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07-SEPTEMBER-2008 03:17:44 - Hepatitis Hepatitis Classification and external resources Alcoholic hepatitis evident by fatty change, cell necrosis, Mallory bodies ICD-10 K75.9 ICD-9 573.3 DiseasesDB 20061 MeSH D006505 Hepatitis plural hepatitides implies injury to the liver characterized by the presence of inflammatory cells in the tissue of the organ. The name is from ancient Greek hepar ηπαÏ? or hepato- ηπατο-, meaning liver, and suffix -itis, meaning inflammation c. 17271. The condition can be self-limiting, healing on its own, or can progress to scarring of the liver. Hepatitis is acute when it lasts less than six months and chronic when it persists longer. A group of viruses known as the hepatitis viruses cause most cases of liver damage worldwide. Hepatitis can also be due to toxins notably alcohol, other infections or from autoimmune process. It may run a subclinical course when the affected person may not feel ill. The patient becomes unwell and symptomatic when the disease impairs liver functions that include, among other things, removal of harmful substances, regulation of blood composition, and production of bile to help digestion. Contents 1 Causes 2 Signs and symptoms 3 Types of hepatitis 3.1 Viral 3.2 Other viral causes of hepatitis 3.3 Alcoholic hepatitis 3.4 Drug induced hepatitis 3.5 Other toxins that cause hepatitis 3.6 Metabolic disorders 3.7 Obstructive 3.8 Autoimmune 3.9 Alpha 1-antitrypsin deficiency 3.10 Non-alcoholic fatty liver disease 3.11 Ischemic hepatitis 4 See also 5 References 6 External links Causes Acute hepatitis Viral Hepatitis: Hepatitis A through E more than 95% of viral cause, Herpes simplex, Cytomegalovirus, Epstein-Barr, yellow fever virus, adenoviruses. Non viral infection: toxoplasma, Leptospira, Q fever,2 rocky mountain spotted fever3 Alcohol Toxins: Amanita toxin in mushrooms, carbon tetrachloride, asafetida Drugs: Paracetamol, amoxycillin, antituberculosis medicines, minocycline and many others see longer list below. Ischemic hepatitis circulatory insufficiency Pregnancy Auto immune conditions, e.g. Systemic Lupus Erythematosus SLE Metabolic diseases, e.g. Wilson's disease Chronic hepatitis Viral hepatitis: Hepatitis B with or without hepatitis D, hepatitis C Hepatitis A and E do not lead to chronic disease Autoimmune: Autoimmune hepatitis Alcohol Drugs: methyldopa, nitrofurantoin, isoniazid, ketoconazole Non-alcoholic steatohepatitis Hery: Wilson's disease, alpha 1-antitrypsin deficiency Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic hepatitis4 Signs and symptoms Acute hepatitis Clinically, the course of acute hepatitis varies widely from mild symptoms requiring no treatment to fulminant hepatic failure needing liver transplantation. Acute viral hepatitis is more likely to be asymptomatic in younger people. Symptomatic individuals may present after convalescent stage of 7 to 10 days, with the total illness lasting 2 to 6 weeks.4 Initial features are of nonspecific flu-like symptoms, common to almost all acute viral infections and may include malaise, muscle and joint aches, fever, nausea or vomiting, diarrhea, and headache. More specific symptoms, which can be present in acute hepatitis from any cause, are: profound loss of appetite, aversion to smoking among smokers, dark urine, yellowing of the eyes and skin i.e., jaundice and abdominal discomfort. Physical findings are usually minimal, apart from jaundice 33% and tender hepatomegaly 10%. There can be occasional lymphadenopathy 5% or splenomegaly 5%.5 Chronic Hepatitis Majority of patients will remain asymptomatic or mildly symptomatic, abnormal blood tests being the only manifestation. Features may be related to the extent of liver damage or the cause of