Hepatitis: Types, Causes, Signs and Symptoms, Diagnosis, Prevention, and Treatment
Introduction to Hepatitis
• Hepatitis is a medical condition characterized by inflammation of the liver. The liver is a vital organ responsible for metabolism, detoxification, bile production, and storage of essential nutrients. When it becomes inflamed or damaged, its functions are compromised, leading to mild, moderate, or severe health consequences.
• The term “hepatitis” is derived from two words: “hepato” (liver) and “itis” (inflammation). Hepatitis can occur due to infections (commonly viruses), toxins, alcohol, drugs, autoimmune diseases, or metabolic disorders.
• Globally, hepatitis affects hundreds of millions of people, especially viral hepatitis caused by hepatitis A, B, C, D, and E viruses. According to the World Health Organization (WHO), more than 354 million people live with chronic hepatitis B and C worldwide, making it a significant public health problem.
Types of Hepatitis
Hepatitis is categorized based on its cause. The most common classification is viral hepatitis, but there are other forms as well.
1. Viral Hepatitis
There are five major types of viral hepatitis:
Hepatitis A (HAV)
• Caused by the hepatitis A virus.
• Transmitted via the fecal-oral route, typically through contaminated food and water.
• Usually self-limiting and does not lead to chronic infection.
Hepatitis B (HBV)
• Caused by the hepatitis B virus.
• Transmitted through blood, sexual contact, and mother-to-child during childbirth.
• Can become chronic, leading to cirrhosis and liver cancer.
Hepatitis C (HCV)
• Caused by the hepatitis C virus.
• Transmitted mainly through blood-to-blood contact (contaminated needles, transfusions, unsafe medical procedures).
• Often asymptomatic for years, but can cause chronic hepatitis, cirrhosis, and liver cancer.
Hepatitis D (HDV)
• Caused by the hepatitis D virus, which requires the presence of hepatitis B virus for replication.
• Transmitted through blood and body fluids.
• Causes severe complications compared to HBV alone.
Hepatitis E (HEV)
• Caused by the hepatitis E virus.
• Transmitted through the fecal-oral route, similar to HAV.
• Common in areas with poor sanitation.
• Dangerous during pregnancy, leading to severe complications.
2. Alcoholic Hepatitis
• Caused by excessive alcohol consumption.
• Chronic alcohol abuse damages liver cells, leading to inflammation and scarring.
3. Autoimmune Hepatitis
• A rare condition where the immune system attacks liver cells.
• More common in women and often associated with other autoimmune diseases.
4. Drug-Induced Hepatitis
• Certain medications (e.g., acetaminophen overdose, antibiotics, and chemotherapy drugs) can damage the liver.
5. Metabolic Hepatitis
Associated with metabolic disorders such as non-alcoholic fatty liver disease (NAFLD) and Wilson’s disease.
Causes of Hepatitis
Hepatitis has multiple causes depending on its type:
• Viral infections (HAV, HBV, HCV, HDV, HEV).
• Alcohol abuse (alcoholic hepatitis).
• Drugs and toxins (paracetamol overdose, anabolic steroids, toxic mushrooms).
• Autoimmune conditions (immune system attacking the liver).
• Metabolic diseases (fatty liver, genetic conditions).
Signs and Symptoms of Hepatitis
The clinical presentation of hepatitis varies depending on the type, severity, and duration of infection.
Common Symptoms
• Fatigue
• Fever
• Loss of appetite
• Nausea and vomiting
• Abdominal pain (especially upper right quadrant)
• Dark urine
• Clay-colored stool
• Yellowing of skin and eyes (jaundice)
• Joint pain
• Itchy skin
Chronic Hepatitis Symptoms
• If hepatitis becomes chronic, symptoms may include:
• Persistent tiredness
• Weight loss
• Swelling of the abdomen (ascites)
• Easy bruising or bleeding
• Confusion (hepatic encephalopathy)
Complications of Hepatitis
• If left untreated, hepatitis can lead to serious health issues:
• Cirrhosis (scarring of the liver).
• Liver failure.
• Liver cancer (hepatocellular carcinoma).
• Portal hypertension.
• Death (in severe cases).
Diagnosis of Hepatitis
Diagnosis involves a combination of clinical evaluation, laboratory tests, and imaging studies.
1. Medical History and Physical Examination
• Review of symptoms, alcohol use, drug history, and risk factors.
• Checking for signs of jaundice, abdominal swelling, or liver enlargement.
2. Laboratory Tests
• Liver function tests (LFTs) – measure enzymes (ALT, AST, ALP) and bilirubin.
• Viral markers – detection of HAV IgM, HBsAg, anti-HCV antibodies.
• Polymerase Chain Reaction (PCR) – to detect viral DNA/RNA.
• Autoimmune markers – ANA, SMA for autoimmune hepatitis.
3. Imaging Studies
• Ultrasound – to detect liver enlargement, fatty liver, or cirrhosis.
• CT scan or MRI – for detailed liver structure analysis.
4. Liver Biopsy
Performed in chronic or unclear cases to evaluate the extent of liver damage.
Prevention of Hepatitis
Preventive measures differ depending on the type of hepatitis:
General Prevention
• Maintain good hygiene (hand washing, safe drinking water).
• Practice safe sex (use of condoms).
• Avoid sharing needles, razors, or toothbrushes.
• Use sterile equipment for medical procedures and tattoos.
• Avoid excessive alcohol and self-medication.
Vaccination
• Hepatitis A vaccine – effective prevention for HAV.
• Hepatitis B vaccine – provides lifelong protection and prevents HDV as well.
• Currently, no vaccine exists for hepatitis C.
• Hepatitis E vaccine is available in some countries but not globally.
Treatment of Hepatitis
Treatment depends on the type and severity of hepatitis.
1. Hepatitis A & E
• Usually self-limiting.
• Supportive care: hydration, rest, balanced diet, and avoiding alcohol.
2. Hepatitis B
• Acute HBV: Mostly supportive care.
• Chronic HBV: Antiviral medications such as tenofovir and entecavir.
3. Hepatitis C
• Direct-acting antivirals (DAAs) such as sofosbuvir, ledipasvir, daclatasvir.
• High cure rates with 8–12 weeks of therapy.
4. Hepatitis D
Difficult to treat; management involves antiviral therapy and interferon.
5. Autoimmune Hepatitis
Immunosuppressive drugs: corticosteroids and azathioprine.
6. Alcoholic & Drug-Induced Hepatitis
• Immediate discontinuation of alcohol or offending drugs.
• Supportive care and in severe cases, liver transplant.
Lifestyle and Dietary Management
• Avoid alcohol completely.
• Eat a liver-friendly diet (fruits, vegetables, lean protein, whole grains).
• Maintain a healthy weight.
• Stay hydrated.
• Exercise moderately.
Global Burden and Public Health Measures
• Hepatitis B and C are major causes of chronic liver disease worldwide.
• WHO has set a goal to eliminate viral hepatitis as a public health threat by 2030.
• Strategies include vaccination programs, safe blood transfusions, harm-reduction measures, and access to antiviral treatment.
Conclusion
Hepatitis is a serious health condition with diverse causes ranging from viral infections to alcohol, drugs, and autoimmune disorders. Early diagnosis, preventive measures like vaccination and safe practices, and timely treatment can prevent complications such as cirrhosis and liver cancer. With global awareness and improved healthcare access, the burden of hepatitis can be significantly reduced.
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Writer: Vandita Singh, Lucknow (GS India Nursing Group)