Summary

Acute hepatitis is inflammation of the liver that develops suddenly, usually over days to weeks. Think of your liver as a factory that processes everything you eat and drink—when it becomes inflamed, it can't do its job properly, leading to a buildup of waste products (causing jaundice—yellow skin and eyes) and potentially life-threatening complications. The most common causes are viruses (hepatitis A, B, C, D, E), but it can also be caused by medications, alcohol, autoimmune conditions, or other toxins. This condition affects millions globally each year, with most cases being mild and self-limiting, but some progress to acute liver failure (mortality 20-50%) or chronic liver disease. The key to management is identifying the cause (viral serology, medication history, alcohol history), supportive care (rest, avoid alcohol/medications that harm liver), and specific treatments when available (antivirals for hepatitis B, sometimes for C). Most people recover completely, but some develop chronic hepatitis or acute liver failure.

Key Facts

• Definition: Acute inflammation of the liver, usually viral but can be other causes
• Incidence: Millions of cases/year globally; varies by region and cause
• Mortality: <1% overall; 20-50% if progresses to acute liver failure
• Peak age: Varies by cause (hepatitis A: children/young adults; B/C: adults)
• Critical feature: Jaundice + elevated liver enzymes
• Key investigation: Liver function tests (ALT, AST, bilirubin), viral serology, medication history
• First-line treatment: Supportive care, identify and treat cause, avoid hepatotoxins

Clinical Pearls

"Jaundice + elevated ALT = Hepatitis" — Yellow skin/eyes (jaundice) plus very high liver enzymes (ALT often >1000) is the classic presentation. The pattern of enzymes and other tests helps identify the cause.

"Most viral hepatitis is self-limiting" — Hepatitis A and E usually resolve completely on their own. Hepatitis B and C can become chronic. Supportive care is usually all that's needed for acute cases.

"Medications can cause hepatitis" — Always ask about medications (prescription, OTC, herbal). Many drugs can cause hepatitis. Stopping the offending drug is often the treatment.

"Acute liver failure is the fear" — Most hepatitis is mild, but some progress to acute liver failure (confusion, bleeding, jaundice). This needs urgent specialist care, may need transplant.

Why This Matters Clinically

Acute hepatitis is common and usually self-limiting, but can progress to acute liver failure (life-threatening) or chronic liver disease (long-term problems). Early recognition allows for appropriate management (supportive care, identify cause, avoid further liver damage) and can prevent complications. Delayed recognition or inappropriate management (like continuing hepatotoxic medications) can worsen outcomes. Most cases resolve completely, but some require specialist care and monitoring.

Structured Approach: ABCDE

A - Airway

• Assessment: Usually patent
• Action: Secure if compromised

B - Breathing

• Look: Usually normal (unless complications)
• Listen: Usually normal
• Measure: SpO2 (usually normal)
• Action: Support if needed

C - Circulation

• Look: Jaundice (yellow skin), may have spider naevi
• Feel: Pulse (usually normal), BP (usually normal)
• Listen: Heart sounds (usually normal)
• Measure: BP (usually normal), HR
• Action: Monitor if severe

D - Disability

• Assessment: GCS, mental status
• Finding: May be confused if liver failure
• Action: Check for encephalopathy (liver failure)

E - Exposure

• Look: Full body examination, look for:
  • Jaundice: Yellow skin, yellow eyes
  • Spider naevi: If chronic component
  • Ascites: If severe
  • Bruising: If clotting problems
• Feel: Abdomen (liver size, tenderness)
• Action: Complete examination

Specific Examination Findings

Jaundice Assessment:

• Skin: Yellow discoloration
• Sclera: Yellow eyes (most reliable early sign)
• Mucous membranes: May be yellow

Abdominal Examination:

• Inspection: May see distension (if ascites)
• Palpation:
  • Liver: Enlarged, tender
  • Spleen: May be enlarged (viral)
• Percussion: May show hepatomegaly, ascites
• Auscultation: Usually normal

Signs of Chronic Liver Disease (If Present):

• Spider naevi: Small blood vessels on skin
• Palmar erythema: Red palms
• Ascites: Fluid in abdomen
• Hepatosplenomegaly: Enlarged liver and spleen

Signs of Acute Liver Failure (If Severe):

• Confusion: Hepatic encephalopathy
• Bruising/bleeding: Coagulopathy
• Ascites: May have
• Hypotension: If severe

Special Tests

Natural History (Without Treatment)

