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Hepatitis Main Page


Patient Information



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]


Hepatitis refers to the inflammation of the liver. The etiologic agent could be infectious (almost always viral) or non-infectious. Hepatitis can be acute and self limiting or can be chronic and progress to cirrhosis or hepatocellular carcinoma (HCC). Most common causes of infectious hepatitis are viral in origin. These include hepatitis A, B, C, D and E . Non infectious causes of hepatitis include autoimmune, alcohol, drugs and toxins. Alcoholic hepatitis and and non alcoholic steatohepatitis (NASH) are the most common non-infectious types of hepatitis.

The common manifestation of acute hepatitis are fever, jaundice, fatigue, abdominal pain, and hepatomegaly. Diagnosis of hepatitis is based on the clinical manifestations and laboratory findings. In rare conditions liver biopsy is required for either the diagnosis or formulating a treatment plan.


Hepatitis may be classified depending on the duration of the disease into the following types:

  • Acute hepatitis
  • Chronic hepatitis

Hepatitis may also be classified on the basis of various causes into the following types:

  • Infectious hepatitis
  • Non-infectious hepatitis

Infectious Hepatitis

Infectious hepatitis can be classified according to the causative viral agent in to 7 major categories.

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

Non-Infectious Hepatitis

Non-infectious Hepatitis
Alcoholic hepatitis
Non-alcoholic steatohepatitis (NASH)
Alpha 1 antitrypsin deficiency
Autoimmune hepatitis
Obstructive hepatitis
Drug related hepatitis
Toxin related hepatitis
Ischemic hepatitis
•Beta-lactam antibiotics
•Sulfa-containing drugs

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 usually present
Hepatitis B +++ ++ ++ +++ + +++ HBs Ag, HBc Ab, HBe Ag ---
  • Percutaneous transmission most common
  • May cause acute hepatic failure or may become chronic
  • Fever usually present
Hepatitis C +++ ++ ++ +++ + +++ HCV Ab ---
Hepatitis E ++ ++ +/- ++ + +++ HEV Ab ---
  • Fecal-oral transmission
  • May cause fulminant disease in pregnancy
  • Fever usually present
CMV hepatitis +/- ++ - + + ++ CMV-specific immunoglobulin (Ig)M antibody --
  • Usually manifests as mononucleosis syndrome
  • fever usually present
EBV hepatitis +/- ++ - +/- + ++ Heterophile antibody test, monospot test --
  • Systemic manifestations as mononucleosis syndrome
  • Fever 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


Treatment of hepatitis A and hepatitis E is supportive as they are usually self-limited. Chronic hepatitis E is treated with the antiviral ribavirin.

Hepatitis B infection is treated with pegylated interferon alfa or nucleoside analogs (entecavir, tenofovir) based on the clinical picture including ALT and HBV DNA levels and presence or absence of cirrhosis.

Treatment is indicated in chronic Hepatitis C infection which is defined as the presence of detectable HCV RNA levels for 6 months. The selection of treatment regimen depends on viral genotype, presence or absence of cirrhosis and other patient factors. Some of the commonly used antiviral regimens include sofosbuvir-velpatasvir, glecaprevir-pibrentasvir and ledipasvir-sofosbuvir

Acute hepatitis D has no specific treatment. For chronic hepatitis D infection, treatment is indicated with PEG interferon alfa for patients with detectable HDV RNA, elevated ALT and evidence of active liver disease. Asymptomatic patients can be monitored for development of active disease.

Alcoholic hepatitis is generally treated with alcohol abstinence and supportive care in mild to moderate cases. Severe cases are treated with tapering courses of glucocorticoids.

Autoimmune hepatitis is treated with glucocorticoid mono therapy or combination of glucocorticoid with azathioprine. Treatment decision is based on symptom severity, laboratory and histologic findings.


Hepatitis A

  • Vaccination especially amongst high-risk individuals who were not vaccinated in childhood. These include IV drug users, Chronic liver disease patients, and Men who have sex with men (MSM).
  • For individuals at risk of both HAV and HBV, the combined vaccine used as a 3-does series is administered.

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