💡 Always consider acute hepatitis causes as infection 🦠, drugs 💊, and alcohol 🍺. Some are self-limiting; others progress to fulminant liver failure 🚨 or evolve into chronic hepatitis 🕰️.

ℹ️ Overview

Hepatitis = hepatocyte necrosis + inflammation; can be reversible or progress to chronic liver disease.
Fulminant liver failure = rapid onset with coagulopathy & encephalopathy; high mortality if untreated.
NICE/UK guidance: early recognition, supportive care, toxin/drug withdrawal, ICU referral, and transplant evaluation if criteria met.

🧬 Causes of Acute Hepatitis

Category	Common Causes (UK / NICE)	Key Points / Management
🦠 Viral	HAV, HBV, HCV, HDV, HEV; EBV, CMV, HSV	Supportive for HAV/HEV; antivirals in selected HBV/HCV cases; avoid hepatotoxins
💊 Drug/Toxin	Paracetamol (commonest in UK), antibiotics, statins, anti-TB drugs, Amanita mushroom 🍄	Stop culprit drug; NAC for paracetamol; supportive care; ICU if fulminant
🍺 Alcoholic	Alcohol binge → alcoholic hepatitis	Abstinence, supportive care; corticosteroids if severe (NICE NG148)
🛡️ Autoimmune	AIH – ANA, SMA, LKM1 positive	Steroids ± azathioprine; rule out infection first
🧬 Metabolic / Other	Wilson’s disease, haemochromatosis, ischaemic hepatitis, pregnancy-related (HELLP, AFLP)	Specific therapy: chelation (Wilson), deliver fetus if pregnancy-related; perfusion support for ischaemia
❓ Idiopathic	Unknown etiology (~10–20%)	Supportive, monitor synthetic function, consider transplant if ALF

🩺 Clinical Features

Non-specific: malaise, fatigue, nausea/vomiting 🤢
Classic: jaundice 🟡, dark urine 🧪, pale stools ⚪, RUQ pain
Clues: cigarette distaste 🚬 (acute HBV), tender hepatomegaly
Severe: hepatic encephalopathy 🧠 → confusion → coma; coagulopathy 🩸; may indicate fulminant liver failure 🚨

🔬 Investigations (UK/NICE Approach)

Test	Purpose / Findings	Clinical Tip
LFTs	ALT/AST often >1000 → paracetamol, viral, ischemic; ↑ bilirubin; INR/PT prolonged	High AST/ALT ≠ liver failure; check synthetic function (INR/albumin)
Viral Serology	HAV IgM, HBsAg, anti-HCV, HEV IgM, HDV markers	Essential for UK-relevant viral hepatitis screening
Autoantibodies	ANA, SMA, LKM1 if autoimmune suspected	Young female with high IgG → consider AIH
Toxicology	Paracetamol level, alcohol/drug screen	Critical for identifying treatable drug-induced hepatitis
Imaging	Ultrasound ± Doppler to exclude obstruction or vascular causes	Rapid bedside assessment for vascular or biliary pathology
Liver Biopsy	Rarely acute; mainly chronic or unclear etiology	Coagulopathy correction required if biopsy considered

💊 Management (NICE/UK Guidelines)

Supportive care: hydration, nutrition, monitor electrolytes, avoid hepatotoxins
Drug-induced: stop offending drug; NAC for paracetamol overdose
Alcoholic hepatitis: abstinence + supportive; corticosteroids if severe (NICE NG148)
Viral hepatitis: supportive; antivirals for HBV/HCV in select cases; monitor for fulminant course
Autoimmune hepatitis: steroids ± azathioprine after excluding infection
Ischaemic hepatitis: restore perfusion; treat underlying cardiac cause
Pregnancy-related: prompt delivery if HELLP/AFLP
Fulminant liver failure 🚨: ICU support, manage complications (coagulopathy, encephalopathy, hypoglycaemia), early transplant referral 🏥

📈 Prognosis

HAV & HEV → usually self-limiting 👍
HBV & HCV → risk of chronic hepatitis → cirrhosis + HCC 📉
Fulminant liver failure → high mortality; transplant may be lifesaving

🎯 Exam Pearls

Paracetamol overdose = commonest cause of ALF in UK → NAC early saves lives
HEV = severe in pregnancy → high maternal/fetal mortality 🤰
Autoimmune hepatitis = young woman + ↑ IgG + ANA/SMA positive
Cigarette distaste 🚬 → acute HBV
Prognostic markers: ↑ INR, bilirubin, encephalopathy grade

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Acute Hepatitis and Acute Liver disease