Acute Viral Hepatitis: Causes, Clinical Picture, Complications and Treatment
Acute viral hepatitis is the inflammation of the liver parenchyma for less than 6 months caused by viruses.
Causes of acute viral hepatitis:
- Hepatotropic viruses: which include virus A, B, non-A non-B (C, E), and Delta agent when it is combined with B virus.
- Non-hepatotropic viruses: Epstein Barr virus (EBV), Herpes simplex, and cytomegallo virus (CMV).
The clinical picture of Hepatotropic viral hepatitis (A, B, C, E, Delta + B):
It could be one of two types; Non-icteric hepatitis or icteric hepatitis as follows:
- Non-icteric hepatitis: it is a mild form of hepatitis, even it may pass unnoticed, clinically there is a mild Flu-like illness with anorexia (the patient doesn’t even like the smell of food and if he was a smoker he wouldn’t tolerate the smell of the cigarettes), Fate: Resolution or it could develop chronic hepatitis.
- Icteric hepatitis: has 3 phases (pre-icteric, icteric, and post icteric)
- Pre-icteric phase symptoms (about 1 week): Fever, Headache, malaise with marked anorexia and distaste for cigarettes, and pain right hypochondrium (anatomical site of the liver)
- Icteric phase (2-4 weeks): there is some improvement of fever, malaise, and headache but Jaundice appears (jaundice: Yellowish discoloration of the skin and mucous membrane), with jaundice there is dark urine and clay stool.
- Post-icteric phase (convalescence): there is the improvement of general condition gradually but jaundice persists for some time, then after about 3-6 months, the patient becomes in a normal condition.
- chronic hepatitis especially with hepatitis C.
- liver cirrhosis (loss of hepatic pattern with portal hypertension).
- Fulmination develops rapidly into liver cell failure and hepatic encephalopathy (especially with hepatitis E infection during pregnancy).
- prolonged cholestasis (prolonged jaundice).
- relapse could occur.
- post hepatitis syndrome which is psychogenic.
- Hepatoma (cancer of the liver).
- Aplastic anemia, purpura.
- urticaria, arthritis, and pancreatitis.
the last 5 points of complications are rare except with hepatitis B and C.
Treatment: (non-specific treatment)
- Rest: it is advisable, but strict confinement to bed is not necessary, rest until the patient becomes clinically normal.
- Diet: high carbohydrate diet, low-fat diet, and no restrictions for proteins except with fulminant hepatitis.
- steroids are contraindicated as they have no benefit and may lead to an exacerbation.
- immunoprophylaxis: vaccines and immunoglobulins.
No need for interferon therapy in Acute viral Hepatitis as it is a simple disease that can be cured by the immune system, Interferon has been used in some acute cases of hepatitis C with some success.