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:
- 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.
- 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)
- 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 it have no benefit and may lead to exacerbation.
- vitamins.
- antiemetics.
- 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.
