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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. Depending on the disease course various kinds of hepatitis may be classified as acute or chronic. Acute viral hepatitis is a spectrum of systemic inflammatory conditions that predominantly involves the liver. Hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), the HBV-associated delta agent or hepatitis D virus (HDV), and hepatitis E virus (HEV) are the most common viruses that may cause acute viral hepatitis. Alcoholic hepatitis and and non alcoholic steatohepatitis (NASH) are the most common non-infectious types of hepatitis. Many drugs and toxins may also result in hepatic injury. The common manifestation among the patients of 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. In some cases disease may become chronic and result in multiple complications such as, hepatocellular carcinoma (HCC), cirrhosis, or hepatorenal syndrome. In such conditions liver transplantation is the definitive treatment option.


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