FFinalistSouthampton · 2027
Gastroenterology
AKT · Gastroenterology/Liver

Viral hepatitis

Hepatotropic viruses A/B/C/D/E (± EBV/CMV)

Overview

Inflammation of the liver caused by hepatotropic viruses. A and E — faeco-oral, acute, self-limiting (E is dangerous in pregnancy). B and C — blood/sexual/vertical, can become CHRONIC (cirrhosis/HCC risk); D only co-infects with B. Presents with prodromal malaise, jaundice, RUQ pain and deranged LFTs (hepatitic: high ALT/AST). Diagnosed serologically; chronic B/C are treated with antivirals. (Hepatitis B is also carded on sexual health — cross-reference.)

Recognise

  • Prodrome (malaise, anorexia, nausea, myalgia) then jaundice, dark urine, pale stools, RUQ discomfort, hepatomegaly
  • Hepatitic LFTs: markedly raised ALT/AST (> ALP), raised bilirubin
  • Transmission: A/E faeco-oral (travel, shellfish; E zoonotic — severe in pregnancy); B/C/D blood-borne/sexual/vertical (chronicity → cirrhosis/HCC)

Red flags

  • Acute liver FAILURE (coagulopathy, encephalopathy) — fulminant hepatitis (esp. B, E in pregnancy) → specialist/transplant
  • Chronic hepatitis B/C → cirrhosis and hepatocellular carcinoma — surveillance and antivirals

Differentials & how to tell them apart

Alcoholic hepatitisAST:ALT >2, alcohol history, raised GGT
Autoimmune hepatitisyoung/middle-aged women, autoantibodies (ANA/anti-smooth-muscle), raised IgG
Drug-induced liver injuryparacetamol/drugs — history, pattern
Biliary obstructioncholestatic LFTs (ALP/bilirubin > ALT), dilated ducts on USS
Jaundice — scleral icterus (yellow sclerae) of liver disease

Jaundice — scleral icterus (yellow sclerae) of liver disease

Sheila J. Toro / CC BY 4.0 — Wikimedia Commons

Investigations

LFTs (hepatitic), clotting (INR — synthetic function). SEROLOGY: anti-HAV IgM; HBsAg/anti-HBc/HBeAg + HBV DNA; anti-HCV then HCV RNA; anti-HEV; HDV if HBsAg+. Liver USS; fibrosis assessment in chronic disease.

Management

Supportive for acute A/E; antivirals (DAAs for C; tenofovir/entecavir for chronic B)

  1. 1Confirm the virus serologically and assess severity (clotting/encephalopathy). Acute A/E: supportive, avoid hepatotoxins, public-health notification. Screen for and treat chronic B/C.Gate: Acute liver FAILURE (rising INR, encephalopathy) needs urgent specialist/transplant assessment; hepatitis E is dangerous in PREGNANCY; chronic B/C require HCC and cirrhosis surveillance
  2. 2Chronic hepatitis C → direct-acting antivirals (cure); chronic hepatitis B → tenofovir/entecavir + surveillance; vaccinate (A/B), trace contacts; manage cirrhosis/HCC. (Hepatitis B detail also on sexual health.)
Supportive (acute A/E) — self-limiting; avoid hepatotoxins/alcohol; notify public health; vaccinate contacts (A)
Antivirals for chronic B (tenofovir/entecavir) and C (direct-acting antivirals) — DAAs cure most hepatitis C; B is suppressed long-term
Hepatitis A and B vaccination — prevention (B vaccine for at-risk; A for travellers)

Key points

Hepatitic LFTs (ALT≫ALP) + jaundice + viral serology = viral hepatitis. A/E faeco-oral & acute (E = pregnancy danger); B/C chronic → cirrhosis/HCC. DAAs cure hepatitis C. Watch for fulminant failure.

Monitor & prognosis

LFTs/INR; chronic B/C surveillance (fibrosis, HCC).

A/E self-limiting; B/C risk chronic liver disease.

Source: BASHH/BHIVA (B/C); NICE; UKHSA