Hepatitis can assume varied forms depending on type & severity of infection and individual immunity.It can be of following forms
Fulminant hepatitis
There is rapid onset of liver failure due to rapid liver cell necrosis which occurs due to modification of host response to viral infection, allowing rapid viral replication Hepatitis B and C and superinfection with delta agent accounts for majority of the cases.
Mortality in 3 weeks is 30 percent and 90-100 percent above age 60 die.
Clinically there is progressive jaundice, hepatic encephalopathy and hepatorenal syndrome prothrombin time is elevated.
Cholestatic Hepatitis
There are features of obstructive jaundice with alkaline phosphatase elevated more than SGPT, during the course of viral hepatitis.
It is to be differentiated from biliary obstruction. The prognosis is excellent, recovery occurs over few months.
Relapsing hepatitis
This occurs several weeks or months after apparent recovery. Sometimes it may be a second bout of hepatitis with a different virus.
Viral hepatitis with autoimmune features
It occurs in 5 percent of patients with hepatitis B due to circulating immune complexes. Anorexia, malaise, fatigue, urticaria, angioedema migrating arthralgia and non-deforming arthritis of knee, ankle and wrist may occur along with vasculitis and glomerulonephritis. Prognosis is excellent as these rarely persist beyond 2 weeks.
Hepatitis with aplastic anemia
This is rarely seen with acute viral hepatitis. The mortality rate is high and no treatment has been effective.
