Makindo Medical Notes.com

Think infection, drugs and alcohol

About

• Multiple causes which result in liver cell necrosis and inflammation
• Some are short limited and reversible
• Some can proceed to Fulminant liver failure
• Some can convert to a chronic hepatitis

Clinical

• Wide spectrum of clinical findings
• Malaise, lethargy, Nausea, Vomiting
• Distaste for cigarettes (HBV)
• RUQ tenderness and liver enlargement
• Jaundice, Pale stools, Dark urine

Causes

• Viral Infections:
  • Hepatitis A Virus (HAV): Commonly transmitted through contaminated food or water. It is usually self-limiting and does not lead to chronic liver disease.
  • Hepatitis B Virus (HBV): Transmitted through blood, sexual contact, or from mother to child during birth. While many recover fully, some can develop chronic hepatitis B.
  • Hepatitis C Virus (HCV): Primarily spread through blood-to-blood contact. Although it often leads to chronic infection, acute hepatitis C can occur shortly after exposure.
  • Hepatitis D Virus (HDV): Requires HBV to replicate and is transmitted similarly. It can cause severe liver disease, especially when co-infection occurs.
  • Hepatitis E Virus (HEV): Typically spread through contaminated water, especially in developing countries. It is usually self-limiting but can be severe in pregnant women.
  • Other Viruses: Non-hepatitis viruses like Epstein-Barr virus (EBV) and cytomegalovirus (CMV) can also cause acute hepatitis.
• Medications and Toxins:
  • Drug-Induced Hepatitis: Certain medications, including paracetamol/acetaminophen (in high doses), antibiotics, and statins, can cause liver inflammation.
  • Alcohol: Acute alcohol-induced hepatitis can occur after heavy drinking.
  • Toxins: Exposure to certain chemicals or toxins can lead to acute liver injury.
• Autoimmune Hepatitis:
  • An immune system disorder in which the body attacks its own liver cells, causing acute inflammation.
• Other Causes:
  • Ischaemic Hepatitis: Caused by reduced blood flow to the liver, often due to heart failure or shock.
  • Metabolic Disorders: Conditions like Wilson's disease (excess copper) or haemochromatosis (excess iron) can lead to acute liver inflammation.

Investigations

• Liver Function Tests (LFTs): Elevated ALT, AST indicate liver inflammation. Bilirubin levels are also typically elevated. Prothrombin time, ↑ GGT - alcohol
• Viral Serologies: HAV, HBV, HCV, HDV, HEV and their antibodies.
• Autoimmune Markers: ANA, SMA, LKM1 can help diagnose autoimmune hepatitis.
• Toxicology Screening: If drug or toxin exposure is suspected, screening for specific substances may be necessary.
• Imaging: Ultrasound, CT scan, or MRI
• Liver Biopsy: a liver biopsy may be performed to determine the extent of inflammation and liver damage.

Management

• Viral Hepatitis: Most cases of acute viral hepatitis (A, B, E) do not require specific antiviral treatment and are managed with supportive care, such as rest, hydration, and nutrition. Antiviral medications may be used for acute hepatitis B or C in certain cases.
• Drug-Induced Hepatitis: The offending drug or toxin should be discontinued immediately, and supportive care should be provided. In cases of acetaminophen overdose, N-acetylcysteine is used as an antidote.
• Alcohol-Induced Hepatitis: Abstaining from alcohol and supportive care are essential. Severe cases may require corticosteroids or other medications.
• Autoimmune Hepatitis: Treatment usually involves corticosteroids (e.g., prednisone) and immunosuppressive drugs (e.g., azathioprine).
• Ischaemic Hepatitis: Treatment focuses on restoring adequate blood flow to the liver and addressing the underlying cause, such as heart failure.

Prognosis:

• Self-Limiting in Many Cases: Acute hepatitis, especially due to HAV or HEV, often resolves on its own with proper supportive care.
• Risk of Chronic Disease: Acute hepatitis B and C can lead to chronic infections in some individuals, which may result in long-term liver damage.
• Severe Cases: In cases of fulminant hepatitis (acute liver failure), the prognosis can be poor without prompt intervention, and liver transplantation may be required.