Hepatitis - Types and Symptoms

Hepatitis means inflammation of the liver, can affect people of both sexes and all ages and ethnicities. In this paper we explain what the main causes of hepatitis are.

Hepatitis is caused mainly by virus, Hepatitis A, B, C, D and E, infections, alcohol, medicines and drugs, autoimmune diseases (when the body inappropriately makes antibodies against ourselves), circulatory shock, steato-hepatitis.

Let's talk a little bit of each. At the end of the article the symptoms will be discussed, which are basically the same, regardless of the cause of hepatitis.



Several viruses can cause inflammation of the liver frames, or hepatitis. These include the dengue, cytomegalovirus and yellow fever. However, we call viral hepatitis only those that are caused by viruses that attack the liver preferentially.

There are five viral hepatitis - A, B, C, D and E. The first three correspond to more than 95% of cases.

Contrary to what common sense leads us to think, the viruses that cause viral hepatitis are very different. The hepatitis C, for example, genetically much more similar to dengue virus than those of other hepatitis. The viral hepatitis should be considered as different diseases with different prognosis and treatment, but having in common the fact that they are viruses that cause hepatitis.

Hepatitis A

It is transmitted by the fecal-oral route, or when the virus shed in feces of infected person is ingested by a healthy person. You might be wondering how disgusting it is and that would never happen to you. But hepatitis A is extremely common. People may contact the virus swimming at a beach or a lake polluted by sewage, eating something prepared by someone who does not wash hands after evacuating or eating shellfish from infected water.

As you might expect, places with lack of sanitation, with open sewers, have high rates of contamination. Look on the map as the prevalence is much higher in poor countries (dark green). Hepatitis A is usually milder than B or C. When contracted in childhood, may be overlooked, being mistaken for a common flu. In adults more often symptomatic (symptoms will be spoken about further down). Even in symptomatic cases, the infection tends to heal.

There is a vaccine for hepatitis A.

Hepatitis B

It is usually transmitted by sexual contact, blood transfusion or contaminated needles, not only by intravenous drug users, but also by tattoos, body piercing and acupuncture.

Most patients also tend to have subclinical hepatitis with nonspecific symptoms of viral infection. The problem is that in 5-10% of cases hepatitis B is never healed and what is called chronic hepatitis is developed, which in the long term can lead to cirrhosis, liver failure and liver cancer. The chance of becoming chronic disease is higher in children below 5 years and reaches 90% infections acquired by newborns during delivery.

Hepatitis B is 100 times more spread than infectious HIV. An estimated 350 million people with chronic hepatitis B worldwide, 25% of these should develop cirrhosis or liver cancer.

There is also a vaccine for Hepatitis B.

Hepatitis C

It has the same transmission routes that hepatitis B, with the difference being much less infectious through sexual contact. While sexual transmission is the main mode of transmission of hepatitis B, the intravenous route is most common in hepatitis C. The great tragedy of hepatitis C virus is that it was only recognized in the early 1990s. Before that no one knew of its existence, and therefore neither the bags of blood for transfusion, or donors, were tested for this infection.

Again, acute hepatitis C is usually little symptomatic in 75% of cases. The big problem is that over 80% of those infected progress to chronic form. 25% of these will progress to cirrhosis or cancer in 20 to 30 years.

Today those people who acquired the virus in the 80s are examined to provide information about complications of chronic infection. Around 170 million people worldwide have hepatitis C. There is no vaccine, but treatment has evolved greatly in recent years, reaching cure rates of up to 80% depending on the subtype C viruses (there are three subtypes).


Alcohol is a known hepatotoxic drug. Alcoholic hepatitis is a syndrome associated with prolonged consumption of alcohol. Like all chronic hepatitis can also progress to cirrhosis and liver failure. If the patient is already carrying viral hepatitis and yet consuming alcohol, the risk of cirrhosis is much greater.

Women are more susceptible to the risks of alcohol hepatitis than men. The main treatment is a total suspension of alcohol consumption.


As with any autoimmune disease, such hepatitis is caused by a malfunction of our defense system is that attacks not only viruses, bacteria and other invading substances but also begins attacking the liver cells. If not treated in time, autoimmune hepatitis leads to a picture of chronic hepatitis that progresses to cirrhosis and liver failure. Without treatment, half of patients with autoimmune hepatitis will die in less than five years.

70% of autoimmune hepatitis occurs in women. Genetic factors are linked to the development of the disease that can be triggered after pictures of viral hepatitis, infection with Epstein-Barr virus, or by drugs such as methyldopa, Nitrofurantoin and Minocycline. Autoimmune hepatitis is related to the presence of autoantibodies in the blood as FAN, Anti-LKM and anti-smooth muscle.

Treatment is corticosteroids and immunosuppressants such as azathioprine.


The inflammation of the liver can be caused by use of some medications. There have been described over 900 drugs or products called "natural" causes of hepatitis drug. The most famous are acetaminophen, ibuprofen, amiodarone, isoniazid, drugs for lowering cholesterol, erythromycin, oral contraceptives, allopurinol, anabolic steroids and valproic acid.

As you may notice they all are common drugs in medical practice. We cannot know beforehand who will progress to hepatitis and who will not. It is therefore important to avoid unnecessary medication and self-medication. This applies particularly in relation to "natural medicines" that often do not present the alleged benefits and may even lead to serious liver injuries.


Ischemic hepatitis is the one that occurs due to a low flow of blood to the liver. It usually occurs after cases of circulatory shock and severe sepsis or advanced heart failure states. Cocaine can cause spasms of the hepatic arteries and also cause ischemic hepatitis.


The steatohepatitis is an advanced form of liver steatosis caused by accumulation of fat in the liver. The main risk factors are alcohol, obesity, type 2 diabetes and hypercholesterolemia.


Symptoms of hepatitis are jaundice (yellow skin and eyes), dark urine (urine color matte) and acholic stools (almost white).

Other less specific symptoms include weakness, generalized itching, nausea, loss of appetite, liver pains and fever. Early diagnosis of hepatitis is important since the discontinuation of the causative agent or the institution of early treatment can prevent progression to cirrhosis or liver failure.

The main blood tests for identification of hepatitis are transaminases (AST and ALT). In acute viral hepatitis there is no specific treatment, but the action is important to identify those who will progress to chronic hepatitis, especially in hepatitis B and C.