Hepatitis survival guide

Jump to navigation Jump to search

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mydah Sajid, MD[2]

Hepatitis Survival Guide Microchapters


This section provides a short and straight-to-the-point overview of acute hepatitis. Acute hepatitis is defined as an acute inflammation of the hepatocytes resulting in deranged liver functions and hepatocyte injury. It can be due to infective or non-infective causes. The most common infective causes included hepatitis viruses (including Hepatitis A, B, C, D, and E). The non-infective causes include medications, alcohol, and autoimmune hepatitis. The treatment is mainly supportive. Regular monitoring should be done to look for adequate resolution of infection, signs of hepatic failure, encephalopathy, or chronic disease.


Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

Common Causes


Shown below is an algorithm summarizing the diagnosis of hepatitis[4][5].

Patients commonly present with:
On physical examination there can be:
Perform liver function tests and abdominal ultrasound
The following results are suggestive of acute hepatitis:
Perform Viral titers and antigen detection tests:


Shown below is an algorithm summarizing the treatment of acute hepatitis[4][6].

Look for severe clinical symptoms like nausea, vomiting, hepatic encephalopathy, i.e., changes in sleep pattern, altered mental status, agitated behavior, and lab finding of hepatic failure, i.e., prolonged prothrombin time and elevated serum bilirubin levels.
For Hepatitis A:
For Hepatitis B:
  • Supportive treatment.
  • All family members and close contacts should be screened for the infection.
  • Hepatitis B surface antigen should be rechecked at regular intervals to assess the chronicity of infection.
    For Hepatitis C: Early Interferon alpha therapy should be initiated as it results in undetectable viral levels with sustained anti-viral action.
    Requires hospitalization with regular monitoring


    • The ALT and AST levels on average raise to the thousands in acute hepatitis indicating hepatocellular injury.
    • Alkaline phosphatase can also be raised showing a cholestatic picture. Serum total bilirubin levels are elevated with an increase in conjugated bilirubin levels. [7]
    • AST and ALT levels in alcoholic hepatitis are usually below 300 iu/L and rarely over 500.
    • Drug-induced hepatitis is indistinguishable from viral hepatitis as it also shows AST and ALT levels in the thousands.
    • Abdominal ultrasound is also done in initial management of acute hepatitis patients. It might show increase in the liver span, changes in echogenicity, texture, acalculous cholecystitis and splenomegaly. [7]


    1. Kwong S, Meyerson C, Zheng W, Kassardjian A, Stanzione N, Zhang K; et al. (2019). "Acute hepatitis and acute liver failure: Pathologic diagnosis and differential diagnosis". Semin Diagn Pathol. 36 (6): 404–414. doi:10.1053/j.semdp.2019.07.005. PMID 31405537.
    2. Hosseini N, Shor J, Szabo G (2019). "Alcoholic Hepatitis: A Review". Alcohol Alcohol. 54 (4): 408–416. doi:10.1093/alcalc/agz036. PMC 6671387 Check |pmc= value (help). PMID 31219169.
    3. Katarey D, Verma S (2016). "Drug-induced liver injury". Clin Med (Lond). 16 (Suppl 6): s104–s109. doi:10.7861/clinmedicine.16-6-s104. PMC 6329561. PMID 27956449.
    4. 4.0 4.1 Ryder SD, Beckingham IJ (2001). "ABC of diseases of liver, pancreas, and biliary system: Acute hepatitis". BMJ. 322 (7279): 151–3. doi:10.1136/bmj.322.7279.151. PMC 1119417. PMID 11159575.
    5. "StatPearls". 2020. PMID 31855397.
    6. Jaeckel E, Cornberg M, Wedemeyer H, Santantonio T, Mayer J, Zankel M; et al. (2001). "Treatment of acute hepatitis C with interferon alfa-2b". N Engl J Med. 345 (20): 1452–7. doi:10.1056/NEJMoa011232. PMID 11794193.
    7. 7.0 7.1 Mackinney-Novelo I, Barahona-Garrido J, Castillo-Albarran F, Santiago-Hernández JJ, Méndez-Sánchez N, Uribe M; et al. (2012). "Clinical course and management of acute hepatitis A infection in adults". Ann Hepatol. 11 (5): 652–7. PMID 22947525.