Hepatitis

• Posted on: Aug 12 2020
• By: Benjamin Penn

What is Hepatitis?

Hepatitis is inflammation of the liver usually due to a virus, but other infections, drugs, alcohol, and autoimmune diseases can cause hepatitis as well. There are 5 types of viral hepatitis A, B, C, D, and E. 

What is Hepatitis A?

It is transmitted through the fecal-oral route and is associated with contaminated food and water and international travel. 

• Patients are usually asymptomatic or mildly symptomatic. Hep A can be associated with spiking fever and on the physical exam there can be malaise, anorexia, nausea, vomiting, abdominal pain. 
• No treatment is needed, and Hep A does not progress to chronic hepatitis. 
• Hepatitis is best prevented with handwashing and improved sanitation. 

What is Hepatitis B?

Transmission is percutaneous, sexual, parenteral, perinatal.

• Most patients present asymptomatically but there are 3 possible states
  • Subclinical: constitutional symptoms (malaise, anorexia, nausea, vomiting, abdominal pain) and a decreased desire to smoke in smokers
  • Icteric: Jaundice
  • Fulminant: Acute hepatic failure
• Diagnosis is made via blood tests and a liver biopsy can be done to assess the extent of the damage.  
• The mainstay of treatment is supportive, the majority of patients do not progress to chronic hepatitis. Antivirals can be used for persistent/severe symptoms medications include entecavir and tenofovir.
• The hep B vaccine is administered in 3 doses at 0 1 and 6 months in adults.

What is Hepatitis C?

Transmission is usually parenteral most commonly through IV drug abuse. 85% of patients progress to chronic disease. 

• Most patients are asymptomatic but acute Hep C presents with constitutional symptoms (malaise, anorexia, nausea, vomiting, abdominal pain) as well as right upper quadrant pain, dark urine, and clay-colored stool. 
• Diagnosis can be made via blood tests for antibodies or HCV RNA which is the most sensitive test.
• There is a wide range of new antiviral treatment options available, including Ledipasvir-Sofosbuvir and Elbasvir-Grazoprevir.  

What is Hepatitis D?

A co-infection with hepatitis B that is primarily transmitted parenterally.

• There is currently no FDA approved management, but interferon alpha has been used for chronic hep D.

What is Hepatitis E?

It is transmitted via a fecal-oral route similar to Hep A

• No treatment is needed as it is self-limiting and not associated with a chronic state.
• There is an increased risk of fulminant hepatitis in pregnant women specifically during the 3^rd trimester

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