[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Viral hepatitis [Conditions](https://durgical.com/en/conditions/) · [Abdomen](https://durgical.com/en/anatomy/region/abdomen/) # Viral hepatitis Viral hepatitis is liver inflammation caused by the hepatitis A, B, C, D or E viruses; B, C and D can become chronic and lead to cirrhosis and liver cancer. Updated 2026-10-30 ## Structures involved Tap one to see what it is and open it in 3D. - [Liver](https://durgical.com/en/anatomy/liver/) - [Spleen](https://durgical.com/en/anatomy/spleen/) - [Gallbladder](https://durgical.com/en/anatomy/gallbladder/) - [Common bile duct](https://durgical.com/en/anatomy/bile-duct/) - [Portal vein](https://durgical.com/en/anatomy/hepatic-portal-vein/) ## In biochemistry - [Alanine aminotransferase (ALT, GPT)](https://durgical.com/en/biochemistry/enzymes/alanine-aminotransferase/) - [Aspartate aminotransferase (AST, GOT)](https://durgical.com/en/biochemistry/enzymes/aspartate-aminotransferase/) - [Transamination and deamination](https://durgical.com/en/biochemistry/topics/transamination-and-deamination/) - [Glucose–alanine cycle](https://durgical.com/en/biochemistry/topics/glucose-alanine-cycle/) - [Liver function tests: reading the pattern](https://durgical.com/en/biochemistry/topics/liver-function-tests-reading-the-pattern/) - [Aminotransferases (ALT and AST) as lab tests](https://durgical.com/en/biochemistry/topics/aminotransferases-as-lab-tests/) - [Alpha-fetoprotein (AFP)](https://durgical.com/en/biochemistry/topics/alpha-fetoprotein/) - [Uroporphyrinogen decarboxylase](https://durgical.com/en/biochemistry/enzymes/uroporphyrinogen-decarboxylase/) - [Bilirubin](https://durgical.com/en/biochemistry/molecules/bilirubin/) - [ELISA (enzyme-linked immunosorbent assay)](https://durgical.com/en/biochemistry/topics/elisa/) - [Isoenzymes](https://durgical.com/en/biochemistry/topics/isoenzymes/) ## Microorganisms that cause it - [Hepatitis B virus](https://durgical.com/en/microbiology/hepatitis-b-virus/) - [Hepatitis A virus](https://durgical.com/en/microbiology/hepatitis-a-virus/) - [Hepatitis C virus](https://durgical.com/en/microbiology/hepatitis-c-virus/) - [Hepatitis D virus](https://durgical.com/en/microbiology/hepatitis-d-virus/) - [Hepatitis E virus](https://durgical.com/en/microbiology/hepatitis-e-virus/) ## In immunology - [Type I interferons (α, β)](https://durgical.com/en/immunology/type-i-interferons/) - [Colombia's PAI schedule (which vaccines, at what age)](https://durgical.com/en/immunology/colombia-s-pai-schedule/) - [Passive immunization: immunoglobulins and antitoxins](https://durgical.com/en/immunology/passive-immunization-immunoglobulins-and-antitoxins/) - [Serology: IgM vs IgG, seroconversion, avidity](https://durgical.com/en/immunology/serology-igm-vs-igg-seroconversion-avidity/) ## In histology - [Cell injury, apoptosis and necrosis](https://durgical.com/en/histology/cell-injury-apoptosis-and-necrosis/) - [Liver: lobule, acinus, hepatocytes, sinusoids, Kupffer cells](https://durgical.com/en/histology/liver-lobule-acinus-hepatocytes-sinusoids-kupffer-cells/) ## In the clinical exam - [Palpation of the liver and spleen](https://durgical.com/en/clinical-exam/palpation-of-the-liver-and-spleen/) - [Pallor, cyanosis and jaundice](https://durgical.com/en/clinical-exam/pallor-cyanosis-and-jaundice/) - [Portal hypertension and the signs of chronic liver disease](https://durgical.com/en/clinical-exam/portal-hypertension-and-the-signs-of-chronic-liver-disease/) - [Jaundice: prehepatic, hepatic and posthepatic](https://durgical.com/en/clinical-exam/jaundice-prehepatic-hepatic-and-posthepatic/) ## In physiology - [Functions of the liver](https://durgical.com/en/physiology/functions-of-the-liver/) ## Why it happens - [Apoptosis: the intrinsic and extrinsic pathways](https://durgical.com/en/general-pathology/apoptosis-the-intrinsic-and-extrinsic-pathways/) - [Fibrosis in organs: TGF-β and the myofibroblast](https://durgical.com/en/general-pathology/fibrosis-in-organs-tgf-and-the-myofibroblast/) - [Liver regeneration](https://durgical.com/en/general-pathology/liver-regeneration/) - [Apoptosis vs necrosis: the comparison table](https://durgical.com/en/general-pathology/apoptosis-vs-necrosis-the-comparison-table/) - [Tissue repair: regeneration or scar; labile, stable and permanent cells](https://durgical.com/en/general-pathology/tissue-repair-regeneration-or-scar-labile-stable-and-permanent-cells/) - [Chronic inflammation: causes, cells and features](https://durgical.com/en/general-pathology/chronic-inflammation-causes-cells-and-features/) ## Show 