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 includes virus A, B, non A non B (C, E) and Delta agent when it is combined with B virus.


• Non hepatotropic viruses: as Epstein Barr virus (EBV), Herpes simplex and cytomegallo virus (CMV).

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:

1. 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 ciggartes smell), Fate: Resolution or it could develop chronic hepatitis.


2. 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 improvement of general condition gradually but jaundice persists for some time, then after about 3-6 months the patient become in a normal condition.

Complications:

• chronic hepatitis specially with hepatitis C.


• liver cirrhosis (loss of hepatic pattern with portal hypertension).


• Fulmination which develops rapidly into liver cell failure and hepatic encephalopathy (specially with hepatitis E infection during pregnancy).


• prolonged cholestasis (prolonged jaundice).


• relapse could occur.


• post hepatitis syndrome which is psychogenic.


• Hepatoma (cancer of liver).


• Aplastic anemia, purpura.


• urticaria, arthritis and pancreatitis.


• glumerulonephritis.


• vasculitis.


• ployneuropathy.

the last 5 points of complications are rare except with hepatitis B and C.

Treatment: (non specific treatment)

1. Rest: it is advisable, but strict confinement to bed is not necessary, rest until the patient becomes clinically normal.


2. Diet: high carbohydrate diet, low fat diet and no restrictions for proteins except with fulminant hepatitis.


3. steroids are contraindicated as it have no benefit and may lead to exacerbation.


4. vitamins.


5. antiemetics.


6. immunoprophylaxis: vaccines and immunoglobulins.

No need for interferon therapy in Acute viral Hepatitis as it is a simple disease that can be cured by immune system, Interferon has been used in some acute cases of hepatitis C with some success.