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Overview of Acute Viral Hepatitis

By

Sonal Kumar

, MD, MPH, Weill Cornell Medical College

Last full review/revision Jan 2021| Content last modified Jan 2021
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Acute viral hepatitis is inflammation of the liver caused by infection with one of the five hepatitis viruses. In most people, the inflammation begins suddenly and lasts only a few weeks.

  • Symptoms range from none to very severe.

  • Affected people may have a poor appetite, nausea, vomiting, fever, pain in the upper right part of the abdomen, and jaundice.

  • Doctors do blood tests to diagnose hepatitis and identify its cause.

  • Vaccines can prevent hepatitis A, B, and E (the hepatitis E vaccine is available only in China).

  • Usually, specific treatment is not needed.

Causes of Acute Viral Hepatitis

The hepatitis A virus is the most common cause of acute hepatitis, followed by the hepatitis B virus.

Engaging in certain activities, such as getting a tattoo or body piercing, sharing needles to inject drugs, or having several sex partners, increases the risk of developing hepatitis.

Symptoms of Acute Viral Hepatitis

Acute viral hepatitis can cause anything from a minor flu-like illness to fatal liver failure Liver Failure Liver failure is severe deterioration in liver function. Liver failure is caused by a disorder or substance that damages the liver. Most people have jaundice (yellow skin and eyes), feel tired... read more . Sometimes there are no symptoms. The severity of symptoms and speed of recovery vary considerably, depending on the particular virus and on the person's response to the infection. Hepatitis A and C often cause very mild symptoms or none at all and may be unnoticed. Hepatitis B and E are more likely to produce severe symptoms. Infection with both hepatitis B and D (called coinfection) may make the symptoms of hepatitis B even more severe.

Symptoms of acute viral hepatitis usually begin suddenly. They include

  • A poor appetite

  • A general feeling of illness (malaise)

  • Nausea and vomiting

  • Fever

  • Pain in the upper right part of the abdomen (where the liver is located)

In people who smoke, a distaste for cigarettes is a typical symptom. Occasionally, especially with hepatitis B, infected people develop joint pains and itchy red hives on the skin (wheals or urticaria Hives Hives are red, itchy, slightly elevated swellings. The swelling is caused by the release of chemicals (such as histamine) from mast cells in the skin, which cause fluid to leak out of small... read more Hives ).

Appetite usually returns about a week after symptoms begin.

Sometimes, after 3 to 10 days, the urine becomes dark, and stool becomes pale. Jaundice Jaundice in Adults In jaundice, the skin and whites of the eyes look yellow. Jaundice occurs when there is too much bilirubin (a yellow pigment) in the blood—a condition called hyperbilirubinemia. (See also Overview... read more Jaundice in Adults (a yellowish discoloration of the skin and whites of the eyes) may develop. It is sometimes accompanied by itching. These symptoms occur because the damaged liver cannot remove bilirubin from the blood as it normally does. Bilirubin is a yellow pigment produced when hemoglobin (the part of red blood cells that carries oxygen) is broken down as part of the normal process of recycling old or damaged red blood cells. Bilirubin then builds up in the blood and is deposited in the skin (making it look yellow and causing itching) and the whites of the eyes (making them look yellow). Bilirubin is normally secreted into the intestine as a component of bile (the greenish-yellow digestive fluid produced by the liver) and excreted in stool, giving stool its typical brown color. In people with hepatitis, stools are pale because bilirubin does not enter the intestine to be eliminated in stool. Instead bilirubin is eliminated in urine, making the urine dark.

The liver may be enlarged and tender.

Most of the initial symptoms (poor appetite, nausea, vomiting, and fever) usually disappear within a week, and people feel better even though the jaundice may worsen. The jaundice usually peaks in 1 to 2 weeks, then fades over 2 to 4 weeks. But it can sometimes take much longer to resolve completely.

Rarely, fulminant hepatitis develops. Fulminant hepatitis is severe hepatitis with signs of liver failure Liver Failure Liver failure is severe deterioration in liver function. Liver failure is caused by a disorder or substance that damages the liver. Most people have jaundice (yellow skin and eyes), feel tired... read more . Fulminant hepatitis can occur in people with hepatitis A, but it is more likely to develop in people with hepatitis B, particularly if they also have hepatitis D. It can also occur in people taking drugs that can damage the liver Liver Injury Caused by Drugs Many drugs can affect the way the liver functions, damage the liver, or do both. (See also Drugs and the Liver.) Some drugs, such as statins (used to treat high cholesterol), can increase the... read more , such as acetaminophen, or be caused by alcoholic hepatitis in people with a long history of heavy drinking Alcohol-Related Liver Disease Alcohol-related liver disease is liver damage caused by drinking too much alcohol for a long time. In general, the amount of alcohol consumed (how much, how often, and for how long) determines... read more Alcohol-Related Liver Disease . Fulminant hepatitis can progress very quickly, usually within days or weeks. The liver can no longer synthesize enough of the proteins that help blood clot. However, even though blood does not clot normally, people are not more likely to bruise or to bleed easily or without cause. The liver cannot remove toxic substances as it normally does. So these toxic substances build up in the blood and reach the brain, causing mental function to deteriorate quickly—called hepatic (portosystemic) encephalopathy Hepatic Encephalopathy Hepatic encephalopathy is deterioration of brain function that occurs in people with severe liver disease because toxic substances normally removed by the liver build up in the blood and reach... read more . People may lapse into a coma within days to weeks. Fulminant hepatitis may be fatal, especially in adults. Sometimes liver transplantation must be done immediately to save the person's life.