Untreated Acute Hepatitis:

• Most cases: Resolve spontaneously (weeks to months)
• Some cases: Become chronic (B, C)
• Rare cases: Progress to acute liver failure (mortality 20-50%)

Outcomes with Treatment

Factors Affecting Outcomes:

Good Prognosis:

• Hepatitis A/E: Usually complete recovery
• Young, healthy: Better recovery
• Early recognition: Better outcomes
• No complications: No liver failure

Poor Prognosis:

• Acute liver failure: High mortality
• Elderly, comorbidities: Worse outcomes
• Alcoholic hepatitis: May be severe
• Chronic progression: B/C can become chronic

Prognostic Factors

Key Guidelines

1. EASL Guidelines (2017) — Hepatitis B and C. European Association for the Study of the Liver

Key Recommendations:

• Supportive care for acute hepatitis
• Antivirals for chronic B/C
• Vaccination for prevention
• Evidence Level: 1A

2. AASLD Guidelines (2018) — Hepatitis B and C. American Association for the Study of Liver Diseases

Key Recommendations:

• Supportive care primary
• Antivirals if indicated
• Evidence Level: 1A

Landmark Trials

Multiple studies on viral hepatitis treatment and management.

Evidence Strength

What is Acute Hepatitis?

Acute hepatitis is sudden inflammation of your liver. Think of your liver as a factory that processes everything you eat and drink—when it becomes inflamed, it can't work properly, leading to a buildup of waste products that make your skin and eyes turn yellow (jaundice). The most common causes are viruses (like hepatitis A, B, or C), but it can also be caused by medications, alcohol, or your immune system attacking your liver.

In simple terms: Your liver suddenly becomes inflamed and stops working properly, causing you to turn yellow and feel unwell. Most people recover completely, but some cases can be serious.

Why does it matter?

Most cases of acute hepatitis are mild and resolve completely on their own. However, some can progress to acute liver failure (life-threatening) or become chronic (long-term problems). The good news? With proper care, most people recover completely. Early recognition and treatment can prevent complications.

Think of it like this: It's like your liver getting a bad case of the flu—it stops working properly for a while, but usually recovers completely with rest and care.

How is it treated?

1. Supportive Care (Most Important):

• Rest: Your liver needs to rest while it heals
• Stop alcohol: This is mandatory—alcohol harms your liver
• Stop harmful medications: If a medication caused it, stopping it usually helps
• Good nutrition: Eat normally, but avoid alcohol and things that stress your liver

2. Treating the Cause:

• If it's a virus: Most viral hepatitis (like hepatitis A) resolves on its own. Some (like B or C) may need special medicines
• If it's a medication: Stopping the medication usually fixes it
• If it's alcohol: Stopping alcohol and getting support is essential
• If it's autoimmune: You may need medicines to calm your immune system

3. Monitoring: Doctors will check your liver function regularly to make sure you're recovering and to watch for any complications.

The goal: Support your liver while it heals, treat the cause, and prevent complications.

What to expect

Recovery:

• Most cases: Start feeling better within days to weeks
• Jaundice: Usually clears within 2-4 weeks
• Energy: Usually returns within weeks to months
• Full recovery: Most people are back to normal within 1-3 months

In the Hospital (If Needed):

• Usually not needed: Most cases can be managed at home
• If severe: You may need hospital care
• If liver failure: You'll need intensive care, may need a liver transplant

After Recovery:

• Lifestyle: Avoid alcohol, maintain healthy lifestyle
• Medications: Be careful with medications (some can harm your liver)
• Follow-up: Regular check-ups to make sure you're recovering
• Prevention: Get vaccinated if you haven't (hepatitis A and B)

Recovery Time:

• Mild cases: Usually recover within weeks
• Moderate cases: Usually recover within months
• Severe cases: May take months, some may have lasting effects

When to seek help

Call 999 (or your emergency number) immediately if:

• You turn yellow (jaundice) and feel very unwell
• You become confused or "not yourself"
• You start bleeding easily or bruising
• You feel like something is very wrong

See your doctor urgently if:

• You turn yellow (jaundice)
• Your urine becomes very dark
• Your stools become very pale
• You have right upper abdominal pain
• You feel very tired and unwell
• You've been exposed to someone with hepatitis

Remember: If you develop jaundice (yellow skin/eyes), especially with other symptoms like dark urine, pale stools, or feeling very unwell, don't wait—see your doctor immediately. Most cases are mild, but some can be serious and need prompt treatment.