Hepatitis

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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]

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	---	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.
	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.