People with acute viral hepatitis usually recover in 4 to 8 weeks, even without treatment. However, some people infected with hepatitis B or C develop chronic infections.

Diagnosis of Acute Viral Hepatitis

  • Blood tests

Doctors suspect acute viral hepatitis based on symptoms. During the physical examination, a doctor presses on the abdomen above the liver, which is tender and somewhat enlarged in about half of the people with acute viral hepatitis.

Doctors suspect fulminant hepatitis if

  • People are very ill and develop jaundice very quickly.

  • Mental function quickly deteriorates.

  • Blood tests to determine how quickly blood clots—prothrombin time or international normalized ratio (INR)—are abnormal.

  • People who have liver disease start worsening rapidly.

Testing for acute viral hepatitis usually begins with blood tests to determine how well the liver is functioning and whether it is damaged (liver tests Liver Blood Tests Liver tests are blood tests that represent a noninvasive way to screen for the presence of liver disease (for example, hepatitis in donated blood) and to measure the severity and progress of... read more ). Liver tests involve measuring the levels of liver enzymes and other substances produced by the liver. These tests can indicate whether the liver is inflamed and often help doctors distinguish hepatitis due to alcohol abuse from that due to a virus.

To diagnosis fulminant hepatitis, doctors do liver tests to determine how quickly blood clots (because if people have fulminant hepatitis, blood does not clot normally).

If acute viral hepatitis seems likely, the cause is identified if possible. To help identify the cause, doctors usually do the following:

These blood tests can detect parts of specific viruses or specific antibodies produced by the body to fight the viruses. (​Antibodies Antibodies One of the body's lines of defense (immune system) involves white blood cells (leukocytes) that travel through the bloodstream and into tissues, searching for and attacking microorganisms and... read more Antibodies ​ are proteins produced by the immune system to help defend the body against attack by viruses and other foreign invaders.)

To determine whether the cause may be something other than a virus, the doctor may ask whether people take any drugs that can cause hepatitis (such as isoniazid, used to treat tuberculosis) and how much alcohol they drink.

Occasionally, if the diagnosis is unclear, a liver biopsy is done: A sample of liver tissue is removed with a needle and examined.

Prevention of Acute Viral Hepatitis

Because treatments for viral hepatitis are only partially effective, preventing viral hepatitis is very important.

Vaccines and immune globulin

Vaccines to prevent hepatitis A and hepatitis B are available in the United States. A vaccine for hepatitis E is currently available only in China. No vaccines against hepatitis C or D virus are available. However, vaccination against hepatitis B virus also reduces the risk of infection with hepatitis D virus. Hepatitis vaccines are given by injection into muscle.

As with most vaccines, protection requires allowing a number of weeks for the vaccine to reach its full effect as the immune system gradually creates antibodies against the particular virus.

If people who have not been vaccinated are exposed to hepatitis A virus, they are given a single dose of hepatitis A vaccine or an injection of standard immune globulin, depending on their age and health. Standard immune globulin contains antibodies obtained from blood collected from a large group of people who have a normal immune system. Immune globulin prevents infection or decreases its severity. However, the amount of protection it provides varies, and the protection is only temporary.

If people who have not been vaccinated are exposed to hepatitis B virus, they are given hepatitis B immune globulin and are vaccinated. Hepatitis B immune globulin contains antibodies obtained from the blood of people who have high levels of antibodies to hepatitis B. It is given by injection into a muscle or into a vein. This preparation helps the body fight the infection and prevents symptoms or decreases their severity, although it is unlikely to prevent infection.

Babies born to mothers with hepatitis B are given hepatitis B immune globulin (injected into a muscle) and hepatitis B vaccine.

Other preventive measures

Other preventive measures against infection with the hepatitis viruses can be taken:

  • Washing hands thoroughly before handling food

  • Not sharing needles to inject drugs

  • Not sharing toothbrushes, razors, or other items that could get blood on them

  • Practicing safe sex—for example, using barrier protection such as a condom

  • Limiting the number of sex partners

Donated blood is unlikely to be contaminated because it is screened. Nonetheless, doctors help reduce the risk of hepatitis by ordering blood transfusions only when essential. Before surgery, people can also sometimes prevent the need for transfusion of blood from an unknown donor by donating their own blood weeks before the operation.

Treatment of Acute Viral Hepatitis

  • Supportive care

For most people with acute viral hepatitis, special treatment is not necessary. However, people with severe acute hepatitis may require hospitalization so that symptoms can be treated. If doctors suspect that fulminant hepatitis is developing, the person is hospitalized so that mental status can be monitored, liver tests can be done, and doctors can determine whether liver transplantation is needed.

After the first several days, appetite usually returns and people do not need to stay in bed. Severe restrictions of diet or activity are unnecessary, and vitamin supplements are not required. Most people can safely return to work after the jaundice clears, even if their liver test results are not quite normal.

People with hepatitis should not drink alcohol until they have fully recovered.

The infected liver may not process (metabolize) drugs normally. So a doctor may need to stop a drug or reduce the dosage of a drug that could accumulate to harmful levels in the body (such as warfarin or theophylline). Thus, people with hepatitis should tell their doctor all the drugs they are taking (both prescription and nonprescription, including any medicinal herbs), so that the dosage of the drug can be adjusted if necessary.

If itching occurs, cholestyramine, taken by mouth, is often effective.

If hepatitis B causes fulminant hepatitis, people are usually treated in an intensive care unit. Antiviral drugs may help. However, liver transplantation Liver Transplantation Liver transplantation is the surgical removal of a healthy liver or sometimes a part of a liver from a living person and then its transfer into a person whose liver no longer functions. (See... read more is the most effective treatment and is the best hope of survival, particularly for adults.

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