Hepatitis is an inflammation of the liver with accompanying liver cell damage. There are many causes of hepatitis both infectious (viral, bacterial, parasitic etc.) and non infectious (drugs, inherited, autoimmune, etc.). The three most common types of viral hepatitis (A, B and C) afflict millions worldwide. Hepatitis is acute when it lasts less than six months and chronic when it persists longer.
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:
The following diagnostic modalities and tests are used in patients with hepatitis:
The following treatment approaches are done in all cases of hepatitis among patients:
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 .
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 .
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 . Drug induced hepatitis may resolve with the immediate cessation of drugs, but some cases may persist even after drug withdrawal . 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 . 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 .
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 .
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 . 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 .
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 .
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.
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.
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.
The common diagnostic methods are serum immunoglobulin assays, blood test of liver enzymes, autoimmune assay and imaging studies (ultrasound, CT-scan, and MRI).
The common treatment modalities are antiviral drugs, interferon, corticosteroids, and the final treatment option is liver transplantation.