Cause |
Clinical Presentation |
Investigations |
Treatment |
Chronic Hepatitis B |
Fatigue, jaundice, anorexia, arthralgia, potential progression to cirrhosis or hepatocellular carcinoma. |
HBsAg, HBeAg, HBV DNA, liver function tests (LFTs), liver biopsy or transient elastography (FibroScan) for fibrosis assessment. |
Antiviral therapy (e.g., tenofovir, entecavir), regular monitoring for liver disease progression, and liver transplantation in end-stage liver disease. |
Chronic Hepatitis C |
Often asymptomatic initially, may progress to fatigue, jaundice, cirrhosis, and hepatocellular carcinoma. |
Anti-HCV antibodies, HCV RNA PCR, LFTs, liver biopsy or transient elastography, genotyping of HCV. |
Direct-acting antivirals (DAAs) tailored to HCV genotype, monitoring for treatment response, and management of liver complications. |
Autoimmune Hepatitis |
Fatigue, jaundice, arthralgia, hepatomegaly, may present with acute liver failure. |
Autoantibodies (ANA, SMA, LKM1), immunoglobulins (IgG), LFTs, liver biopsy for histological confirmation. |
Corticosteroids (e.g., prednisolone), immunosuppressants (e.g., azathioprine), and monitoring for relapse or progression to cirrhosis. |
Alcoholic Hepatitis |
Jaundice, hepatomegaly, ascites, and signs of chronic liver disease in heavy alcohol users. |
LFTs (elevated AST:ALT ratio), serum bilirubin, liver biopsy if diagnosis unclear, assessment for alcohol use disorder. |
Abstinence from alcohol, nutritional support, corticosteroids in severe cases, liver transplantation in advanced disease. |
Non-Alcoholic Fatty Liver Disease (NAFLD) |
Usually asymptomatic, can progress to non-alcoholic steatohepatitis (NASH) with fatigue, hepatomegaly, and cirrhosis. |
LFTs, ultrasound, liver biopsy or transient elastography, assessment for metabolic syndrome components. |
Lifestyle modifications (weight loss, exercise), management of comorbidities (e.g., diabetes, dyslipidemia), potential use of vitamin E or pioglitazone in selected cases. |
Drug-Induced Hepatitis |
Jaundice, fatigue, nausea, potentially asymptomatic; related to medication use (e.g., acetaminophen, isoniazid). |
History of drug use, LFTs, exclusion of other causes of hepatitis, liver biopsy if necessary. |
Discontinuation of the offending drug, supportive care, monitoring for liver recovery, and avoidance of hepatotoxic drugs in the future. |
Wilson's Disease |
Hepatic symptoms (jaundice, hepatomegaly), neurological symptoms (tremor, dysarthria), psychiatric disturbances. |
Serum ceruloplasmin, 24-hour urinary copper, liver biopsy with copper quantification, genetic testing for ATP7B mutation. |
Copper-chelating agents (e.g., penicillamine), zinc therapy, liver transplantation in cases of liver failure. |
Haemochromatosis |
Fatigue, arthralgia, hepatomegaly, skin pigmentation ("bronze diabetes"), diabetes, cardiomyopathy. |
Serum ferritin, transferrin saturation, genetic testing for HFE mutation, liver biopsy for iron quantification if diagnosis unclear. |
Phlebotomy to reduce iron levels, chelation therapy (e.g., deferoxamine) if phlebotomy is contraindicated, management of complications (e.g., diabetes). |