Hepatitis is swelling and inflammation of the liver. The term is often used to refer to a viral infection of the liver.A.D.A.M.

Causes, incidence, and risk factors

Hepatitis can be caused by:

• Immune cells in the body attacking the liver and causing autoimmune hepatitis
• Infections from viruses (such as hepatitis A, hepatitis B, or hepatitis C), bacteria, or parasites
• Liver damage from alcohol, poisonous mushrooms, or other poisons
• Medications, such as an overdose of acetaminophen, which can be deadly

Liver disease can also be caused by inherited disorders such as cystic fibrosis or hemochromatosis, a condition that involves having too much iron in your body (the excess iron deposits in the liver).

Other causes include Wilson's disease (excess copper deposits in the body).

Symptoms

Hepatitis may start and get better quickly (acute hepatitis), or cause long-term disease (chronic hepatitis). In some instances, it may lead to liver damage, liver failure, or even liver cancer.

How severe hepatitis is depends on many factors, including the cause of the liver damage and any illnesses you have. Hepatitis A, for example, is usually short-term and does not lead to chronic liver problems.

The symptoms of hepatitis include:

• Abdominal pain or distention
• Breast development in males
• Dark urine and pale or clay-colored stools
• Fatigue
• Fever, usually low-grade
• General itching
• Jaundice (yellowing of the skin or eyes)
• Loss of appetite
• Nausea and vomiting
• Weight loss

You may not have symptoms when first infected with hepatitis B or C. You can still develop liver failure later. If you have any risk factors for either type of hepatitis, you should be tested regularly.

Signs and tests

You will have a physical exam to look for:

• Enlarged and tender liver
• Fluid in the abdomen (ascites)
• Yellowing of the skin

Your doctor may order laboratory tests to diagnose and monitor the hepatitis, including:

• Abdominal ultrasound
• Autoimmune blood markers
• Hepatitis virus serologies
• Liver function tests
• Liver biopsy to check for liver damage
• Paracentesis if fluid is in your abdomen

Treatment

Your doctor will talk to you about treatment options. Treatments will vary depending on the cause of your liver disease. Your doctor may recommend a high-calorie diet if you are losing weight.

Support Groups

There are support groups for people with all types of hepatitis. These groups can help you learn about the latest treatments and how to cope with having the disease.

Expectations (prognosis)

The outlook for hepatitis will depend on what is causing the liver damage. 

Complications

• Liver cancer
• Liver failure
• Permanent liver damage, called cirrhosis

Other complications include:

• Esophageal varices that can bleed
• Spontaneous bacterial peritonitis (fluid in the abdomen that becomes infected)

Calling your health care provider

Seek care immediately if you:

• Have symptoms from too much acetaminophen or other medicines -- you may need to have your stomach pumped
• Vomit blood
• Have bloody or tarry stools
• Are confused or delirious

Call your doctor if:

• You have any symptoms of hepatitis or believe that you have been exposed to hepatitis A, B, or C.
• You cannot keep food down due to excessive vomiting. You may need to receive nutrition through a vein (intravenously).
• You feel sick and have travelled to Asia, Africa, South America, or Central America.

Prevention

Talk to your doctor about vaccination for hepatitis A and hepatitis B.

Lifestyle measures for preventing spread of hepatitis B and C from one person to another include:

 •Avoid sharing personal items, such as razors or toothbrushes.

•Do not share drug needles or other drug equipment (such as straws for snorting drugs). 

 •Clean blood spills with a solution containing 1 part household bleach to 9 parts water.  

 •Be careful when getting tattoos and body piercings.

To reduce your risk of spreading or catching hepatitis A:

 •Always wash your hands thoroughly after using the restroom and when you come in contact with aninfected person's blood, stools, or other bodily fluid.

 •Avoid unclean food and water.

References

1. Dienstag JL. Hepatitis B virus infection. N Engl J Med. 2008;359:1486-1500. [PubMed: 18832247]
2. Jou JH, Muir AJ. In the clinic. Hepatitis C. Ann Intern Med. 2008;148:iTC6-1-ITC6-16. [PubMed: 18519925]
3. Sjogren MH, Cheatham JG. Hepatitis A. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa:Saunders Elsevier; 2010:chap 77.
4. Pawlotsky JM, Mchutchison J. Chronic viral and autoimmune hepatitis. In: Goldman L, Ausiello D, eds.Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 151.

Review Date: 10/16/2011.

Reviewed by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.