ACUTE HEPATITIS
INTRODUCTION:
Wide variety of conditions - acute inflammation of the hepatic parenchyma or
injury to hepatocytes - elevated liver function indices.
Classified as acute- inflammation lasts for less than six months.
ETIOLOGY:
Infectious and non-infectious causes.
Most common - viral infection or drug-induced liver injury.
INFECTIOUS CAUSES:
⬧ Hepatotropic viruses:
✓ Hepatitis A Virus
✓ Hepatitis B Virus
✓ Hepatitis C Virus
✓ Hepatitis D Virus
✓ Hepatitis E Virus
⬧ Non-hepatotropic virus:
✓ Epstein-Barr virus (EBV)
✓ Cytomegalovirus (CMV)
✓ Herpes simplex virus (HSV)
✓ Coxsackievirus
✓ Adenovirus
✓ Dengue virus
✓ Coronavirus-19(COVID-19)
⬧ Bacteria, fungi, and parasites.
TOXIN OR SUBSTANCE RELATED CAUSES:
⬧ Alcohol-related:
✓ Fatty liver disease.
✓ Acute alcoholic hepatitis.
✓ Alcoholic cirrhosis.
⬧ Drugs and toxins:
✓ Dose-dependent – acetaminophen.
✓ Non-dose-dependent - idiosyncratic drug reaction - antibiotics and
anticonvulsants, statins, NSAIDs and herbal/nutritional
supplements.
✓ Other toxins - mushroom (Amanita phalloides), herbal and dietary
supplements, carbon tetrachloride, sea anemone sting.
Immunologic or inflammatory conditions:
⬧ Autoimmune hepatitis
⬧ Biliary disease:
✓ Primary biliary cholangitis or primary sclerosing cholangitis.
Metabolic or hereditary:
⬧ Non-alcoholic fatty liver disease.
, ⬧ Hemochromatosis.
⬧ Wilson's disease.
Pregnancy-related:
⬧ Preeclampsia
⬧ Acute fatty liver of pregnancy
⬧ HELLP syndrome
Ischemic and Vascular:
⬧ Cardiogenic/Distributive shock.
⬧ Hypotension
⬧ Heatstroke
⬧ Cocaine, methamphetamine, ephedrine.
⬧ Acute Budd-Chiari syndrome.
⬧ Sinusoidal obstruction syndrome.
Miscellaneous:
⬧ Malignancy
⬧ Reye' syndrome.
⬧ Primary graft non-function after liver transplantation.
CLINICAL FEATURES:
Depends on the underlying aetiology.
Ranging from asymptomatic elevated liver function tests to acute liver failure
requiring liver transplantation.
Acute viral hepatitis - fever, malaise, fatigue, loss of appetite, vomiting, diarrhoea,
abdominal pain, yellowish discoloration of their sclera (icterus) and /or skin
(jaundice), dark-coloured urine, and light-coloured stools.
Signs of acute encephalopathy, seizures, bleeding diathesis, hypotension.
Acute on chronic liver disease - caput medusae, spider nevi, palmar erythema,
ascites, dupuytren contracture, gynecomastia, and hepatic encephalopathy.
Travel history.
High-risk activities like IV drug use, alcohol consumption.
Sexual history.
Prior blood-product transfusion history.
Recent food intake.
Drug history - recent or current prescription medications and over-the-counter
medications, acetaminophen (paracetamol), common cough/cold medications,
multivitamins, and herbal/nutritional supplements.
ACUTE VIRAL HEPATITIS:
⬧ HEPATITIS A:
✓ RNA virus belonging to the picornavirus group.
✓ Survives on human hands and fomites.
✓ Resistant to freezing, detergents and acids.
✓ Source - persons incubating or suffering from the disease.
✓ Faecal-oral route- water, milk, and shellfish.
✓ Children - most affected.
✓ Overcrowding and poor sanitation – facilitate.
INTRODUCTION:
Wide variety of conditions - acute inflammation of the hepatic parenchyma or
injury to hepatocytes - elevated liver function indices.
Classified as acute- inflammation lasts for less than six months.
ETIOLOGY:
Infectious and non-infectious causes.
Most common - viral infection or drug-induced liver injury.
INFECTIOUS CAUSES:
⬧ Hepatotropic viruses:
✓ Hepatitis A Virus
✓ Hepatitis B Virus
✓ Hepatitis C Virus
✓ Hepatitis D Virus
✓ Hepatitis E Virus
⬧ Non-hepatotropic virus:
✓ Epstein-Barr virus (EBV)
✓ Cytomegalovirus (CMV)
✓ Herpes simplex virus (HSV)
✓ Coxsackievirus
✓ Adenovirus
✓ Dengue virus
✓ Coronavirus-19(COVID-19)
⬧ Bacteria, fungi, and parasites.
TOXIN OR SUBSTANCE RELATED CAUSES:
⬧ Alcohol-related:
✓ Fatty liver disease.
✓ Acute alcoholic hepatitis.
✓ Alcoholic cirrhosis.
⬧ Drugs and toxins:
✓ Dose-dependent – acetaminophen.
✓ Non-dose-dependent - idiosyncratic drug reaction - antibiotics and
anticonvulsants, statins, NSAIDs and herbal/nutritional
supplements.
✓ Other toxins - mushroom (Amanita phalloides), herbal and dietary
supplements, carbon tetrachloride, sea anemone sting.
Immunologic or inflammatory conditions:
⬧ Autoimmune hepatitis
⬧ Biliary disease:
✓ Primary biliary cholangitis or primary sclerosing cholangitis.
Metabolic or hereditary:
⬧ Non-alcoholic fatty liver disease.
, ⬧ Hemochromatosis.
⬧ Wilson's disease.
Pregnancy-related:
⬧ Preeclampsia
⬧ Acute fatty liver of pregnancy
⬧ HELLP syndrome
Ischemic and Vascular:
⬧ Cardiogenic/Distributive shock.
⬧ Hypotension
⬧ Heatstroke
⬧ Cocaine, methamphetamine, ephedrine.
⬧ Acute Budd-Chiari syndrome.
⬧ Sinusoidal obstruction syndrome.
Miscellaneous:
⬧ Malignancy
⬧ Reye' syndrome.
⬧ Primary graft non-function after liver transplantation.
CLINICAL FEATURES:
Depends on the underlying aetiology.
Ranging from asymptomatic elevated liver function tests to acute liver failure
requiring liver transplantation.
Acute viral hepatitis - fever, malaise, fatigue, loss of appetite, vomiting, diarrhoea,
abdominal pain, yellowish discoloration of their sclera (icterus) and /or skin
(jaundice), dark-coloured urine, and light-coloured stools.
Signs of acute encephalopathy, seizures, bleeding diathesis, hypotension.
Acute on chronic liver disease - caput medusae, spider nevi, palmar erythema,
ascites, dupuytren contracture, gynecomastia, and hepatic encephalopathy.
Travel history.
High-risk activities like IV drug use, alcohol consumption.
Sexual history.
Prior blood-product transfusion history.
Recent food intake.
Drug history - recent or current prescription medications and over-the-counter
medications, acetaminophen (paracetamol), common cough/cold medications,
multivitamins, and herbal/nutritional supplements.
ACUTE VIRAL HEPATITIS:
⬧ HEPATITIS A:
✓ RNA virus belonging to the picornavirus group.
✓ Survives on human hands and fomites.
✓ Resistant to freezing, detergents and acids.
✓ Source - persons incubating or suffering from the disease.
✓ Faecal-oral route- water, milk, and shellfish.
✓ Children - most affected.
✓ Overcrowding and poor sanitation – facilitate.
