Hepatitis is defined as inflammation of the liver, a vital organ responsible for detoxification, metabolism, and digestion. The most common causes of hepatitis include viral infections (A, B, C, D, E), excessive alcohol consumption, and hepatotoxic medications. Among these, viral hepatitis is the most widespread and remains a significant public health concern worldwide.
Each type of viral hepatitis differs in mode of transmission, clinical presentation, diagnostic markers, treatment, and prevention strategies. Understanding these differences is crucial for early detection, management, and prevention of liver damage.
What is Hepatitis?
The liver plays a central role in maintaining the body’s internal balance by metabolizing nutrients, producing bile, and detoxifying harmful substances. When the liver becomes inflamed, its normal functions are compromised, leading to a range of systemic symptoms.
Hepatitis may present as acute infection (short-term, self-limiting) or chronic infection (long-lasting, progressive liver damage). Chronic hepatitis significantly increases the risk of cirrhosis and liver cancer (hepatocellular carcinoma).
Causes of Hepatitis
Hepatitis can result from multiple causes, but the three most common categories are:
- Viral Hepatitis (A, B, C, D, E) – caused by hepatotropic viruses.
- Alcohol-induced Hepatitis – from prolonged excessive drinking.
- Drug/Toxin-induced Hepatitis – caused by hepatotoxic medications (e.g., acetaminophen overdose, chemotherapy drugs).
This article focuses on viral hepatitis, the most common and preventable type.
Types of Hepatitis (A, B, C, D, E)
Hepatitis A (HAV)
Nature: Acute only (does not become chronic).
Transmission: Fecal-oral route (contaminated food, water, poor hygiene).
Risk Groups: Travelers, people in crowded settings, areas with poor sanitation.
Symptoms: Flu-like illness, jaundice, nausea, abdominal pain.
Diagnosis: Anti-HAV IgM indicates active infection; IgG indicates past infection and immunity.
Treatment: Supportive therapy with rest, hydration, and nutrition.
Vaccine: Available and effective in prevention.
Hepatitis B (HBV)
Nature: Both acute and chronic.
Transmission: Blood and body fluids (unprotected sex, IV drug use, transfusion, childbirth).
Risk Groups: Healthcare workers, IV drug users, newborns of infected mothers.
Symptoms: GI upset, jaundice, dark urine, fatigue.
Diagnosis: HBsAg indicates active infection; Anti-HBs shows recovery or immunity.
Treatment:
- Acute: Supportive care.
- Chronic: Antiviral therapy (entecavir, tenofovir) to suppress viral replication.
Hepatitis C (HCV)
Nature: Both acute and chronic; most infections become chronic.
Transmission: Bloodborne (IV drug use is the most common route).
Symptoms: Often asymptomatic in early stages; may progress to chronic liver disease.
Diagnosis: Anti-HCV antibodies and HCV RNA detection.
Treatment: Direct-acting antivirals (DAAs) provide >95% cure rates.
Vaccine: None available.
Hepatitis D (HDV)
Nature: Requires hepatitis B for replication (cannot exist alone).
Transmission: Blood and body fluids, similar to HBV.
Complications: Superinfection with HBV worsens prognosis, leading to fulminant hepatitis and cirrhosis.
Diagnosis: Detection of HDV antigen or anti-HDV antibodies.
Treatment: Limited options; interferon-based therapies may be used.
Vaccine: No direct vaccine, but HBV vaccination prevents HDV infection.
Hepatitis E (HEV)
Nature: Acute only (usually self-limiting).
Transmission: Fecal-oral route (contaminated food, water, undercooked meats).
Risk Groups: Endemic in developing countries; severe in pregnant women.
Symptoms: Similar to HAV, with additional risk of fulminant hepatitis in pregnancy.
Diagnosis: Detection of anti-HEV antibodies.
Treatment: Supportive care (rest, hydration, nutrition).
Vaccine: Limited availability; not widely used.
Common Signs and Symptoms of Hepatitis
While symptoms vary across types, common clinical features include:
- Gastrointestinal upset (nausea, vomiting, abdominal pain, anorexia).
- Jaundice (yellowing of skin and eyes).
- Dark urine.
- Clay-colored stool.
- Fatigue and malaise.
- Flu-like symptoms.
Diagnostic Investigations
Diagnostic tools vary by hepatitis type but commonly include:
| Test | Interpretation |
|---|---|
| Liver Enzymes (ALT, AST) | Elevated in all types of hepatitis |
| Bilirubin | Increased in jaundice |
| Ammonia | Elevated in advanced cases (hepatic encephalopathy) |
| Anti-HAV IgM/IgG | Distinguishes active vs past HAV infection |
| HBsAg, Anti-HBs | Indicates HBV infection status and immunity |
| Anti-HCV, HCV RNA | Confirms HCV infection |
| HDAg, Anti-HDV | Identifies HDV infection |
| Anti-HEV | Indicates HEV infection |
Treatment Approaches
- Supportive Therapy: Rest, hydration, and nutritional support in acute hepatitis (A & E, and mild cases of B).
- Antivirals: Chronic HBV and HCV infections are treated with antiviral agents to suppress viral replication and prevent progression.
- Interferon Therapy: Occasionally used in chronic HCV and HDV infections.
- Liver Transplant: In cases of end-stage liver disease or liver failure due to hepatitis.
Prevention and Vaccination
- HAV Vaccine: Effective and recommended, especially for travelers and high-risk groups.
- HBV Vaccine: Universal vaccination protects against both HBV and HDV.
- HCV Vaccine: Not available; preventive strategies rely on avoiding exposure.
- HEV Vaccine: Available in limited regions; not widely accessible.
Preventive measures include:
- Practicing good hand hygiene.
- Avoiding unprotected sex with infected partners.
- Avoiding sharing of needles or personal hygiene products.
- Consuming safe, clean food and water.
- Limiting alcohol and hepatotoxic medications.
Patient Education for Hepatitis
Patients should be educated on:
- Rest and proper nutrition with small frequent meals.
- Diet modifications: low fat and protein, high carbohydrates and calories.
- Avoidance of alcohol, acetaminophen, and other hepatotoxic drugs.
- Safe practices to prevent transmission (no sharing personal items, safe sex).
- Avoiding sexual activity until hepatitis antibodies are negative.
Complications of Hepatitis
If left untreated, hepatitis can lead to:
- Acute liver failure.
- Chronic hepatitis (B, C, D).
- Cirrhosis and portal hypertension.
- Hepatocellular carcinoma.
- Fulminant hepatitis (especially in HEV during pregnancy).
Frequently Asked Questions (FAQ)
Q1. What is the most dangerous type of hepatitis?
Hepatitis B, C, and D are most dangerous due to their chronic nature and potential to cause cirrhosis and liver cancer.
Q2. Can hepatitis be completely cured?
HAV and HEV are self-limiting and curable. HCV can now be cured with direct-acting antivirals. HBV and HDV can only be suppressed, not eradicated.
Q3. How long can hepatitis viruses survive outside the body?
HAV can survive for weeks in the environment, while HBV is known to remain infectious for up to 7 days.
Q4. Why is hepatitis E dangerous during pregnancy?
Hepatitis E infection in pregnant women carries a high risk of fulminant liver failure and maternal mortality.
Q5. Can you get hepatitis from food?
Yes, HAV and HEV are spread via contaminated food and water.
Q6. Which vaccines are mandatory?
Hepatitis B vaccine is included in most childhood immunization programs. Hepatitis A vaccine is recommended in endemic regions.
