Hepatitis is a disease of the liver that results in widespread destruction of liver cells. It can be acute or chronic (lasting longer than six months) and may progress to liver failure, cirrhosis, and/or liver cancer. The most common causes of hepatitis in the United States are alcohol abuse and viral infection.

Viral hepatitis can be caused by dozens of different viruses. The most common are called hepatitis viruses: hepatitis A, hepatitis B, and hepatitis C.

• Hepatitis A is a common cause of acute hepatitis, but does not result in chronic disease. It is usually spread by poor hygienic practices and inadequate sanitation, especially in third-world countries. The disease is usually mild, and patients may be asymptomatic.
• Hepatitis B generally does not cause severe acute disease, but can result in chronic hepatitis, which can be fatal. It is spread by blood and body fluids (e.g., unprotected sex, intravenous drug use, blood transfusions, and tattoo and body piercing). Sexual contact is the most common mode of transmission in the United States.
• Hepatitis C is the most common cause of chronic hepatitis in the United States and is the most common reason for liver transplantation. Patients with chronic hepatitis C usually do well for 20 to 25 years before developing cirrhosis. The most common cause of hepatitis C in the United States is intravenous drug use. Although transmission rarely occurs via blood products, this is much less common since universal blood screening for hepatitis began in 1990.

Symptoms

Many cases are asymptomatic. However, the condition may cause these symptoms:

• Fever
• Nausea and vomiting
• Fatigue
• Jaundice (yellow discoloration of the skin)
• Right-sided abdominal pain
• Dark urine with pale stools

Risk Factors

• Exposure to blood or body fluids (e.g., intravenous drug use, unprotected sexual intercourse, tattoos, body piercing, blood transfusion, and occupational needlestick exposure). Transmission via blood transfusion is now rare due to universal blood screening.
• Contact with an infected person (hepatitis A)
• Poor hygiene and inadequate sanitation (hepatitis A)
• Underlying liver disease. Patients with underlying liver disease (e.g., autoimmune hepatitis, hemochromatosis, Wilson's disease, and alpha-1 antitrypsin deficiency) are at increased risk of developing symptomatic hepatitis.
• Alcohol use, smoking, HIV infection, and fatty liver. Each of these is a risk factor for progression of hepatitis to a chronic state.

Viral Hepatitis: Diagnosis and Treatment

Diagnosis

• History and physical examination is the first step and may reveal risk factors.
• Blood testing is used to evaluate liver function and to test for the hepatitis viruses.
• An ultrasound of the abdomen is usually needed to evaluate the liver and rule out gallstones.
• A liver biopsy may be necessary.
• Abdominal x-ray, CT scan, MRI, and/or other testing may be necessary to rule out other abdominal diseases, such as pancreatitis, gall bladder disease, and cancer.

Treatment

• Initial treatment often includes hospitalization, intravenous fluids, monitoring of nutrition status, and avoidance of drugs or medications that may be toxic to the liver (e.g., alcohol, acetaminophen, and statins). Abstinence from alcohol is essential, as noted below.
• In addition to the above measures, antiviral medications may be necessary, especially for individuals with chronic hepatitis B or C. They may require drug treatment for six months to a year or longer.
• Vaccination is available for hepatitis A and hepatitis B. All individuals with chronic hepatitis B should be vaccinated for hepatitis A, and those with hepatitis C should be vaccinated for both hepatitis A and hepatitis B.
• Individuals who develop liver failure may require additional testing, medications, and blood transfusions.
• Individuals with the most severe liver disease may require liver transplantation.

• Hygiene and sanitation: Persons who travel internationally or who are in areas where contamination occurs should be aware of an increased risk for hepatitis A. Uncooked food can increase the risk for hepatitis A transmission, as can water and even ice. Drinking bottled water, making sure food is prepared hygienically, and careful washing of hands and dishes can help prevent the spread of the virus. 
• Shellfish risk: Shellfish are often harvested from wastewater-polluted areas of the sea. As many as 4 million cases of hepatitis A occur each year globally as a result of consumption of raw or partially cooked shellfish/mollusks taken from polluted coastal waters.
• Alcohol abstinence: In persons with hepatitis C, alcohol appears to have undesirable effects on virus replication as well as on immune function and regeneration of liver cells, and may disrupt the effect of medications. Alcohol and the hepatitis C virus also act together to increase liver damage. People who have hepatitis C and are also alcohol users do much worse than those who do not have alcohol as a complicating factor.
• High-antioxidant diet: Patients with increased dietary intake of antioxidants may have a lower risk of liver disease. Further, preliminary evidence indicates that certain antioxidants may improve the effectiveness of antiviral treatments. This does not mean that people with liver disease necessarily need to take antioxidant supplements. The best way to increase antioxidants in the diet is to eat plenty of fruits, vegetables, and whole grains.
• Iron-restricted diet: Some authorities believe that having too much iron may increase liver damage in patients with hepatitis. The American Liver Foundation suggests that chronic hepatitis C patients whose blood iron level is elevated, or who have cirrhosis, avoid iron-containing supplements and restrict intake of high-iron foods (e.g., red meat and many other animal products).