Other causes of hepatitis

Viral hepatitis
HAV Significant cause of acute hepatitis especially in developing countries HBV Can cause acute hepatitis, and is also the most common cause of chronic hepatitis in Africa and Far East HCV Leading cause of chronic hepatitis in the developed world HDV needs HBV co-infection HEV Significant amongst pregnant females in developing countries. May be the most common form of acute hepatitis in some developed European countries

Some hepatitis memory aids

Transmission of Hep A and E is by fAEcael-oral Generally: A is for acute and C is for chronic The 4 Cs of state: Carrier state, Chronic disease, Cirrhosis, Carcinoma Physically handicapped friend danced crazily/happily
HAV: Picornavirus HBV: Hepadnavirus HCV: Flavivirus HDV: Deltavirus HEV: Calcivirus/Hepevirus

Hepatitis A
Most common cause of acute viral hepatitis and is particularly common among children and young adults In some countries, over 75% of adults have been exposed It spreads primarily by faecal-oral contact and thus may occur in areas of poor hygiene Contaminated raw shellfish can sometimes cause it Most infections in adults are symptomatic, whereas 70% of infections in children younger than 6 years are asymptomatic It does not cause chronic liver disease

Hepatitis A
The time from exposure to clinical manifestations of acute hepatitis A averages 30 days (range 15 to 50) Abrupt-onset fever, abdominal pain, malaise, jaundice Hepatomegaly and clinical jaundice Marked elevation of serum transaminases (usually >1000 units/L) Diagnosis: IgM anti-HAV serology Rx: Mainly supportive. Avoid paracetamol and ETOH. No specific anti-viral therapy
Fulminant course (<1%) warrants transplantation (more likely in adults and older adolescents. Look for worsening jaundice and encephalopathy) Vaccination is recommended for all people at risk for hepatitis A through travel, lifestyle or occupation

85% have full clinical and biochemical recovery within a 3-month period with nearly all individuals recovering within 6 months
10-20% develop a prolonged, relapsing course which can last several months

Hepatitis A

Non-infectious causes
Alcoholic liver disease
Fatty liver (steatosis), alcoholic hepatitis (inflammation and necrosis), and alcoholic liver cirrhosis All are caused by chronic heavy alcohol ingestion

Non-alcoholic fatty liver disease

Liver disease in those who do not consume alcohol in amounts generally considered harmful to the liver Leading theory: insulin resistance is the key mechanism leading to the accumulation of excessive triglyceride accumulation in the liver and subsequent development of hepatic steatosis

Non-infectious causes
Drug-related
Take your pick.... Paracetamol Isoniazid Antibiotics eg nitrofurantoin, penicillin, tetracycline NSAIDs MAOi Statins

Non-infectious causes
Autoimmune hepatitis
Characterised by the presence of circulating autoantibodies Occurs mainly in females Several subtypes Positive autoantibodies
Antinuclear antibody [ANA] Smooth muscle antibody [SMA] Antibody to liver-kidney microsomes type 1 [anti-LKM1]

Most need life-long prednisolone and azathioprine therapy

Non-infectious causes
Inherited Diseases
Wilsons disease
Disease of copper accumulation and toxicity Patients are usually aged 10 to 40 years and present with either hepatic disease or a neurological movement disorder Kayser-Fleischer rings, Parkinsonian-like tremor Decreased serum ceruloplasmin, increased copper excretion in urine

Alpha-1-antitrypsin deficiency
Variants of the enzyme may polymerise and accumulate in the liver, resulting in hepatic failure

Haemochromatosis
Disorder of inappropriately increased dietary iron absorption In the liver, iron accumulates in the periportal hepatocytes and can progress to cirrhosis

Bile duct obstruction may lead to hepatic inflammation and necrosis

References
eTG Best Practice Murtagh