hepatitis. Many experience return of symptoms related to acute hepatitis. Jaundice can be a late feature and may indicate extensive damage. Other features include abdominal fullness from enlarged liver or spleen, low grade fever and fluid retention ascites. Extensive damage and scarring of liver i.e., cirrhosis leads to weight loss, easy bruising and bleeding tendencies. Acne, abnormal menstruation, lung scarring, inflammation of the thyroid gland and kidneys may be present in women with autoimmune hepatitis.6 Findings on clinical examination are usually those of cirrhosis or are related to aetiology. Types of hepatitis Please see the respective articles for more detailed information. See also: Infectious canine hepatitis Viral Main article: viral hepatitis Most cases of acute hepatitis are due to viral infections: Hepatitis A Hepatitis B Hepatitis C Hepatitis B with D Hepatitis E Hepatitis F virus existence unknown Hepatitis G, or GBV-C In addition to the hepatitis viruses please note that the hepatitis viruses are not all related, other viruses can also cause hepatitis, including cytomegalovirus, Epstein-Barr virus, yellow fever, etc. Other viral causes of hepatitis Other viral infections can cause hepatitis inflammation of the liver: Mumps virus Rubella virus Cytomegalovirus Epstein-Barr virus Other herpes viruses Alcoholic hepatitis Main article: Alcoholic hepatitis Ethanol, mostly in alcoholic beverages, is a significant cause of hepatitis. Usually alcoholic hepatitis comes after a period of increased alcohol consumption. Alcoholic hepatitis is characterized by a variable constellation of symptoms, which may include feeling unwell, enlargement of the liver, development of fluid in the abdomen ascites, and modest elevation of liver blood tests. Alcoholic hepatitis can vary from mild with only liver test elevation to severe liver inflammation with development of jaundice, prolonged prothrombin time, and liver failure. Severe cases are characterized by either obtundation dulled consciousness or the combination of elevated bilirubin levels and prolonged prothrombin time; the mortality rate in both categories is 50% within 30 days of onset. Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption. Alcoholic hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis. Alcoholic hepatitis by itself does not lead to cirrhosis, but cirrhosis is more common in patients with long term alcohol consumption. Patients who drink alcohol to excess are also more often than others found to have hepatitis C.citation needed The combination of hepatitis C and alcohol consumption accelerates the development of cirrhosis. Drug induced hepatitis Main article: Hepatotoxicity A large number of drugs can cause hepatitis:7 Allopurinol Amitriptyline antidepressant Amiodarone antiarrhythmic Atomoxetine 8 Azathioprine9 Halothane a specific type of anesthetic gas Hormonal contraceptives Ibuprofen and indomethacin NSAIDs Isoniazid INH, rifampicin, and pyrazinamide tuberculosis-specific antibiotics Ketoconazole antifungal Loratadine antihistamine Methotrexate immune suppressant Methyldopa antihypertensive Minocycline tetracycline antibiotic Nifedipine antihypertensive Nitrofurantoin antibiotic Phenytoin and valproic acid antiepileptics Troglitazone antidiabetic, withdrawn in 2000 for causing hepatitis Zidovudine antiretroviral i.e. against HIV Some herbs and nutritional supplements10 The clinical course of drug-induced hepatitis is quite variable, depending on the drug and the patient's tendency to react to the drug. For example, halothane hepatitis can range from mild to fatal as can INH-induced hepatitis. Hormonal contraception can cause structural changes in the liver. Amiodarone hepatitis can be untreatable since the long half life of