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Hepatitis
Classification and external resources
Alcoholic hepatitis evident by fatty change, cell necrosis, Mallory bodies ICD-10 ICD-9 DiseasesDB MeSH K75.9 573.3 20061 D006505
Hepatitis (plural hepatitides) is an inflammation of the liver characterized by the presence of inflammatory cells in the tissue of the organ. The name is from the Greek hepar (), the root being hepat- (-), meaning liver, and suffix -itis, meaning "inflammation" (c. 1727).[1] The condition can be self-limiting (healing on its own) or can progress to fibrosis (scarring) and cirrhosis. Hepatitis may occur with limited or no symptoms, but often leads to jaundice, anorexia (poor appetite) and malaise. Hepatitis is acute when it lasts less than six months and chronic when it persists longer. A group of viruses known as the hepatitis viruses cause most cases of hepatitis worldwide, but it can also be due to toxins (notably alcohol, certain medications and plants), other infections and autoimmune diseases.
Contents
[hide]
1 Signs and symptoms o 1.1 Acute o 1.2 Chronic 2 Causes o 2.1 Acute o 2.2 Chronic o 2.3 Alcoholic hepatitis o 2.4 Drug induced
2.5 Other toxins 2.6 Metabolic disorders 2.7 Obstructive 2.8 Autoimmune 2.9 Alpha 1-antitrypsin deficiency 2.10 Non-alcoholic fatty liver disease 2.11 Ischemic hepatitis 3 See also 4 References
o o o o o o o
5 External links
[edit] Chronic
Chronic hepatitis often leads nonspecific symptoms such as malaise, tiredness and weakness, and often leads to no symptoms at all. It is commonly identified on blood tests performed either for screening or to evaluate nonspecific symptoms. The occurrence of jaundice indicates advanced liver damage. On physical examination there may be enlargement of the liver.[4] Extensive damage and scarring of liver (i.e. cirrhosis) leads to weight loss, easy bruising and bleeding tendencies, peripheral edema (swelling of the legs) and accumulation of
ascites (fluid in the abdominal cavity). Eventually, cirrhosis may lead to various complications: esophageal varices (enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction). Acne, abnormal menstruation, lung scarring, inflammation of the thyroid gland and kidneys may be present in women with autoimmune hepatitis.[4]
[edit] Causes
[edit] Acute
Viral hepatitis: o Hepatitis A, B, C, D, and E. o Herpes simplex o Cytomegalovirus o Epstein-Barr o Yellow fever o adenoviruses Non viral infection o toxoplasma o Leptospira o Q fever[5] o rocky mountain spotted fever[6] Alcohol Toxins: Amanita toxin in mushrooms, carbon tetrachloride, asafetida Drugs: Paracetamol, amoxycillin, antituberculosis medicines, minocycline and many others (see longer list below). Ischemic hepatitis (circulatory insufficiency) Pregnancy Auto immune conditions, e.g., Systemic Lupus Erythematosus (SLE) Metabolic diseases, e.g., Wilson's disease
[edit] Chronic
Viral hepatitis: Hepatitis B with or without hepatitis D, hepatitis C (neither hepatitis A nor hepatitis E causes chronic hepatitis) Autoimmune o Autoimmune hepatitis Alcohol Drugs o methyldopa o nitrofurantoin o isoniazid o ketoconazole
Non-alcoholic steatohepatitis Heredity o Wilson's disease o alpha 1-antitrypsin deficiency Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic hepatitis[3]
Agomelatine (antidepressant) Allopurinol Amitriptyline (antidepressant) Amiodarone (antiarrhythmic) Atomoxetine [8] Azathioprine[9] Halothane (a specific type of anesthetic gas) Hormonal contraceptives Ibuprofen and indomethacin (NSAIDs) Isoniazid (INH), rifampicin, and pyrazinamide (tuberculosis-specific antibiotics) Ketoconazole (antifungal)
Loratadine (antihistamine) Methotrexate (immune suppressant) Methyldopa (antihypertensive) Minocycline (tetracycline antibiotic) Nifedipine (antihypertensive) Nitrofurantoin (antibiotic) Paracetamol (acetaminophen in the United States) can cause hepatitis when taken in an overdose. The severity of liver damage may be limited by prompt administration of acetylcysteine. Phenytoin and valproic acid (antiepileptics) Troglitazone (antidiabetic, withdrawn in 2000 for causing hepatitis) Zidovudine (antiretroviral i.e., against HIV) Some herbs and nutritional supplements[10]
The clinical course of drug-induced hepatitis is quite variable, depending on the drug and the patient's tendency to react to the drug. For example, halothane hepatitis can range from mild to fatal as can INH-induced hepatitis. Hormonal contraception can cause structural changes in the liver. Amiodarone hepatitis can be untreatable since the long half life of the drug (up to 60 days) means that there is no effective way to stop exposure to the drug. Statins can cause elevations of liver function blood tests normally without indicating an underlying hepatitis. Lastly, human variability is such that any drug can be a cause of hepatitis.
Amatoxin-containing mushrooms, including the Death Cap (Amanita phalloides), the Destroying Angel (Amanita ocreata), and some species of Galerina. A portion of a single mushroom can be enough to be lethal (10 mg or less of -amanitin). White phosphorus, an industrial toxin and war chemical. Carbon tetrachloride ("tetra", a dry cleaning agent), chloroform, and trichloroethylene, all chlorinated hydrocarbons, cause steatohepatitis (hepatitis with fatty liver). Cylindrospermopsin, a toxin from the cyanobacterium Cylindrospermopsis raciborskii and other cyanobacteria.
[edit] Obstructive
"Obstructive jaundice" is the term used to describe jaundice due to obstruction of the bile duct (by gallstones or external obstruction by cancer). If longstanding, it leads to destruction and inflammation of liver tissue.
[edit] Autoimmune
Anomalous presentation of human leukocyte antigen (HLA) class II on the surface of hepatocytes, possibly due to genetic predisposition or acute liver infection; causes a cellmediated immune response against the body's own liver, resulting in autoimmune hepatitis.
Patients with ischemic hepatitis are usually very ill due to the underlying cause of shock. Rarely, ischemic hepatitis can be caused by local problems with the blood vessels that supply oxygen to the liver (such as thrombosis, or clotting of the hepatic artery which partially supplies blood to liver cells). Blood testing of a person with ischemic hepatitis will show very high levels of transaminase enzymes (AST and ALT), which may exceed 1000 U/L. The elevation in these blood tests is usually transient (lasting 7 to 10 days). It is rare that liver function will be affected by ischemic hepatitis.
[edit] References
1. ^ Online Etymology Dictionary 2. ^ Ryder S, Beckingham I (2001). "ABC of diseases of liver, pancreas, and biliary system: Acute hepatitis". BMJ 322 (7279): 151153. doi:10.1136/bmj.322.7279.151. PMID 11159575.