Hepatitis:Causes, Symptoms, investigation, treatment

 Hepatitis 

Hepatitis Inflammation of liver parenchyma is called hepatitis. It can be caused by a variety of infectious and non-infectious agents. Types of hepatitis are:-

(a) Acute hepatitis 

b) Chronic hepatitis 

Acute parenchymal liver damage can be caused by many agents. if there is wide spread damage of hepatocytes, the normal liver architecture may collapse. The extent of hepatocellular danage may be extremely variable.

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Causes of  Hepatitis:

Viral infections: Virus A, B, C, D, E, G, H Epstein – Barr virus Cytomegalovirus Non A – E viral hepatitis Herpes simplex virus Yellow fever virus. Viral Hepatitis Viral Hepatitis is caused by the specific hepatitis virus that predominantly affect the epatocytes and cause an inerease in transaminases. Specific hepatitis viruses: Hepatitis A virus (HAV), Hepatitis B virus (HBV),Hepatitis C virus (HCV). Hepatitis D virus (HDV), Hepatitis E virus (HEV), Hepatitis G virus (HGV)

Non- viral infections: 

Toxoplasma gondii Leptospira Q. fever

Alcohol consumption Alcoholic hepatitis

Drugs: Paracetamol overdose Halothane 

Poisons:Amanita phalloides Alfa toxin Carbon Tetrachloride 

Other causes are Pregnancy,Circulatory insufficiency,Autoimmune hepatitis,Wilson’s disease, 

Clinical Features and Symptoms of Hepatitis : 

Pre – icteric phase:

Lethargy , 

chills , headache

malaise Anorexia 

distaste. Nausea 

vomiting and diarrhoea Upper abdominal pain Arthralgia , skin rashes and polyarthritis ( HBV ) 

Icteric phase:

 Jaundice Constitutional symptoms diminish Dark – Coloured urine due to bilirubinuria.  Clay – Coloured stool due to cholestasis Loss of weight Pruritus. as a result of elevated serum bile acid / salts .

 Post- icteric phase ( recovery phase ):

 Disappearance of jaundice Urine and stool colour become normal.  Appetite improve Gastrointestinal symptoms disappear . B. Signs Jaundice Tender hepatomegaly Splenomegaly ( 10 % cases ) Enlarged cervical lymph node Recovery occurs within 3 – 6 weeks 

Investigation of Hepatitis:

( i ) Blood for TC , DC , Hb % ESR – leucopenia , High ESR 

( ii ) Liver function test: 

  • Serum bilirubin – raised 
  • Serum aminotransferase – very high ( ALT > AST ) > 400 U / L 
  • Serum alkaline phosphatase level 250 U / L
  •  Prolonged prothrombin time 
  • Note:-( ALT : Alanine aminotransferase , AST : Asparate aminotransferase )

( iii ) Viral markers :

  •  IgM- Anti HAV ( hepatitis A virus ) 
  • HBsAg ( Hepatitis B surface antigen ) 
  • IgM – anti HBc ( Hepatitis B core anligen )
  •  Anti – HCV , HCV antigen Anti – HEN , HEV antigen

Treatment of Hepatitis:

There is no specific treatment only severely affected patients require hospitalization that developing fulminant hepalic failure can be detected early. Bed rest Treatment Diet normal diet with slight fat restriction. Nutritious diet containing 2000-3000 Kcal per day with good protein diet. Glucose and Iruit juice. If severe vomiting – Anti emeties, ORS, iv fluids, Avoid drugs as far as possible especially sedative and hypnotics: Educate patient about personal hygiene.

Complications of acute viral hepatitis:

  • Acute fulminant hepatitis 
  • Chronic hepatitis 
  • Cirrhosis of liver 
  • Hepatocellular carcinoma (Hepatoma) 
  • Renal failure 
  • Hepatic encephalopathy 
  • Bleeding disorders. 
  • Henoch – schonlein purpura (HSP) (A) 

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  1. I was diagnosed as HEPATITIS B carrier in 2013 with fibrosis of the
    liver already present. I started on antiviral medications which
    reduced the viral load initially. After a couple of years the virus
    became resistant. I started on HEPATITIS B Herbal treatment from
    ULTIMATE LIFE CLINIC (www.ultimatelifeclinic.com) in March, 2020. Their
    treatment totally reversed the virus. I did another blood test after
    the 6 months long treatment and tested negative to the virus. Amazing
    treatment! This treatment is a breakthrough for all HBV carriers.