the drug up to 60 days means that there is no effective way to stop exposure to the drug. Statins can cause elevations of liver function blood tests normally without indicating an underlying hepatitis. Lastly, human variability is such that any drug can be a cause of hepatitis. Other toxins that cause hepatitis Toxins and drugs can cause hepatitis: Amatoxin-containing mushrooms, including the Death Cap Amanita phalloides, the Destroying Angel Amanita ocreata, and some species of Galerina. A portion of a single mushroom can be enough to be lethal 10 mg or less of α-amanitin. White phosphorus, an industrial toxin and war chemical. Paracetamol acetaminophen in the United States can cause hepatitis when taken in an overdose. The severity of liver damage may be limited by prompt administration of acetylcysteine. Carbon tetrachloride tetra, a dry cleaning agent, chloroform, and trichloroethylene, all chlorinated hydrocarbons, cause steatohepatitis hepatitis with fatty liver. Cylindrospermopsin, a toxin from the cyanobacterium Cylindrospermopsis raciborskii and other cyanobacteria. Metabolic disorders Some metabolic disorders cause different forms of hepatitis. Hemochromatosis due to iron accumulation and Wilson's disease copper accumulation can cause liver inflammation and necrosis. See below for non-alcoholic steatohepatitis NASH, effectively a consequence of metabolic syndrome. Obstructive Obstructive jaundice is the term used to describe jaundice due to obstruction of the bile duct by gallstones or external obstruction by cancer. If longstanding, it leads to destruction and inflammation of liver tissue. Autoimmune Main article: Autoimmune hepatitis Anomalous presentation of human leukocyte antigen HLA class II on the surface of hepatocytes, possibly due to genetic predisposition or acute liver infection; causes a cell-mediated immune response against the body's own liver, resulting in autoimmune hepatitis. Alpha 1-antitrypsin deficiency In severe cases of alpha 1-antitrypsin deficiency A1AD, the accumulated protein in the endoplasmic reticulum causes liver cell damage and inflammation. Non-alcoholic fatty liver disease Non-alcoholic fatty liver disease NAFLD is the occurrence of fatty liver in people who have no history of alcohol use. It is most commonly associated with obesity 80% of all obese people have fatty liver. It is more common in women. Severe NAFLD leads to inflammation, a state referred to as non-alcoholic steatohepatitis NASH, which on biopsy of the liver resembles alcoholic hepatitis with fat droplets and inflammatory cells, but usually no Mallory bodies. The diagnosis depends on medical history, physical exam, blood tests, radiological imaging and sometimes a liver biopsy. The initial evaluation to identify the presence of fatty infiltration of the liver is medical imaging, including such ultrasound, computed tomography CT, or magnetic resonance MRI. However, imaging cannot readily identify inflammation in the liver. Therefore, the differentiation between steatosis and NASH often requires a liver biopsy. It can also be difficult to distinguish NASH from alcoholic hepatitis when the patient has a history of alcohol consumption. Sometimes in such cases a trial of abstinence from alcohol along with follow-up blood tests and a repeated liver biopsy are required. NASH is becoming recognized as the most important cause of liver disease second only to hepatitis C in numbers of patients going on to cirrhosis.citation needed Ischemic hepatitis See also: Ischemic hepatitis Ischemic hepatitis is caused by decreased circulation to the liver cells. Usually this is due to decreased blood pressure or shock, leading to the equivalent term shock liver. Patients with ischemic hepatitis are usually very ill due to the