Breaking Down Hepatitis

What is hepatitis? Simply, it is an inflammation of the liver. It can be caused by a viral infection, which is known as viral hepatitis, and is the most known worldwide.

Hepatitis can also occur from toxins, excessive alcohol consumption, overuse of medications or drugs, fatty liver, over deposition of iron or copper in the liver and body, or when a person’s body produces antibodies to work against their own liver tissue. When hepatitis occurs due to these factors, it is collectively known as non-viral hepatitis.

In this article, we’ll break down the difference between these two types of Hepatitis, as well as options for treatment and prevention.

5 Types of Viral Hepatitis

Hepatitis A – This type occurs from infection with the hepatitis A virus (HAV). It is most commonly transmitted through food and water contaminated with feces from a person infected with the hepatitis A virus. It does not lead to chronic liver disease. It mostly causes acute infection and is resolved without long term consequence. Hepatitis A is the most prevalent worldwide.

Hepatitis B This type occurs from infection with the hepatitis B virus (HBV). It is generally transmitted through cuts and wounds and other contact with bodily fluids such as blood, saliva, and semen. Having sexual relations with a person with the hepatitis B virus can easily cause infection. Sharing needles, use of contaminated needles, or using a razor contaminated with HBV can lead to infection. It mostly causes acute infection and is resolved without long term consequence, but infection during childbirth and in the first year of life can lead to chronic hepatitis as well as a HBV carrier status. According to the World Health Organization, as of April 2017, an estimated 257 million people are living with hepatitis B virus infection (defined as hepatitis B surface antigen positive).

Hepatitis C This type occurs from infection with the hepatitis C virus (HCV). It is transmitted through cuts and wounds and other contact with bodily fluids such as blood, saliva, and semen. Having sexual relations with a person with the hepatitis C virus can cause infection. Sharing needles, use of contaminated needles, or using a razor contaminated with HCV can lead to infection. Hepatitis C is one of the most common viral blood infections. Infection mostly occurs during adulthood, with a 70% risk of it turning into chronic hepatitis. According to the World Health Organization, as of April 2017, an estimated 71 million people have chronic hepatitis C infection worldwide.

Hepatitis D This type occurs from infection with the hepatitis D virus (HDV). It is generally transmitted through cuts and wounds and other contact with infected blood. Hepatitis D only occurs alongside hepatitis B and is generally very uncommon.

Hepatitis E – This type occurs from infection with the hepatitis E virus (HEV). It is waterborne. Hepatitis E is generally contracted by ingesting contaminated fecal matter, and is commonly found in unsanitary places. It causes only acute hepatitis, without chronic consequence.

All of these forms of hepatitis can either be acute or chronic, although hepatitis B and C generally may become chronic. Generally, Hepatitis A and E are contracted through consuming contaminated food and water, while hepatitis B, C, and D, are contracted through blood and bodily fluids.

Complications That Come Along with Chronic Hepatitis B and C

Chronic hepatitis B and C are especially dangerous, as they can lead to more serious health problems. People with either chronic hepatitis B or chronic hepatitis C are at a risk for the following:

  • Liver failure – resulting in the following as well:
    • Kidney failure
    • Bleeding disorders
    • Fluid build-up in the abdomen and legs
    • High pressure in the portal veins of the liver
    • Coma
    • Death

Non-Viral Hepatitis

Excessive alcohol consumption or overuse of medications can cause liver inflammation, known as toxic hepatitis (or alcoholic hepatitis from only alcohol).

Non-alcoholic fatty liver disease (NAFLD) – and non-alcoholic steatohepatitis (NASH), which is the extreme form of NAFLD – is when excess fat deposits in the liver cells and causes liver inflammation. It is generally related to diabetes, hyperlipidemia, obesity, and high blood pressure (metabolic syndrome). It may lead to chronic hepatitis, cirrhosis, and liver cancer.

With autoimmune hepatitis, the liver becomes inflamed through a person’s own body when the person’s immune system mistakes the liver to be harmful towards the body and produces anti-bodies to attack the liver. This causes chronic liver inflammation and may eventually lead to cirrhosis of the liver, etc.

The liver can also become acutely inflamed in assosiation with other conditions such as chickenpox, glandular fever, leptospirosis, and dengue fever – but does not become chronic.

These types of hepatitis are collectively known as non-viral hepatitis, which is basically any form of hepatitis not caused by a hepatitis virus.

Non-viral hepatitis can lead to cirrhosis of the liver, liver cancer, and liver failure. It’s vital to take the necessary treatment steps if suffering from chronic non-viral hepatitis.

Other rare metabolic and genetic forms of chronic hepatitis include hemochromatosis (excessive iron deposits in the liver and other organs, and Wilson’s disease (excessive copper deposits in the liver and other organs).


