Chronic Hepatitis

Authored by Dr Colin Tidy, 11 Feb 2014

Reviewed by:
Dr Adrian Bonsall, 11 Feb 2014

Patient professional reference

Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Jaundice article more useful, or one of our other health articles.

Chronic hepatitis is defined as inflammatory disease of the liver lasting for more than six months. The histological differentiation between chronic persistent hepatitis (no cell necrosis) and chronic active hepatitis (cell necrosis) does not correlate with prognosis and is therefore now much less used.

  • Viral hepatitis: hepatitis B, hepatitis C, cytomegalovirus, Epstein-Barr virus.
  • Metabolic: non-alcoholic fatty liver disease (NAFLD), haemochromatosis, Wilson's disease, alpha-1-antitrypsin deficiency.
  • Toxic and drugs: alcoholic liver disease, amiodarone, isoniazid, methyldopa, methotrexate, nitrofurantoin.
  • Autoimmune: autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis.
  • Sarcoidosis.

See also the separate article on Abdominal Examination.

Symptoms

  • Nonspecific symptoms - eg, fatigue, anorexia, muscle pains, arthralgia, weight loss.
  • Right hypochondrial pain (liver distension).
  • Abdominal distension (ascites).
  • Ankle swelling (fluid retention).
  • Haematemesis and melaena (gastrointestinal haemorrhage).
  • Pruritus (cholestasis).
  • Breast swelling (gynaecomastia), testicular atrophy, loss of libido and amenorrhoea due to endocrine dysfunction.
  • Confusion and drowsiness (encephalopathy).

Signs

  • Spider naevi (chest and upper body), slate-grey appearance in haemochromatosis.
  • Palmar erythema.
  • Jaundice.
  • Clubbing.
  • Dupuytren's contracture (alcoholic cirrhosis).
  • Xanthomas: palmar creases or above the eyes in primary biliary cirrhosis.
  • Initial hepatomegaly may be followed by a small liver in well-established cirrhosis.
  • Splenomegaly (portal hypertension).
  • Hirsutism.
  • Urinalysis: bilirubin and urobilinogen.
  • Blood tests:
    • FBC (associated anaemia, thrombocytopenia, raised MCV with alcohol abuse), clotting studies (clotting impairment with hepatic dysfunction).
    • Renal function and electrolytes (associated renal dysfunction).
    • LFTs, serum albumin, prothrombin time.
    • Immunoglobulins (IgG raised in autoimmune hepatitis; IgM raised in primary biliary cirrhosis).
    • Autoantibodies: antinuclear antibodies, smooth muscle antibodies, anti-mitochondrial antibodies; see the separate article on Plasma Autoantibodies (Disease Associations).
    • Hepatitis B and C serology.
    • Alpha-1 antitrypsin.
    • Caeruloplasmin, copper (haemochromatosis).
    • Iron studies.
    • Alpha-fetoprotein (hepatocellular carcinoma).
  • Ultrasound, CT or MRI scan: local liver or biliary tract abnormality, especially hepatocellular carcinoma which may occur as a complication of cirrhosis.
  • Transient elastography has been shown to be a simple and effective method for assessing liver fibrosis.[1]
  • Genetic testing - eg, haemochromatosis.
  • Upper gastrointestinal endoscopy (diagnosis and management of oesophageal varices).
  • Liver biopsy: the main indication for liver biopsy in chronic viral hepatitis is to assess the severity of the disease, in terms of both necro-inflammation (grade) and fibrosis (stage), which is important for management and prognosis.[2]

Other causes of chronic liver failure or the development of cirrhosis.

See the separate articles on specific causes - eg:

Prevention is covered in the separate articles on Hepatitis B Vaccination and Prevention and Hepatitis C.

Further reading and references

  1. Diagnosis of fibrosis and cirrhosis. Liver biopsy is not always necessary.; Diagnosis of fibrosis and cirrhosis. Liver biopsy is not always necessary. Prescrire Int. 2010 Feb19(105):38-42.

  2. Guido M, Mangia A, Faa G; Chronic viral hepatitis: the histology report. Dig Liver Dis. 2011 Mar43 Suppl 4:S331-43. doi: 10.1016/S1590-8658(11)60589-6.

  3. El-Serag HB; Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology. 2012 May142(6):1264-1273.e1. doi: 10.1053/j.gastro.2011.12.061.

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