# Hepatitis --- **Hepatitis** is the inflammation of the [[liver]]. The causes can be viral or non-viral, and it can range in severity as well as being acute or chronic (or sometimes even both). ## Non-Viral Hepatitis Non-viral hepatitis can be caused by [[alcohol]], hepatotoxic meds or drugs ([[acetaminophen|Tylenol]] being the big one), or toxins. **Alcohol-related hepatitis** is a result of repeated binge drinking. One night of getting blackout is not going to do it, but if you're getting blackout every weekend for a while you're going to have a bad time. In the beginning stages fat deposits start to accumulate in the liver, which eventually leads to inflammation. Over time, repeated inflammation can lead to scarring of the liver, or fibrosis. Before the fibrosis gets to bad, abstinence from alcohol can lead to healing of the liver tissue, but once scarring happens the damage is irreversible. If an individual continues to drink after this point, it will eventually (in a couple years) lead to [[cirrhosis]], which is really the point of no return in terms of liver failure. ![[alcohol-related hepatitis.png]] ## Viral Hepatitis **Viral hepatitis** is caused by a [[animal virus|viral]] infection that goes to the liver to replicate, leading to inflammation and damage to the hepatocytes. The hepatitis we have identified are identified by the letters A, B, C, D, E and G. Although they share some characteristics, they do have distinct features. - **Hepatitis A** is transmitted primarily by the oral–fecal route. - [[vaccine]] preventable - people at risk are people experiencing homelessness or traveling - **Hepatitis B** is a quite contagious [[bloodborne pathogens|bloodborne pathogen]], that's 100x more contagious than HIV. - [[vaccine]] preventable - hep B is frequently spread by sexual contact or by blood transfer - healthcare workers are at high risk in the context of accidental needle-sticks - there is a high risk for complications like [[cirrhosis]] - treatment includes **alpha-interferon** - once-weekly SC injections for 4 months, and it's expensive - **Hepatitis C** is the most common [[bloodborne pathogens|bloodborne pathogen]] in the US, and the leading cause of [[organ transplant|liver transplant]]. - there is no vaccine, but there are many [[antivirals|medications]] available to treat it, and 95% of cases are curable - **alpha-interferon** is a big one - **ledipasvir-sofosbuvir** (brand name: **Harvoni**) - ledipasvir inhibits NS5A, a protein required for viral replication. - Sofosbuvir inhibits RNA-dependent RNA polymerase, resulting in inhibition of viral replication. - infection with hep C increases the risk of a person developing [[liver cancer|hepatic cancer]] - signs and symptoms are vague. - at risk populations are IV drug users - **Hepatitis E** is similar to hep A. - **Hepatitis G** is similar to hep C. ### Progression of Viral Hepatitis There are three stages of acute viral hepatitis, preicteric (or prodromal), icteric (meaning [[jaundice]]), and convalescent. * The **preicteric** phase is pretty vague and variable, commonly characterized by feelings of "meh", or flu-like symptoms. * GI symptoms like nausea, vomiting, diarrhea * body aches, malaise * Right upper quadrant pain * This is the key finding, and the one thing that can distinguish hepatitis from the flu. - The **icteric** phase occurs 5-10 days after the first signs and symptoms of hepatitis appear. As the name suggests, [[jaundice]] appears, as well as inflammation or enlargement of the liver, called **hepatomegaly**. - The **convalescent** phase occurs several weeks to months after onset. Jaundice diminishes and liver enzymes return to normal. Pain decreases and energy returns. ___