Hepatitis | Anatomy2Medicine
Hepatitis Causes

Hepatitis

    • Viral Hepatitis
      • Acute viral hepatitis is characterized by  (MCQ)
  • Jaundice
        • dramatically elevated AST and ALT
  • Chronic viral hepatitis requires symptoms persisting for longer than 6 months. (MCQ)
  • Hepatitis A virus (HAV) (MCQ)
        • spread through fecal-oral transmission.
  • It usually affects children and adolescents.
  • Serology demonstrates acute antibodies (IgM anti-HAV).
        • It is a self-limiting acute disease.
  • Hepatitis B virus (HBV) (MCQ)
        • a DNA virus. (MCQ)
        • The complete virion is known as the Dane particle. (MCQ)
  • Transmission may be through the blood and bodily fluids.
        • Vertical transmission (maternal-fetal) is common (90%).
        • incubation period averages 6–8 weeks. (MCQ)
        • causes acute hepatitis with resolution (> 90%).(MCQ)
        • cause chronic hepatitis, cirrhosis (5%), and cancer.
        • Fulminant hepatitis with extensive necrosis may occur (< 1%). (MCQ)
        • HBV causes characteristic ground-glass hepatocytes (MCQ)
        • Diagnosis is made by serology.
  • HBsAg (surface antigen) (MCQ)
            • provides the first evidence of infection
  • appears in the serum before symptoms.
  • HBcAg (core antigen) (MCQ)
            • may be the only evidence of infection during the “window period” between the disappearance of HBsAg and the detectability of anti-HBs.
  • HBsAB (hepatitis B surface antibody)  (MCQ)
            • does not rise until the acute infection is over
            • it represents recovery
            • it is detectable for years following vaccination. (MCQ)
      • Hepatitis C virus (HCV)
        • a RNA virus. (MCQ)
        • Transmission is primarily through the blood.
        • It was the cause of nearly all transfusion-related hepatitis
        • The incubation period is typically 6–12 weeks.
  • Most patients have only mild symptoms with waxing and waning liver enzyme levels. (MCQ)
        • Chronic disease develops in most patients with a significantly increased risk of cirrhosis and hepatocellular carcinoma (HCC). (MCQ)
        • Diagnosis is confirmed by detecting HCV by
  • reverse transcription–polymerase chain reaction (RT-PCR) (MCQ)
          • immunoassay for serum anti-HCV antibody. (MCQ)
  • Disease is monitored using liver function tests and serial liver needle core biopsies to score for grade of inflammation and stage of fibrosis, culminating in cirrhosis.
  • macronodular cirrhosis
          • defined as nodules larger than 3 mm, (MCQ)
          • Viral hepatitis classically causes
          • this pattern may also be seen in (MCQ)
            • Wilson disease
  • Alpha1-antitrypsin deficiency.
  • Chronic disease occurs in 85% of patients. (MCQ)
  • The leading cause is injection drug use.
        • Cirrhosis will develop in 20% of patients within 20 years.
      • Hepatitis D virus (HDV, delta agent)
        • can only infect hepatocytes in association with infection by HBV. (MCQ)
  • Viral replication is completely dependent on the HBsAg.
        • Coinfection of HDV and HBV (MCQ)
          • results in a more severe illness than HBV alone,
          • up to 5% of patients having fulminant disease (vs 1%).
        • Superinfection (HDV infection of a hepatitis B carrier)  (MCQ)
          • has an even higher rate of chronic progressive disease (80% vs 5%).
  • Hepatitis E virus (HEV)
        • an enterically transmitted infection
        • responsible for water-borne epidemics in equatorial regions. (MCQ)
        • The disease is usually self-limited. (MCQ)
  • In pregnant women, it is associated with a high mortality rate (20%).(MCQ)
    • Other causes of viral hepatitis
  • Epstein-Barr virus
  • Cytomegalovirus and herpes simplex virus type-1 may cause hepatitis in immunocompromised patients. (MCQ)
        • Adenovirus is an enteric virus
  • Fulminant hepatitis
        • There is rapid progression of acute liver failure.
        • More than 50% of cases are caused by viral hepatitis.
  • Other causes include acetaminophen, isoniazid, monoamine oxidase inhibitors, halothane, methyldopa, and mushroom toxins (eg, Amanita phalloides). (MCQ)
        • It is characterized by massive liver necrosis,causing jaundice and mental status changes without signs of chronic liver disease.
      • Autoimmune Hepatitis
  • It mostly affects young women with HLA-B8 or HLA-DRw3. (MCQ)
  • Histology shows chronic hepatitis with an infiltrate of lymphocytes and plasma cells. (MCQ)
        • Serologic diagnosis is based on
          • absent viral serologic markers
          • elevated titers for
  • antinuclear antibody (ANA)
  • anti-smooth muscle antibody (SMA)
  • anti-liver/kidney microsome (anti-LKM1) (MCQ)
      • Drug-Induced Liver Damage
        • Most important causes
  • alcohol (ethanol)
  • acetaminophen
  • salicylates.
  • Alcohol (ethanol) abuse
  • Hepatic steatosis
            • begins as tiny fat droplets (microvesicular steatosis)
            • progresses to large globules that fill the cytoplasm that displaces the nucleus (macrovesicular). (MCQ)
            • Steatosis is reversible. (MCQ)
            • Steatosis may progress to hepatitis and cirrhosis.
  • Alcoholic hepatitis
            • may present acutely, especially following excessive alcohol intake.
            • Biopsy reveals
  • ballooning degeneration of swollen hepatocytes (MCQ)
  • protein tangles (Mallory bodies) (MCQ)
  • cell necrosis (acidophil bodies) (MCQ)
  • steatosis, and inflammation (MCQ)
  • Alcoholic cirrhosis
            • irreversible end-stage form of alcoholic liver disease.
          • Alcohol abuse is a leading cause of cirrhosis.
  • Classically, alcohol causes micronodular cirrhosis (regenerative nodules are less than 3 mm in size). (MCQ)
  • Biopsy reveals nodular hepatocyte regeneration surrounded by bridging bands of fibrosis (MCQ)
  • Patients present with the stigmata of chronic liver disease, or compli- cations of portal hypertension.
            • There is also an increased risk of HCC.
  • However, most patients die of hepatic failure, variceal bleeding, or infection.
  • Nonalcoholic steatohepatitis (NASH)
          • clinically and histologically similar to alcoholic liver disease
          • occurs without heavy alcohol consumption
          • NASH is associated with obesity, dyslipidemia, and diabetes. (MCQ)
  • Reye syndrome
            • Aspirin treatment of children with a viral illness
  • Leads to potentially fatal, acute mitochondrial disorder(MCQ)
          • involves the liver and brain.
  • Fatty liver of pregnancy

