Hepatitis refers to inflammatory disorders of the liver. It can have varied presentations ranging from asymptomatic incidental detection to development of vomiting, loss of appetite, jaundice. It can be acute or chronic depending on whether the illness lasts for less than or more than six months. Acute hepatitis can be a self-limiting ailment with resolution over few weeks or months. However, in a subset of cases, it can progress to chronic hepatitis with long term risk of cirrhosis, liver failure, and liver cancer. Rarely, acute hepatitis can result in acute liver failure which can be life threatening.
Acute hepatitis is most commonly caused by hepatitis virus infection. In addition, autoimmune hepatitis, alcoholic liver disease, ischemic hepatitis, drugs, and toxin induced liver injury can also have an acute presentation. Acute viral hepatitis is characterized by three distinct phases :
- Prodromal phase – Nonspecific constitutional symptoms including anorexia, nausea, vomiting, fever, lethargy etc. mark the prodromal phase. Passage of dark coloured urine and clay coloured stool may be seen late in this phase. It can last up to 1-2 weeks.
- Icteric phase – It is characterized by resolution of prodromal features and development of yellowish discolouration of urine and eyes. Mild abdominal pain or discomfort in right upper quadrant of the abdomen or weight loss might be experienced by few patients. It can last up to 4 weeks.
- Recovery phase – Recovery from acute viral hepatitis depends on its etiology. Complete resolution of symptoms and laboratory abnormalities takes place in 4-8 weeks of hepatitis A and E. Resolution rates vary with the age of the patient in case of hepatitis B. Mo st of the cases are self-limiting in adults and resolve within 6 months. However, resolution rates are much lower with the development of chronic hepatitis in children. Hepatitis C develops chronicity in most of the cases.
Cases of acute hepatitis persisting beyond 6 months result in chronic hepatitis. These patients often remain asymptomatic and are incidentally detected on evaluation for other reasons or non specific symptoms. Patients with hepatitis B and autoimmune hepatitis can have intermittent flares with development of jaundice and other complications. Chronic hepatitis can progress to cirrhosis and liver cancer. Patients with cirrhosis can present with various complications including jaundice, ascites, gastrointestinal bleeding, hepatic encephalopathy, kidney failure etc. These patients are prone to infections and often develop infections of chest, urinary tract, ascitic fluid, skin and soft tissues.
Fulminant hepatitis or acute liver failure is an uncommon and life threatening complication of acute hepatitis, often seen in patients with hepatitis B, E and A. It can also develop in patients with autoimmune hepatitis, Wilson’s disease, drug and toxin induced hepatitis. The patients present with altered sensorium and coagulopathy, often associated with jaundice. It is more common in cases with hepatitis B and D coinfection and in pregnant patients with hepatitis E. The disease carries a high risk of mortality in absence of adequate treatment.