underlying cause of shock. Rarely, ischemic hepatitis can be caused by local problems with the blood vessels that supply oxygen to the liver such as thrombosis, or clotting of the hepatic artery which partially supplies blood to liver cells. Blood testing of a person with ischemic hepatitis will show very high levels of transaminase enzymes AST and ALT, which may exceed 1000 U/L. The elevation in these blood tests is usually transient lasting 7 to 10 days. It is rare that liver function will be affected by ischemic hepatitis. See also World Hepatitis Day Hepatocellular carcinoma References ^ Online Etymology Dictionary 1 ^ Figure 7.12 Some causes of acute parenchymal damage, Parveen, M.D. Kumar or, Michael, M.d. Clark or. Clinical Medicine: with STUDENT CONSULT Access. Philadelphia, PA: W.B. Saunders Company. ISBN 0-7020-2763-4. ^ Scott Moses, MD, Acute Hepatitis causes, Family practice notebook.com ^ a b V.G. Bain and M. Ma, Acute Viral Hepatitis, Chapter 14, First principle of gastroenterology an online text book ^ Ryder S, Beckingham I 2001. ABC of diseases of liver, pancreas, and biliary system: Acute hepatitis. BMJ 322 7279: 151-153. doi:10.1136/bmj.322.7279.151. PMID 11159575. ^ Chronic hepatitis at Merck Manual of Diagnosis and Therapy Home ion ^ Hepatitis as a result of chemicals and drugs in English. HealthAtoZ. Retrieved on 2006-07-01. ^ Lim JR, Faught PR, Chalasani NP, Molleston JP 2006. Severe liver injury after initiating therapy with atomoxetine in two children. J. Pediatr. 148 6: 831-4. doi:10.1016/j.jpeds.2006.01.035. PMID 16769398. ^ Bastida G, Nos P, Aguas M, Beltrán B, RubÃn A, Dasà F, Ponce J 2005. Incidence, risk factors and clinical course of thiopurine-induced liver injury in patients with inflammatory bowel disease.. Aliment Pharmacol Ther 22 9: 775-82. doi:10.1111/j.1365-2036.2005.02636.x. PMID 16225485. ^ Nadir A, Reddy D, Van Thiel DH 2000. Cascara sagrada-induced intrahepatic cholestasis causing portal hypertension: case report and review of herbal hepatotoxicity. Am. J. Gastroenterol. 95 12: 3634-7. doi:10.1111/j.1572-0241.2000.03386.x. PMID 11151906. External links WHO fact sheet of hepatitis Viral Hepatitis at the Centers for Disease Control v d e Digestive system - Digestive disease - Gastroenterology primarily K20-K93, 530-579 Upper GI tract Esophagus Esophagitis Candidal - Boerhaave syndrome - UES Zenker's diverticulum - LES Barrett's esophagus, Mallory-Weiss syndrome - Esophageal motility disorder Nutcracker esophagus, Achalasia, Diffuse esophageal spasm, GERD - Esophageal stricture - Megaesophagus Stomach Gastritis Atrophic, Ménétrier's disease, Gastroenteritis - Peptic gastric ulcer/Dieulafoy's lesion - Dyspepsia - Pyloric stenosis - Achlorhydria - Gastroparesis - Gastroptosis - Portal hypertensive gastropathy - Gastric antral vascular ectasia - Gastric dumping syndrome - Gastric volvulus Intestinal/ enteropathy Small intestine/ duodenum/jejunum/ileum Enteritis Duodenitis, Jejunitis, Ileitis Peptic duodenal ulcer Malabsorption: Coeliac - Tropical sprue - Blind loop syndrome - Whipple's - Short bowel syndrome - Steatorrhea Large intestine appendix/colon Appendicitis - Colitis Pseudomembranous, Ulcerative, Ischemic Functional colonic disease IBS, Intestinal pseudoobstruction/Ogilvie syndrome Megacolon/Toxic megacolon - Diverticulitis/Diverticulosis Large and/or small Enterocolitis Necrotizing - IBD Crohn's disease vascular: Abdominal angina - Mesenteric ischemia - Angiodysplasia Bowel obstruction: Ileus - Intussusception - Volvulus - Fecal impaction Constipation - Diarrhea Rectum/anus Proctitis Radiation proctitis - Proctalgia fugax - Rectal prolapse - Anal fissure/Anal fistula - Anal abscess Accessory Liver Hepatitis Viral hepatitis, Autoimmune hepatitis, Alcoholic hepatitis - Cirrhosis PBC - Fatty liver NASH - vascular Hepatic veno-occlusive disease, Portal hypertension, Nutmeg liver - Alcoholic liver disease - Liver failure Hepatic encephalopathy, Acute liver failure - Liver abscess - Hepatorenal syndrome - Peliosis hepatis Gallbladder Cholecystitis - Gallstones/Cholecystolithiasis - Cholesterolosis - Rokitansky-Aschoff sinuses - Postcholecystectomy syndrome Bile duct/ other biliary tree Cholangitis PSC, Ascending - Cholestasis/Mirizzi's syndrome - Biliary fistula - Haemobilia - Gallstones/Cholelithiasis common bile duct Choledocholithiasis, Biliary dyskinesia Pancreatic Pancreatitis Acute, Chronic, Herary - Pancreatic pseudocyst - Exocrine pancreatic insufficiency - Pancreatic fistula Hernia Diaphragmatic: Congenital diaphragmatic - Hiatus Abdominal hernia: Inguinal Indirect, Direct - Umbilical - Incisional - Femoral Obturator hernia - Spigelian hernia Peritoneal Peritonitis Spontaneous bacterial peritonitis - Hemoperitoneum - Pneumoperitoneum GI bleeding Upper Hematemesis, Melena - Lower Hematochezia See also congenital, neoplasia v d e Inflammation Acute Plasma derived mediators Bradykinin - complement C3, C5a, MAC - coagulation Factor XII, Plasmin, Thrombin Cell derived mediators preformed: Lysosome granules - vasoactive amines Histamine, Serotonin synthesized on demand: cytokines IFN-γ, IL-8, TNF-α, IL-1 - eicosanoids Leukotriene B4, Prostaglandins - Nitric oxide - Kinins Chronic Macrophage - Epithelioid cell - Giant cell - Granuloma Processes Traditional: Rubor - Calor - Tumor - Dolor pain - Functio laesa Modern: Acute-phase reaction/Fever - Vasodilation - Increased vascular permeability - Exudate - Leukocyte extravasation - Chemotaxis Specific types Cardiovascular Endocarditis - Myocarditis - Pericarditis - Vasculitis Arteritis, Phlebitis Digestive mouth Stomatitis, Gingivitis, Gingivostomatitis, Glossitis, Tonsillitis, Sialadenitis/Parotitis - tract Esophagitis, Gastritis, Gastroenteritis, Enteritis, Colitis, Enterocolitis, Duodenitis, Ileitis, Caecitis, Appendicitis, Proctitis - accessory Hepatitis, Cholangitis, Cholecystitis, Pancreatitis - Peritonitis Musculoskeletal Arthritis - Dermatomyositis - soft tissue Myositis, Synovitis/Tenosynovitis, Bursitis, Enthesitis, Fasciitis, Capsulitis, Epicondylitis, Tendinitis, Panniculitis - Osteochondritis Osteitis, Chondritis Integumentary Dermatitis Folliculitis - Hidradenitis - Mastitis Nervous Encephalitis - Meningitis - Myelitis - Neuritis - Otitis - eye Dacryoadenitis, Scleritis, Keratitis, Choroiditis, Retinitis, Chorioretinitis, Blepharitis, Conjunctivitis, Iritis, Uveitis Respiratory upper Sinusitis, Rhinitis, Pharyngitis, Laryngitis - lower Tracheitis, Bronchitis, Bronchiolitis, Pneumonitis, Pleuritis Reproductive female: Oophoritis - Salpingitis - Endometritis - Parametritis - Cervicitis - Vaginitis - Vulvitis male: Orchitis - Epididymitis - Prostatitis - Balanitis - Balanoposthitis pregnancy/newborn: Chorioamnionitis - Omphalitis Urinary Nephritis Glomerulonephritis, Pyelonephritis - Ureteritis - Cystitis - Urethritis Retrieved from http://en..org/wiki/Hepatitis Categories: Gastroenterology | Hepatitis | InflammationsHidden categories: All articles with statements | Articles with statements since April 2008 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages العربية Bosanski БългарÑ?ки Català Česky Dansk Deutsch Ελληνικά Español Esperanto Euskara Ù?ارسی Français Galego í•œêµì–´ Hrvatski Bahasa Indonesia Ã?slenska Italiano עברית Latina Lietuvių Magyar МакедонÑ?ки Bahasa Melayu Nederlands 日本語 ‪Norsk bokmÃ¥l‬ Polski Português РуÑ?Ñ?кий Shqip Simple English СрпÑ?ки / Srpski Suomi Svenska ไทย Tagalog اردو ä¸æ–‡ This page was last modified on 22 August 2008, at 14:16
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