4 more - [Oncogenic viruses and H. pylori: the table to know](https://durgical.com/en/general-pathology/oncogenic-viruses-and-h-pylori-the-table-to-know/) - [Causes of cell injury](https://durgical.com/en/general-pathology/causes-of-cell-injury/) - [Precancerous conditions: when chronic inflammation, metaplasia or hyperplasia raise the risk](https://durgical.com/en/general-pathology/precancerous-conditions-when-chronic-inflammation-metaplasia-or-hyperplasia-rais/) - [Heme breakdown and bilirubin](https://durgical.com/en/biochemistry/pathways/heme-breakdown-and-bilirubin/) ## What it is Inflammation of the liver caused by the hepatotropic viruses A, B, C, D and E. It can be acute and self-limited or, for B, C and D, become chronic and lead to cirrhosis and liver cancer. ## Who gets it Hepatitis A and E spread where sanitation is poor; B and C are the main viral causes of cirrhosis and liver cancer worldwide. B and its dependent virus D are commoner in parts of the Amazon. Colombia vaccinates children against hepatitis B (from birth) and A. In Medellín, a small study found hepatitis E in 9 of 40 people (22.5%) with clinical viral hepatitis. ## Causes - Hepatitis A (RNA virus): faecal-oral, contaminated food and water; acute only - Hepatitis B (DNA virus): blood, sexual and mother-to-child transmission; can become chronic - Hepatitis C (RNA virus): mainly blood (injecting drugs, unsafe injections, transfusion before screening); often chronic - Hepatitis D: needs hepatitis B to replicate; co-infection or superinfection - Hepatitis E (RNA virus): faecal-oral, waterborne; also undercooked pork or game in some genotypes ## Risk factors - Poor sanitation and unsafe water (A, E) - Unvaccinated status (A, B) - Birth to a mother with hepatitis B - Injection drug use, unsafe medical injections, needlestick injury - Unprotected sex, multiple partners, HIV infection - Haemodialysis, tattoos or piercing with unsterile equipment ## Pathophysiology The viruses infect hepatocytes, and most of the liver damage comes from the immune response that clears infected cells. Hepatitis B, C and D can persist, causing ongoing inflammation, fibrosis and cirrhosis. Hepatitis B DNA can integrate into the host genome, so it can cause liver cancer even without cirrhosis. ## Classification - Acute vs chronic (persisting more than six months) - By virus: A, B, C, D, E - Hepatitis D: co-infection with B vs superinfection of chronic B (more often severe) - Fulminant hepatitis (acute liver failure) ## Symptoms and signs - Many infections, especially in children, are silent - Prodrome: tiredness, nausea, loss of appetite, low fever, right upper quadrant ache - Jaundice, dark urine and pale stools - Tender enlarged liver - Chronic infection is usually silent until cirrhosis develops ## Red flags - Confusion or drowsiness (encephalopathy) - Bleeding or a prolonged INR - Persistent vomiting or inability to keep fluids down - Hepatitis E or severe hepatitis in pregnancy - Rapidly deepening jaundice ## Diagnosis **Clinical** Exposure history (travel, water, sex, injections, vaccination), jaundice and [liver](https://durgical.com/en/anatomy/liver/) tenderness; signs of chronic liver disease in long-standing infection. **Tests** Aminotransferases (often very high in acute disease), bilirubin, INR. Serology: anti-HAV IgM; for hepatitis B, HBsAg, anti-HBc (IgM in acute infection), anti-HBs (immunity), HBeAg and HBV DNA; anti-HCV with HCV RNA; anti-HDV in HBsAg-positive patients; anti-HEV IgM. **Imaging** Ultrasound excludes biliary obstruction and assesses the liver and [spleen](https://durgical.com/en/anatomy/spleen/). Elastography stages fibrosis in chronic hepatitis. ## Differential diagnosis - Drug- or toxin-induced liver injury (including paracetamol) - Alcohol-related hepatitis - Autoimmune hepatitis - Biliary obstruction (choledocholithiasis) - Ischaemic hepatitis - Leptospirosis, yellow fever, dengue or malaria with liver involvement ## Goal of treatment Support recovery in acute hepatitis, detect acute liver failure early, and in chronic infection suppress or cure the virus to prevent cirrhosis and liver cancer. ## Treatment **Conservative** Acute hepatitis A and E and most acute hepatitis B: supportive care, avoidance of alcohol and hepatotoxic drugs, and monitoring. **Acute** Acute liver failure: hospital care, intensive support and early contact with a transplant centre. **Medical** Chronic hepatitis B: nucleoside or nucleotide analogues for long-term suppression, or interferon in selected