Syndromic classification of hepatitis

1. Carrier state; state of the disease with out apparent illness(sub-clinical hepatits). May also be described as asymptomatic hepatistis where there is only serological evidence of infection.

2. Acute hepatitis; divided into: a) Pre-icteric phase(Prodromal phase )- This phase begins about 2 weeks after exposure to hepatitis. The infection is easily transmitted during this phase & the symptoms are those of acute infection including;

   • Fever
   • Anorexia/N&V
   • Right upper guadrant pain
   • Musculoskeletal pain and Rash. This stage ends when

   b) Icteric phase; s$s are directly related due to changes in the liver. This is known as the actual phase of illness. It begins 1-2 weeks after the prodromal phase and continues for 2-6 weeks. These include

   • Jaundice
   • Dark urine
   • Pale clay-coloured stools
   • The liver becomes enlarged, tender and the person feels pain if the liver is per cussed

   c) Convalescence; The recovery begins when the jaundice starts to clear. The liver stays enlarged and tender but the other symptoms start to diminsh. It usually begins 6-8 weeks after exposure. The liver regains normal function 2-12 weeks

3. Chronic hepatitis; diagnosed when inflammation continues beyond 6months. This may manifest in 2 forms

   • a) Chronic persistent hepatitis; is defined as “the persistance of clinical picture and liver inflamm’n after acute hepatitis B, C, D. Liver function tests remain abnormal for > than 6 months, and hep B surface antigen (HbsAg) persists”
   • b) Chronic active hepatitis; Is more severe form of the dse & usually leads to severe inflammation and necrosis that ends in fibrosis and cirrhosis. Extra hepatic abnormalities usually x-terise chronic active hepatitis

4. Fulminant hepatitis; Thisis the worst form of the dse x-terised by gross hepatic insufficiency and hepatic encephalopathy.

5. Alcoholic hepatitis; An acute and chronic inflamation of the liver due to heavy ETOH. It can be reversible after wthdraw but can lead to cirrhosis and poor prognosis if nt wthdrwn presenting wth;

   • Anorexia, N& V
   • Abd pain
   • Spleenomegally
   • Jaundice
   • Ascites
   • Fever and encephalopathy

6. Toxic hepatitis; This occurs after exposure to hepatotoxins. These are mostly drugs like;

   • Acetaminophen
   • Isonniazid
   • Tetracycline
   • Methotrexate
   • Allopurinol
   • Phentyoin
   • Methyl dopa
   • Sulfasalazine
   • Aspirin
   • CAF & COC’S

Lab Investigations

Diagnosis is made by:

• assessing an individual’s symptoms, physical exam, and medical history
• **Blood tests :**Blood testing includes blood chemistry, liver enzymes, serology and nucleic acid testing. Abnormalities in blood chemistry and enzyme results may be indicative of certain causes or stages of hepatitis
• Serological tests. If Hep B, detection of HBsAg is a diagnostic as HAsAg diagnoses Hep A. these antigens may be found in carriers.
• Imaging: Imaging can identify steatosis of the liver
• liver biopsy is required to demonstrate fibrosis and cirrhosis. Histology indicates neutrophitic / lymphocytic infiltration and hyperplasia of kuffer cells
• Urinalysis-other infections