Makindo Medical Notes

💡 Always consider infection 🦠, drugs 💊, and alcohol 🍺 when faced with acute hepatitis. Some cases are self-limiting, others progress to fulminant liver failure 🚨 or evolve into chronic hepatitis.

ℹ️ About

• Hepatitis = hepatocyte necrosis + inflammation (many causes).
• May be short-lived and reversible or progress to chronic hepatitis/cirrhosis.
• ⚠️ Fulminant liver failure: minority of cases, but very high mortality.

🩺 Clinical Features

• Non-specific: malaise, fatigue, nausea, vomiting 🤢
• Classic: jaundice 🟡, dark urine 🧪, pale stools ⚪, RUQ pain.
• Clues: cigarette distaste 🚬 (HBV), tender hepatomegaly.
• Severe: hepatic encephalopathy (confusion, coma) → acute liver failure 🚨

🧬 Causes

• Viral Hepatitis:
  • HAV 🦠 – faeco-oral; self-limiting, no chronicity.
  • HBV – blood, sex, vertical transmission; ~10% → chronic.
  • HCV – blood-borne (IVDU, transfusions); often chronic.
  • HDV – requires HBV; more severe coinfection.
  • HEV – waterborne; severe in pregnancy 🤰.
  • Other viruses: EBV, CMV, HSV.
• Drugs & Toxins 💊:
  • Paracetamol overdose (UK commonest; antidote = NAC 🧴).
  • Antibiotics, statins, anti-TB drugs.
  • Alcohol binges → alcoholic hepatitis.
  • Toxins (mushrooms 🍄, industrial chemicals).
• Autoimmune Hepatitis 🤒: ANA, SMA, LKM1 positive; young women common.
• Other Causes:
  • Ischaemic (“shock liver”) from hypotension/heart failure ❤️.
  • Metabolic: Wilson’s disease (copper 🟤 rings), haemochromatosis (iron overload).

🧪 Investigations

• LFTs: ALT/AST often >1000; ↑ bilirubin; ↑ INR/PT (poor prognosis if prolonged).
• Viral serology: HAV IgM, HBsAg, anti-HCV, HEV IgM, HDV markers.
• Autoantibodies: ANA, SMA, LKM1 if autoimmune suspected.
• Toxicology: paracetamol level, alcohol/drug screen.
• Imaging: USS liver/biliary tree to exclude obstruction; CT/MRI if unclear.
• Liver biopsy: rarely acute, more for chronic/unclear causes.

💊 Management

• Viral Hepatitis: Supportive (hydration, nutrition, rest). – HBV/HCV: antivirals in select cases. – Avoid alcohol & hepatotoxins (e.g., paracetamol).
• Drug-Induced: Stop culprit drug; NAC for paracetamol overdose.
• Alcoholic Hepatitis: Abstinence + supportive care; corticosteroids if severe.
• Autoimmune: Prednisolone ± azathioprine.
• Ischaemic: Restore perfusion – fluids, inotropes, treat cardiac cause.
• Fulminant liver failure 🚨: ICU + urgent transplant referral 🏥.

📈 Prognosis

• HAV & HEV → usually self-limiting 👍
• HBV & HCV → risk of chronic hepatitis → cirrhosis + HCC risk 📉
• Fulminant hepatitis → high mortality; transplant may be only option.

🎯 Exam Pearls

• Paracetamol overdose = commonest cause in UK → NAC early saves lives.
• HEV = severe in pregnancy → high maternal/fetal mortality.
• Autoimmune hepatitis = young woman + ↑ IgG + ANA/SMA positive.
• Clue: cigarette distaste 🚬 strongly suggests acute HBV.
• Prognosis markers: ↑ INR, encephalopathy, ↑ bilirubin.