patients, based on viral load, enzymes and fibrosis. **Medical** Chronic hepatitis C: oral direct-acting antivirals, which cure most patients after a short course. **Medical** Hepatitis D: interferon-based therapy; newer entry inhibitors exist in some countries. Hepatitis B treatment continues. **Follow-up** Chronic B and C: follow-up of liver tests, viral load and fibrosis; ultrasound surveillance for liver cancer in cirrhosis and in selected hepatitis B carriers. ## Drugs for this condition - [Lamivudine](https://durgical.com/en/pharmacology/lamivudine/) - [Tenofovir disoproxil](https://durgical.com/en/pharmacology/tenofovir-disoproxil/) - [Tenofovir alafenamide](https://durgical.com/en/pharmacology/tenofovir-alafenamide/) - [Dolutegravir + lamivudine + tenofovir disoproxil (TLD)](https://durgical.com/en/pharmacology/dolutegravir-lamivudine-tenofovir-disoproxil/) - [Entecavir](https://durgical.com/en/pharmacology/entecavir/) - [Ribavirin](https://durgical.com/en/pharmacology/ribavirin/) - [Sofosbuvir](https://durgical.com/en/pharmacology/sofosbuvir/) - [Sofosbuvir + velpatasvir](https://durgical.com/en/pharmacology/sofosbuvir-velpatasvir/) - [Ledipasvir + sofosbuvir](https://durgical.com/en/pharmacology/ledipasvir-sofosbuvir/) - [Glecaprevir + pibrentasvir](https://durgical.com/en/pharmacology/glecaprevir-pibrentasvir/) - [Interferon alfa](https://durgical.com/en/pharmacology/interferon-alfa/) - [Hepatitis B vaccine](https://durgical.com/en/pharmacology/hepatitis-b-vaccine/) - [Hepatitis A vaccine](https://durgical.com/en/pharmacology/hepatitis-a-vaccine/) ## Complications - Acute liver failure - Chronic hepatitis, cirrhosis and portal hypertension - Hepatocellular carcinoma - Extrahepatic disease: glomerulonephritis, cryoglobulinaemia, polyarteritis nodosa - Severe hepatitis E in pregnancy ## Prognosis Hepatitis A and E usually resolve fully. Most adults clear hepatitis B, but most infected newborns develop chronic infection. Hepatitis C is now curable in most patients; superinfection with hepatitis D speeds progression to cirrhosis. ## Prevention - Hepatitis B vaccination from birth, with immunoglobulin for babies of infected mothers - Hepatitis A vaccination; safe water, sanitation and hand hygiene - Screening of blood donors, safe injections and needle exchange - Condom use; screening in pregnancy - Hepatitis B vaccination also prevents hepatitis D ## Test yourself Think of the answer, then tap the question to see it. ## Which hepatitis B marker pattern indicates immunity from vaccination only? Anti-HBs positive with HBsAg and anti-HBc negative; anti-HBc is positive only after natural infection. ## Which serological marker shows acute hepatitis B, including during the window period? IgM anti-HBc, which can be the only positive marker after HBsAg clears and before anti-HBs appears. ## Which hepatitis virus needs hepatitis B to replicate? Hepatitis D (delta), which uses the hepatitis B surface antigen as its envelope; hepatitis B vaccination also prevents it. ## Which viral hepatitis is especially dangerous in pregnancy? Hepatitis E, which can cause fulminant hepatitis, particularly in the third trimester. ## Which drug class cures most patients with chronic hepatitis C? Oral direct-acting antivirals, given for a short course of several weeks. [Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/viral-hepatitis/) ## Related conditions - [Cirrhosis](https://durgical.com/en/conditions/cirrhosis/) - [Hepatocellular carcinoma](https://durgical.com/en/conditions/hepatocellular-carcinoma/) - [Portal hypertension](https://durgical.com/en/conditions/portal-hypertension/) - [HIV infection and AIDS](https://durgical.com/en/conditions/hiv-infection-and-aids/) - [Leptospirosis](https://durgical.com/en/conditions/leptospirosis/) - [Amoebic liver abscess](https://durgical.com/en/conditions/amoebic-liver-abscess/) - [Malaria](https://durgical.com/en/conditions/malaria/) Educational information, not medical advice. For any symptom, see a health professional. Sources: [Viral Hepatitis](https://www.ncbi.nlm.nih.gov/books/NBK554549/) (StatPearls (NCBI Bookshelf), 2024); [Hepatitis E Virus Genotype 3 in Colombia: Survey in Patients with Clinical Diagnosis of Viral Hepatitis](https://europepmc.org/article/PMC/PMC4757071) (PloS one, 2016) · adapted, [CC BY 4.0](https://creativecommons.org/licenses/by/4.0/). [← All conditions](https://durgical.com/en/conditions/) ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/conditions/viral-hepatitis/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/viral-hepatitis/