Symptoms of Hepatitis Infection

Symptoms of hepatitis occur differently for acute and chronic infections. Symptoms of acute hepatitis normally show quickly, while chronic hepatitis symptoms generally do not show until significant liver damage occurs.

Common signs and symptoms include:

  • Flu-like symptoms
  • Abdominal pain
  • Yellowing of the skin and eyes (jaundice)
  • Loss of appetite
  • Pale colored stool
  • Dark colored urine
  • Fatigue
  • Unexplained weight loss


How Hepatitis is Diagnosed

There are a few different methods in which hepatitis is diagnosed.

These include:

Physical Examination – A physical examination is performed to see whether a patient’s liver has become enlarged. The doctor will press down on the patient’s abdomen, where the patient will generally feel pain or tenderness if there is a problem. If the patient’s eyes and skin are yellowish, the doctor takes note of it as it is also an important sign of hepatitis as well.

Liver Function Test – With a liver function test, a blood sample is collected and examined to determine how efficiently the liver is functioning – by checking to see how well the liver clears blood waste, level of jaundice, enzymes, and proteins. If a high level of enzymes is detected, it means that there is liver damage.

Liver Biopsy – A liver biopsy involves the doctor taking a small sample of the patient’s liver. It does not require surgery; a sample can be taken through the skin using a specialized needle under ultrasound guidance. A biopsy can tell whether liver inflammation, damage, or cirrhosis has occurred. However, a biopsy is usually not required.

Blood Test – A blood test can determine the presence of hepatitis virus antigens and antibodies, and confirm which type of hepatitis the patient has contracted.

Viral DNA or RNA Testing – This test is performed to see whether a specific hepatitis virus is present.

Abdominal Ultrasound – An ultrasound is used to confirm an enlarged liver and liver damage, as well as view the texture of the liver and liver mass.

CT Scan or MRI Scan – A computerized tomography (CT) scan or magnetic resonance imaging (MRI) scan is used to confirm a liver mass, liver damage, and cirrhosis, etc.

Hepatitis Treatment

Treatment of hepatitis depends on which type the patient has contracted, as well as if it is either acute or chronic.

Hepatitis A – Patients with hepatitis A generally do not need specific treatment. If vomiting and diarrhea occur, the doctor will put the patient on intravenous fluids and a special diet in order to prevent malnutrition and dehydration. It will usually spontaneously recover without long-term consequence.

Hepatitis B – Patients with acute hepatitis B do not require specific treatment, but need medical attention. Patients with chronic hepatitis B may need antiviral medications. For chronic hepatitis B, the use of antiviral medications generally requires long-term treatment along with regular monitoring to see if the virus is still under control. Cirrhosis and liver cancer may follow, which require regular surveillance.

Hepatitis C – For both acute and chronic hepatitis C, antiviral medications are used in treatment. A combination of different antiviral medications may be used for chronic cases. In extreme cases where patients develop end stage cirrhosis and liver cancer, a liver transplant may be required.

Hepatitis D – Chronic hepatitis D can be treated with PEG interferon for 48 weeks, although effectiveness is low and comes with side effects. For some cases of HDV, a liver transplant may be necessary.

Hepatitis E – There is no specific treatment for hepatitis E. Hepatitis E generally does not require hospitalization as it generally goes away on its own like hepatitis A.

Non-Viral Hepatitis – Stop consumption of alcohol and over-the-counter medications, as well as nutritional supplements. Take any necessary medications only as directed, without exceeding doses. The doctor may prescribe medication to reduce liver inflammation and may even require the patient to be admitted to the hospital, especially for cases of serious alcoholic hepatitis. Reduce intake of refined sugar, carbohydrates, and fatty foods, as well as exercising 3-4 times per week to reduce weight is necessary – especially for NAFLD and NASH, as effective medications for treating these two conditions are still under development.


Currently, vaccinations are only available for hepatitis A and B. These vaccinations are generally given to newborns, but adults are able to receive vaccinations as well. Around the world, adults working in the medical field are required to be vaccinated for both.



Hepatitis, whether viral or non-viral, affects millions of people worldwide.

If you feel you may be at risk or believe you may have contracted a hepatitis virus, contact your doctor for immediate medical assistance, and make sure to check with your doctor prior to taking any long-term medications to make sure that they are safe to take.

The Liver Center at Bumrungrad International Hospital is always ready to help patients with any concerns and questions. If you feel that you have been infected, the Liver Center can help you through the proper diagnosis and care.

You can make an appointment to consult with a specialist at the Liver Center at Bumrungrad International Hospital by emailing us at [email protected].

By Dr . Virasak Wongpaitoon , Gastroenterologist and Hepatologist, Liver Center, Bumrungrad Hospital

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