View source for Hepatitis

__NOTOC__

'''For patient information click [[{{PAGENAME}} (patient information)|here]].'''

{{Hepatitis}}
{{CMG}}{{AE}}{{SMP}}, {{USAMA}}

==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.
<br>
<br>
{| align="center"
|-
| 
{{familytree/start}}
{{familytree | | | | | | | | | | | | | | | A01 | | | | | |A01='''Viral Hepatitis'''}}
{{familytree | | | | | | | | | | | | | | | |!| | | | | | | | }}
{{familytree | |,|-|-|-|v|-|-|-|v|-|-|-|v|-|^|-|v|-|-|-|v|-|-|-|v|-|-|-|.| | }}
{{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| }}
{{familytree | D01 | |D02| | D03 | | D04 | |D05| | D06 | | D07 | |D08| | |D01=[[Hepatitis A]]|D02=[[Hepatitis B]]|D03=[[Hepatitis C]]|D04=[[Hepatitis D]]|D05=[[Hepatitis E]]|D06=[[Hepatitis F]]|D07=[[Hepatitis G]]|D08=Other}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| }}
{{familytree |boxstyle=text-align: left; | | | | | | | | | | | | | | | | | | | | | | | | | | | | | E01 |E01= • [[Mononucleosis natural history#Complications|EBV hepatitis]]<br>• [[Cytomegalovirus infection natural history, complications and prognosis#Complications|CMV hepatitis]] <br>• [[Herpes simplex natural history, complications and prognosis#Complications|HSV hepatitis]] <br>• [[Coxsackie virus#Classification|Coxsackie B virus hepatitis]] <br>}}
{{familytree/end}}
|}
<br>
<br>

===Non-Infectious Hepatitis===
<br><br>
{{familytree/start}}
{{familytree | | | | | | | | | | | | | A01 | | | | | |A01='''Non-infectious Hepatitis'''}}
{{familytree | | | | | | | | | | | | | |!| | | | | | | | }}
{{familytree | |,|-|-|-|v|-|-|-|v|-|-|-|+|-|-|-|v|-|-|-|v|-|-|-|v|-|-|-|.| | }}
{{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| }}
{{familytree | D01 | |D02| | D03 | | D04 | |D05| | D06 | | D07 | |D08| | |D01=[[Alcoholic hepatitis]]|D02=[[Non-alcoholic steatohepatitis]] ([[NASH]])|D03=[[a-1 antitrypsin defieciency]]|D04=[[Autoimmune hepatitis]]|D05=Obstructive hepatitis|D06=[[Drug induced liver injury|Drug related hepatitis]]|D07=Toxin related hepatitis|D08=Ischemic hepatitis}}
{{familytree | | | | | | | | | | | | | | | | | |!| | | |!| | | |!| | | | | }}
{{familytree |boxstyle=text-align: left; | | | | | | | | | | | | | | | | | E01 | | E02 | | E03 | | | | | |E01=•[[Gallstones]] <br>•[[Tumors]]|E02= •[[Isoniazid]]<br>•[[NSAIDs]]<br>•Beta-lactam antibiotics<br>•Sulfa-containing drugs<br>•[[HAART]]|E03=Chemicals}}
{{familytree/end}}
<br><br>
Another classification scheme for hepatitis is based on duration of disease which may classified as '''Acute''' vs '''Chronic'''.
<br>

==Differential diagnosis==
Hepatitis must be differentiated from other conditions that may cause [[fever]], [[fatigue]], [[nausea and vomiting]], and elevated [[liver enzymes]].
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! colspan="2" rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease
! colspan="5" align="center" style="background:#4479BA; color: #FFFFFF;" |Clinical manifestations
! colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Laboratory findings
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Additional findings
|-
! colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Symptoms
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Signs
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Transaminitis (elevated AST and ALT)
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Viral markers
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Autoimmune markers
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" |Nausea & vomiting
! align="center" style="background:#4479BA; color: #FFFFFF;" |Abdominal pain
! align="center" style="background:#4479BA; color: #FFFFFF;" |Arthralgia
! align="center" style="background:#4479BA; color: #FFFFFF;" |Jaundice
! align="center" style="background:#4479BA; color: #FFFFFF;" |Hepatomegaly
|-
| rowspan="6" style="background:#4479BA; color: #FFFFFF" |Acute viral hepatitis
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hepatitis A]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +++
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ++
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +++
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +++
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[HAV]] Ab
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ---
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Fecal-oral transmission
* Usually acute and self limit
* [[Fever]] is usually present.
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hepatitis B]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +++
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ++
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ++
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +++
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +++
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |HBs Ag, HBc Ab, HBe Ag
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ---
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Percutaneous transmission is the most common way.
* May cause acute hepatic failure  or becomes chronic
* [[Fever]] is usually present.
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hepatitis C]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +++
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>++</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>++</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+++</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+++</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |HCV Ab
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>---</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Percutaneous transmission is the most common way.
* Higher rate of chronic progression
* Associated with extra hepatic manifestation such as, [[cryoglobulinemia]] and [[membranoproliferative glomerulonephritis]].
* [[Fever]] is usually present.
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hepatitis E]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>++</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>++</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+/-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>++</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+++</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |HEV Ab
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>---</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Fecal-oral transmission
* May cause fulminant disease in pregnant women.
* [[Fever]] is usually present.
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cytomegalovirus infection natural history, complications and prognosis|CMV hepatitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+/-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>++</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>++</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |CMV-specific immunoglobulin (Ig)M antibody
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>--</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Usually manifests as mononucleosis syndrome, [[fever]] is usually present.
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |EBV hepatitis
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+/-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>++</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+/-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>++</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Antibody|Heterophile antibody test]], monospot test
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>--</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Systemic manifestations as mononucleosis syndrome, fever is usually present.
|-
| colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |[[Autoimmune hepatitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+/-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>++</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+++</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>---</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Antinuclear antibodies|ANA]], [[Anti-SM antibody|ASMA]], anti SLA/LP, [[ANCA]], ALKM-1 antibodies
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Liver biopsy may be required for diagnosis
|-
| colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |[[Alcoholic hepatitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+/-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Aspartate transaminase|AST]]>[[Alanine transaminase|ALT]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ---
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>---</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |History of alcohol intake
|-
| colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |[[Drug induced liver injury|Drug induced hepatitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+/-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>++</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>---</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>---</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |May cause either cholestatic or hepatocellular injury.
|}

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[[Category:Gastroenterology]]
[[Category:Hepatology]]
[[Category:Primary care]]
[[Category:Infectious disease]]
[[Category:Disease]]