Acute fatty liver of pregnancy presents in the third trimester. (MCQ)

  • Symptoms range from mildly elevated liver function tests to fulminant hepatitis.
          • Mechanism :  defective mitochondrial fatty acid oxidation, leading to steatosis. (MCQ)
        • Hereditary hemochromatosis
          • inherited disorder of iron absorption and accumulation,
          • causes cirrhosis, diabetes, and heart disease
        • Wilson disease
          • autosomal recessive disorder of copper accumulation(MCQ)
          • presents in adolescents and young adults.
          • Copper deposits in the liver, eye, brain, and kidney.
          • Liver findings range from chronic hepatitis to cirrhosis.
          • Kayser-Fleischer rings
            • circumferential copper deposits at the periphery of the cornea. (MCQ)
          • Involvement of the lenticular nucleus of the putamen, a portion of the basal ganglia, causes a movement disorder.
          • Dementia and psychosis may develop. (MCQ)
  • Serum studies show decreased levels of the copper-binding protein, ceruloplasmin. (MCQ)
        • Alpha 1-Antitrypsin (A1AT) deficiency
          • causes pan-lobular pulmonary emphysema and chronic liver disease.
          • The A1AT gene
            • located on chromosome 14(MCQ)
            • The most severe disease is associated with PiZ homozygotes. (MCQ)
          • Alpha 1-Antitrypsin deficiency is the most common chronic liver disease in children. (MCQ)
  • Cholestasis is present in infancy, with 75% of patients having an elevated ALT. (MCQ)
        • Symptoms and liver function tests usually resolve by adolescence, before a second peak in late adulthood.
        • Late complications include
          • cirrhosis, which develops in 15–20% of those over age 50
          • increased risk of HCC. (MCQ)
        • Liver biopsy reveals red cytoplasmic globules of A1AT highlighted by pe- riodic acid-Schiff (PAS) stain (MCQ)
        • Diagnosis can be confirmed by low serum A1AT levels.