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Hepatitis

Definition

Hepatitis is swelling and inflammation of the liver. It is not a condition, but is often used to refer to a viral infection of the liver.

Causes, incidence, and risk factors

Hepatitis can be caused by:

• Immune cells in the body attacking the liver and causing autoimmune hepatitis
• Infections from viruses (such as hepatitis A, B, or C), bacteria, or parasites
• Liver damage from alcohol, poisonous mushrooms, or other poisons
• Medications, such as an overdose of acetaminophen, which can be deadly

For more information about the causes and risk factors for different types of hepatitis, see also:

• Alcoholic hepatitis
• Autoimmune hepatitis
• Delta agent (hepatitis D)
• Drug-induced hepatitis
• Hepatitis A
• Hepatitis B
• Hepatitis C

Liver disease can also be caused by inherited disorders such as cystic fibrosis or hemochromatosis, a condition that involves having too much iron in your body (the excess iron deposits in the liver).

Other causes include Wilson's disease.

Symptoms

Hepatitis may start and get better quickly (acute hepatitis), or cause long-term disease (chronic hepatitis). In some instances, it may lead to liver damage, liver failure, or even liver cancer.

How severe hepatitis is depends on many factors, including the cause of the liver damage and any illnesses you have. Hepatitis A, for example, is usually short-term and does not lead to chronic liver problems.

The symptoms of hepatitis include:

• Abdominal pain or distention
• Breast development in males
• Dark urine and pale or clay-colored stools
• Fatigue
• Fever, usually low-grade
• General itching
• Jaundice (yellowing of the skin or eyes)
• Loss of appetite
• Nausea and vomiting
• Weight loss

Many people with hepatitis B or C do not have symptoms when they are first infected. They can still develop liver failure later. If you have any risk factors for either type of hepatitis, you should be tested regularly.

Signs and tests

A physical examination may show:

• Enlarged and tender liver
• Fluid in the abdomen (ascites) that can become infected
• Yellowing of the skin

Your doctor may order laboratory tests to diagnose and monitor the hepatitis, including:

• Abdominal ultrasound
• Autoimmune blood markers
• Hepatitis virus serologies
• Liver function tests
• Liver biopsy to check for liver damage
• Paracentesis if fluid is in your abdomen

Treatment

Your doctor will discuss possible treatments with you, depending on the cause of your liver disease. Your doctor may recommend a high-calorie diet if you are losing weight.

Support Groups

There are support groups for people with all types of hepatitis, which can help you learn about the latest treatments and better cope with having the disease.

See: Liver disease support groups

Expectations (prognosis)

For information on hepatitis outlook, see these articles:

• Alcoholic hepatitis
• Autoimmune hepatitis
• Delta agent (hepatitis D)
• Drug-induced hepatitis
• Hepatitis A
• Hepatitis B
• Hepatitis C

Complications

• Liver cancer
• Liver failure
• Permanent liver damage, called cirrhosis

Other complications include:

• Esophageal varices that can bleed
• Spontaneous bacterial peritonitis (fluid in the abdomen that becomes infected)

Calling your health care provider

Seek immediate care if you:

• Have symptoms from too much acetaminophen or other medicines -- you may need to have your stomach pumped
• Vomit blood
• Have bloody or tarry stools
• Are confused or delirious

Call your doctor if:

• You have any symptoms of hepatitis or believe that you have been exposed to hepatitis A, B, or C.
• You cannot keep food down due to excessive vomiting. You may need to receive nutrition through a vein (intravenously).
• You feel sick and have travelled to Asia, Africa, South America, or Central America.

Prevention

For more information on how to prevent hepatitis, see:

• Alcoholic hepatitis
• Autoimmune hepatitis
• Delta agent (hepatitis D)
• Drug-induced hepatitis
• Hepatitis A
• Hepatitis B
• Hepatitis C

References

Dienstag JL. Hepatitis B virus infection. N Engl J Med. 2008;359:1486-1500.

Jou JH, Muir AJ. In the clinic. Hepatitis C. Ann Intern Med. 2008;148:iTC6-1-ITC6-16.

Sjogren MH, Cheatham JG. Hepatitis A. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa:Saunders Elsevier; 2010:chap 77.