Hepatitis: What are the types of hepatitis?

Hepatitis is inflammation of the liver tissue with yellow discoloration of the skin and whites of the eyes, poor appetite, vomiting, tiredness, abdominal pain, or diarrhea.

Updated: June 16, 2022

Hepatitis is inflammation of the liver tissue with yellow discoloration of the skin and whites of the eyes, poor appetite, vomiting, tiredness, abdominal pain, or diarrhea. Hepatitis may be temporary (acute) or long term (chronic) depending on the duration it lasts. It is commonly caused by a viral infection. But there are other possible causes of hepatitis which include autoimmune hepatitis and hepatitis that occurs as a secondary result of medications, drugs, toxins, and alcohol. When your body makes antibodies against your liver tissue, autoimmune hepatitis is developed.

Types of Viral Hepatitis:

Hepatitis caused by a viral infection of the liver is mainly of five types. A different virus is responsible for each type of virally transmitted hepatitis. These are:

Hepatitis A:

Hepatitis A is caused by an infection with the hepatitis A virus (HAV). This type of hepatitis is mostly spread by consuming food or water contaminated by feces from a person infected with hepatitis A. Hepatitis A is preventable with immunization.

Hepatitis B:

Hepatitis B is mainly sexually transmitted. This can be spread through contact with infectious body fluids such as blood, vaginal secretions, or semen containing the hepatitis B virus (HBV). Sharing razors or injection with an infected person increase your risk of getting hepatitis B. This may also be passed from mother to baby during pregnancy or childbirth. Hepatitis B is also preventable with immunization.

Hepatitis C:

Hepatitis C comes from the hepatitis C virus (HCV). Hepatitis C is transmitted through direct contact with infected body fluids, usually through injection drug use and sexual contact. Viral particles have also been found in saliva and breast milk. Hepatitis C can present either acutely or chronically.

Hepatitis D:

Hepatitis D is a serious liver disease caused by the hepatitis D virus (HDV). HDV is are transmitted when blood or mucous membranes are exposed to infected blood and body fluids, such as semen and vaginal secretions. Hepatitis D is a rare form of hepatitis that only occurs in conjunction with hepatitis B infection. The hepatitis D virus can not grow without the presence of hepatitis B.

Hepatitis E:

Hepatitis E is caused by the hepatitis E virus (HEV) and is a waterborne disease. Hepatitis E is mainly found in areas with poor sanitation and usually results from ingesting fecal matter that contaminates the water supply.

Types of Noninfectious Hepatitis:

Alcoholic Hepatitis:

Excessive alcohol consumption can cause liver damage and inflammation. The alcohol directly injures the cells of your liver. Long exposure to alcohol can cause permanent damage and lead to liver failure and cirrhosis, thickening, and scarring of the liver. The most important risk factors for the development of alcoholic hepatitis are the quantity and duration of alcohol intake. Alcoholic hepatitis can vary from asymptomatic hepatomegaly (enlarged liver) to symptoms of acute or chronic hepatitis to liver failure.

Toxic and Drug-induced Hepatitis:

Overuse or overdose of medications, exposure to industrial toxins, chemical agents, and herbal and dietary supplements can cause this type of hepatitis. It could be acute hepatitis, chronic hepatitis, or acute liver failure. Toxins and medications can cause liver injury including direct cell damage, disruption of cell metabolism, and causing structural changes.

The types of drugs that can cause liver injury includes:

Analgesic paracetamol
Antibiotics such as isoniazid, nitrofurantoin, amoxicillin-clavulanate, erythromycin, and trimethoprim-sulfamethoxazole
Anticonvulsants such as valproate and phenytoin
Cholesterol-lowering statins
Steroids such as oral contraceptives and anabolic steroids
Highly active antiretroviral therapy used in the treatment of HIV/AIDS
The industrial toxin carbon tetrachloride and the wild mushroom Amanita phalloides are other known hepatotoxins. Exposure to hepatotoxins can occur accidentally or intentionally through ingestion, inhalation, and skin absorption which can lead to hepatitis.

Non-Alcoholic Fatty Liver Disease:

This could be non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH), or cirrhosis to liver cancer. Non-alcoholic liver disease occurs in people with little or no history of alcohol use. The cause of non-alcoholic hepatitis can be a metabolic syndrome, obesity, insulin resistance and diabetes, and hypertriglyceridemia.

Over time, non-alcoholic fatty liver disease can lead to non-alcoholic steatohepatitis. This will result in liver cell death, liver inflammation, and possible fibrosis. The risk factors associated with the progression from NAFLD to NASH are obesity, older age, non-African American ethnicity, female gender, diabetes mellitus, hypertension, low platelet count, higher ALT or AST level, higher AST/ALT ratio, and an ultrasound steatosis score.

Autoimmune System Response:

When the immune system mistakes the liver as a harmful object and begins to attack it, causes an ongoing inflammation that can range from mild to severe. This will result in obstructing liver function. This could be acute or chronic hepatitis or fulminant liver failure.

Genetic:

Genetic causes of hepatitis include alpha-1-antitrypsin deficiency, Wilson's disease, and hemochromatosis. The abnormal accumulation of the protein within liver cells, leading to liver disease is known as an alpha-1-antitrypsin deficiency.

In Wilson's disease, excess amounts of copper accumulate in the liver and brain, causing cirrhosis and dementia whereas in hemochromatosis, excess amounts of iron accumulate in multiple body sites, including the liver, which can lead to cirrhosis.

Ischemic Hepatitis:

Ischemic hepatitis is also known as shock liver. This occurs when blood flow is reduced to the liver as in shock, heart failure, or vascular insufficiency. The condition is most often associated with heart failure but can also be caused by shock or sepsis. A person with ischemic hepatitis will have very high levels of transaminase enzymes (AST and ALT).