Hepatitis

Hepatitis is most commonly due to Hep A, B, C, or Alcohol. Other causes are Hep D, E, Autoimmune, CMV, EBV. Patients may present with:

• Malaise and fatigue

• RUQ pain

• Jaundice

• Diarrhoea

• N+V

• Hepato/splenomegaly

• Liver failure - characterised by hepatic encephalopathy, jaundice, ascites, and abnormal clotting

LFTs will show a Raised AST and ALT as an indication of hepatocellular injury.

• Mildly raised ALP = Acute

• Normal ALP = Chronic

N.B. All infectious hepatitis cases are notifiable diseases.

Hepatitis A Virus:

This contains RNA and is trasmitted by the faecal-oral route (usually contaminated food/water). It presents with flu-like symptoms, followed by jaundice, pale stools (in some), dark urine and abdominal pain. It's managed supportively and complete recovery can take up to 6 months.

Hepatitis B Virus:

This is the most common cause of hepatitis globally. It contains dsDNA, and is transmitted by infected blood or body fluids (vertically from pregnant woman, unprotected sex, transfusion, IVDU). Patients. present with Jaundice, fever, and malaise. Some go on to develop Chronic disease, which can in turn cause Liver fibrosis and a Hepatocellular carcinoma.

Serology:

• HBsAg - Surface antigen indicating active infection (given in vaccine)

• HBsAb (Anti-HBs) - Indicates previous vaccination

• HBcAb (Anti-HBc) - Indicates previous infection

  • IgM = active infection

  • IgG = past infection

• HBeAg - E antigen released during viral replication, therefore a marker of its infectivity

  • The higher the level, the more infectious

Investigations - FibroScan, and USS for its complications

Management - Peginterferon alfa-2a

Hepatitis C Virus:

This contains RNA and is transmitted by the exchange of blood and bodily fluids (unprotected sex, transfusion, IVDU). Most present asymptomatically and only 15-25% clear the virus, leading to the rest going on to develop Chronic disease, which can in turn cause Liver fibrosis and a Hepatocellular carcinoma.

Investigations:

• Anti-HepC

• FibroScan and USS to check for complications

Management is curative with Direct Acting Antivirals (DAAs).

Hepatitis D Virus:

This virus only affects those with Hep B as it needs to attach to HBsAg to survive. Like others, it can lead to chronic disease, liver fibrosis, and a hepatocellular carcinoma. It doesn't have any specific management, but the Hep B vaccine can help protect against it.

Autoimmune Hepatitis:

There are 3 types of this:

• Type 1 - most common, and present from menopause - is +ve for anti-smooth muscle antibodies

• Type 2 - less common but more severe - is +ve for anti-liver/kidney microsomal antibodies

• Type 3 - less common

LFTs - Raised ALT and bilirubin with normal/mildly raised ALP

Management - Steroid (prednisolone) induction therapy followed by maintenance therapy with azathioprine

Alcoholic Hepatitis:

Most patients with this go on to develop liver fibrosis and a hepatocellular carcinoma.

LFTs - AST > 2x ALT, and a raised GGT

Management - Stop drinking to allow the liver time to recover