Hepatitis

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Hepatitis Main Page

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Patient Information

Overview

Classification

Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E
Alcoholic Hepatitis
Autoimmune Hepatitis

Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2], Usama Talib, BSc, MD [3]

Overview

Classification

Hepatitis may be classified based on etiology in to two major category.

  • Infectious causes
  • Non-infectious causes

Infectious Causes

Infectious hepatitis classified according to viral agent in to 7 major category.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
Viral Hepatitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hepatitis A
 
Hepatitis B
 
Hepatitis C
 
Hepatitis D
 
Hepatitis E
 
Hepatitis F
 
Hepatitis G
 
Other
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
EBV hepatitis
CMV hepatitis
HSV hepatitis
Coxsackie B virus hepatitis



Non-Infectious Hepatitis



 
 
 
 
 
 
 
 
 
 
 
 
Non-infectious Hepatitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Alcoholic hepatitis
 
Non-alcoholic steatohepatitis (NASH)
 
a-1 antitrypsin defieciency
 
Autoimmune hepatitis
 
Obstructive hepatitis
 
Drug related hepatitis
 
Toxin related hepatitis
 
Ischemic hepatitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Gallstones
Tumors
 
Isoniazid
NSAIDs
•Beta-lactam antibiotics
•Sulfa-containing drugs
HAART
 
Chemicals
 
 
 
 
 



Another classification scheme for hepatitis is based on duration of disease which may classified as Acute vs Chronic.

Differential diagnosis

Hepatitis must be differentiated from other conditions that may cause fever, fatigue, nausea and vomiting, and elevated liver enzymes.

Disease Clinical manifestations Laboratory findings Additional findings
Symptoms Signs Transaminitis (elevated AST and ALT) Viral markers Autoimmune markers
Nausea & vomiting Abdominal pain Arthralgia Jaundice Hepatomegaly
Acute viral hepatitis Hepatitis A +++ ++ + +++ + +++ HAV Ab ---
  • Fecal-oral transmission
  • Usually acute and self limit
  • Fever is usually present.
Hepatitis B +++ ++ ++ +++ + +++ HBs Ag, HBc Ab, HBe Ag ---
  • Percutaneous transmission is the most common way.
  • May cause acute hepatic failure or becomes chronic
  • Fever is usually present.
Hepatitis C +++ ++ ++ +++ + +++ HCV Ab ---
Hepatitis E ++ ++ +/- ++ + +++ HEV Ab ---
  • Fecal-oral transmission
  • May cause fulminant disease in pregnant women.
  • Fever is usually present.
CMV hepatitis +/- ++ - + + ++ CMV-specific immunoglobulin (Ig)M antibody -- Usually manifests as mononucleosis syndrome, fever is usually present.
EBV hepatitis +/- ++ - +/- + ++ Heterophile antibody test, monospot test -- Systemic manifestations as mononucleosis syndrome, fever is usually present.
Autoimmune hepatitis - + +/- ++ + +++ --- ANA, ASMA, anti SLA/LP, ANCA, ALKM-1 antibodies Liver biopsy may be required for diagnosis
Alcoholic hepatitis +/- + - + - AST>ALT --- --- History of alcohol intake
Drug induced hepatitis +/- + - + + ++ --- --- May cause either cholestatic or hepatocellular injury.

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