Hepatitis is the inflammation of the liver, commonly caused by viral infections, though it can also result from other factors such as autoimmune reactions, drug toxicity, and alcohol abuse. Viral hepatitis is categorized by different types (A, B, C, D, and E), each caused by specific viruses.
Etiopathogenesis
1. Viral Hepatitis:
– Hepatitis A (HAV): Fecal-oral transmission through contaminated food or water.
– Hepatitis B (HBV): Bloodborne transmission, often through sexual contact, needle sharing, or perinatal transmission.
– Hepatitis C (HCV): Bloodborne transmission, primarily through injecting drug use and, in the past, transfusions or organ transplants.
– Hepatitis D (HDV): Occurs in individuals with HBV, enhancing the severity of HBV infection.
– Hepatitis E (HEV): Similar to HAV, transmitted through contaminated water, and prevalent in developing countries.
2. Non-Viral Causes:
– Autoimmune Hepatitis: Immune system attacks the liver cells.
– Alcoholic Hepatitis: Resulting from chronic alcohol consumption.
– Drug-Induced Hepatitis: Medications, toxins, and herbal supplements can cause liver inflammation.
3. Risk Factors:
– Unprotected sex, intravenous drug use, contaminated blood products, and certain medical procedures increase the risk of viral hepatitis.
– Alcohol abuse, certain medications, and underlying liver diseases can contribute to non-viral hepatitis.
Clinical Manifestations
1. Acute Hepatitis:
– General Symptoms: Fatigue, malaise, loss of appetite.
– Digestive Symptoms: Nausea, vomiting, abdominal pain, jaundice (yellowing of the skin and eyes).
– Systemic Symptoms: Fever, joint pain.
2. Chronic Hepatitis:
– Often asymptomatic initially.
– May progress to liver cirrhosis, leading to symptoms like ascites, portal hypertension, and hepatic encephalopathy.
3. Fulminant Hepatitis:
– Rapid and severe liver failure, associated with altered mental status, coagulopathy, and a high risk of mortality.
Non-pharmacological Management
1. Rest and Nutrition:
– Adequate rest to support the body during the acute phase.
– Nutritious diet to support liver function and recovery.
2. Avoidance of Hepatotoxic Substances:
– Abstinence from alcohol and elimination of potentially hepatotoxic drugs.
3. Vaccination:
– Vaccination against Hepatitis A and B to prevent infection.
4. Hygiene Practices:
– Promoting hygiene to prevent the spread of viral hepatitis.
Pharmacological Management
1. Antiviral Medications:
– Hepatitis B: Nucleoside/nucleotide analogs (e.g., tenofovir, entecavir).
– Hepatitis C: Direct-acting antivirals (DAAs) that target specific steps in the HCV life cycle.
2. Immune Modulators:
– Used in autoimmune hepatitis to suppress the immune response (e.g., corticosteroids, azathioprine).
3. Symptomatic Treatment:
– Medications to relieve symptoms such as nausea, pain, or itching.
4. Liver Transplantation:
– Considered in severe cases of acute liver failure or end-stage liver disease.
Follow-up and Prognosis
– Monitoring Liver Function:
– Regular assessment of liver enzymes, viral load, and other markers.
– Complications:
– Surveillance for complications like cirrhosis, hepatocellular carcinoma, and portal hypertension.
– Patient Education:
– Emphasizing the importance of vaccination, lifestyle modifications, and adherence to medications.
In conclusion, hepatitis encompasses a diverse group of liver inflammations with viral and non-viral etiologies. Management involves addressing the underlying cause, symptomatic relief, and supportive care. Early diagnosis, vaccination, and lifestyle modifications are crucial in preventing the progression of the disease and reducing the risk of complications.
