Acute Viral Hepatitis: Causes, Clinical Picture, Complications and Treatment

Acute viral hepatitis is inflammation of the liver parenchyma of less than 6 months duration caused by viruses.

Causes of acute viral hepatitis:

• Hepatotropic viruses: including A, B, non-A non-B (C, E) viruses, and Delta agent when combined with B viruses.
• Non-hepatotropic viruses: such as Epstein Barr virus (EBV), Herpes simplex, and cytomegalovirus (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, although it can go unnoticed, clinically it is a mild flu with anorexia (the patient does not even like the smell of food and if he were a smoker he would not tolerate the smell of cigarettes), Destiny: Resolution or you 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 disgust for cigarettes and pain in the right hypochondrium (anatomical site of the liver)
• icteric phase (2-4 weeks): there is some improvement in fever, malaise and headache but jaundice appears (jaundice: yellowing of the skin and mucous membranes), with jaundice there is dark urine and clayey stools.
• post icteric phase (convalescence): there is an improvement of the general condition gradually but the jaundice persists for some time, then after about 3-6 months the patient returns to his normal state.

Complications:

• Chronic hepatitis especially with hepatitis C.
• liver cirrhosis (loss of liver pattern with portal hypertension).
• Fulmination that rapidly develops into liver cell failure and hepatic encephalopathy (especially with hepatitis E infection during pregnancy).
• prolonged cholestasis (prolonged jaundice).
• a delay could occur.
• posthepatitis syndrome that is psychogenic.
• Hepatoma (liver cancer).
• Aplastic anemia, purpura.
• hives, arthritis and pancreatitis.
• glumerulonephritis.
• vasculitis
• polyneuropathy.

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 bed rest is not necessary, rest until the clinical normality of the patient.
2. Diet: high-carbohydrate diet, low-fat diet, and no protein restriction except with fulminant hepatitis.
3. steroids are contraindicated as they are of no benefit and may cause an exacerbation.
4. vitamins
5. antiemetics
6. immunoprophylaxis: vaccines and immunoglobulins.

Interferon therapy is not necessary in acute viral hepatitis, as it is a simple disease that can be cured by the immune system. Interferon has been used in some acute cases of hepatitis C with some success.