic hepatitis is still unknown. Although some studies postulate that genetic predisposition and susceptibility of patients to alcohol play a major role in the development of alcoholic hepatitis. Toxicity studies reveal that aldehyde or the metabolite of ethanol metabolism has been shown to directly damage the hepatocyte membranes. The other byproducts of alcohol like free radicals, superoxides, and hydroperoxides are thought to facilitate cell damage through oxidative stress and induce hepatic inflammations. The accumulation of lipid laden hepatocytes from the nonoxidative metabolism of ethanol may rupture and cause hepatic granuloma reactions and fibrosis that my lead to cirrhosis if left unchecked [8].

Hepatitis A is effectively prevented with proper sanitation and good hygiene. Immunizations against hepatitis B is the best preventive option available for uninfected individuals. Because a great deal of hepatotoxic drugs can cause hepatitis, it is most prudent to abide strictly on prescription medications and avoid self-medication at all cost. The use of alcohol should be regulated to prevent the onset of alcoholic hepatitis.

Hepatitis is a clinical disorder characterized by the inflammation of the liver. It is marked by diffuse and patchy necrosis of the liver parenchyma. It is most commonly caused by viruses, alcohol and drugs.

Hepatitis is a serious liver disorder and could either be infectious, autoimmune, or toxic in nature. Hepatitis can be classified as acute if inflammation resolves within 6 months, or chronic if persists beyond 6 months. Patient with chronic hepatitis are more prone to serious complications like liver cirrhosis or liver failure. Severe toxic or alcoholic hepatitis can lead to neurologic complications which carry a high mortality and morbidity rate.

Definition

Hepatitis is the inflammation of the liver which can eventually cause liver parenchymal damage. It is a serious liver disorder that could either be infectious, autoimmune, or toxic in nature.

Cause

Hepatitis is a condition caused most commonly by viruses. Few medications also can cause secondary hepatitis. Chronic alcohol consumption is also implicated to cause hepatitis.

Symptoms

Symptoms of hepatitis are similar though the causative agent varies. The symptoms are due to liver damge. They include jaundice, flu-like symptoms, vomiting, hepatosplenomegaly and malnutrition.

Diagnosis

The common diagnostic methods are serum immunoglobulin assays, blood test of liver enzymes, autoimmune assay and imaging studies (ultrasound, CT-scan, and MRI).

Treatment

The common treatment modalities are antiviral drugs, interferon, corticosteroids, and the final treatment option is liver transplantation.

1. Fairhurst DA,Sheehan-Dre R. Autoimmune hepatitis associated with infliximab in a patient with palmoplanter pustular psoriasis. Clin Exp Dermatol. 2009/04; 34(3):421-2.
2. Liu ZX, Kaplowitz N. Immune-mediated drug-induced liver disease. Clin Liver Dis. Aug 2002; 6(3):755-74.
3. Wasley A, Grytdal S, Gallagher K. Surveillance for acute viral hepatitis--United States, 2006. MMWR Surveill Summ. Mar 21 2008; 57(2):1-24.
4. Previsani N, Lavanchy D. World Health Organization. Hepatitis A (WHO/CDS/CSR/EDC/2000.7). 2000.
5. Michitaka K, Nishiguchi S, Aoyagi Y, Hiasa Y, Tokumoto Y, Onji M. Etiology of liver cirrhosis in Japan: a nationwide survey. J Gastroenterol. Sep 30 2009.
6. Zintzaras E, Stefanidis I, Santos M, Vidal F. Do alcohol-metabolizing enzyme gene polymorphisms increase the risk of alcoholism and alcoholic liver disease? Hepatology. Feb 2006; 43(2):352-61.
7. Keeffe EB, Dieterich DT, Han SH, Jacobson IM, Martin P, Schiff ER, et al. A treatment algorithm for the management of chronic hepatitis B virus infection in the United States: 2008 update. Clin Gastroenterol Hepatol. Dec 2008; 6(12):1315-41; quiz 1286.
8. Testino G, Sumberaz A, Ancarani AO, Borro P, Ravetti G, Ansaldi F, et al. Influence of body mass index, cholesterol, triglycerides and steatosis on pegylated interferon alfa-2a and ribavirin treatment for recurrent hepatitis C in patients transplanted for HCV and alcoholic cirrhosis. Hepatogastroenterology. Mar-Apr 2009; 56(90):501-3.
9. Kirk AP, Jain S, Pocock S, et al. Late results of the Royal Free Hospital prospective controlled trial of prednisolone therapy in hepatitis B surface antigen negative chronic active hepatitis. Gut. Jan 1980; 21(1):78-83.
10. Horie Y, Ishii H, Hibi T. Severe alcoholic hepatitis in Japan: prognosis and therapy. Alcohol Clin Exp Res. Dec 2005; 29(12 Suppl):251S-8S.