Hepatitis
💡 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.
