Hepatitis
- Fysiobasen
- Sep 13
- 9 min read
Hepatitis is a condition in which the liver becomes inflamed, meaning an inflammatory reaction occurs in the liver tissue. The liver is a vital organ responsible for breaking down waste products, producing important proteins, and regulating metabolism. Inflammation of the liver may resolve spontaneously or progress to more serious conditions such as fibrosis (scarring of the liver), cirrhosis, or, in the worst case, liver cancer¹. Hepatitis is considered a major global health problem because it affects millions of people worldwide and can lead to severe illness and death.
Causes and Pathophysiology
Hepatitis can have several different causes, but the most common worldwide is infection with viruses that target the liver¹. The most important hepatitis viruses are divided into five main types: hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), and hepatitis E virus (HEV). Each of these has different transmission routes and varying courses of disease and severity².
Hepatitis A and E are usually transmitted via food and water contaminated with feces (fecal-oral transmission). They typically cause acute and self-limiting inflammation.
Hepatitis B, C, and D are transmitted through blood or other bodily fluids, for example through needle sharing, blood transfusions, or sexual contact. Hepatitis B can also be transmitted from mother to child during birth or through close household contact.
Once inside the body, the virus infects liver cells (hepatocytes). The immune system responds by attacking the virus, and it is this immune reaction that produces the inflammation in the liver tissue. In some cases, the body clears the virus completely (acute course). In other cases, a persistent infection develops (chronic hepatitis), where inflammation lasts longer than six months³. Chronic inflammation can cause liver tissue damage, scarring (fibrosis), cirrhosis, and eventually liver cancer.
Hepatitis may also be caused by non-viral factors. Some people develop hepatitis after exposure to toxins (e.g., alcohol, certain medications, or solvents), or due to autoimmune reactions in which the immune system attacks liver cells (autoimmune hepatitis).
Risk Factors
Risk factors for developing hepatitis depend on the specific type:
Hepatitis A and E: Highest risk in areas with poor water quality and hygiene, or after consuming contaminated food or drink.
Hepatitis B, C, and D: Most common among individuals exposed to blood or bodily fluids—such as through unsafe injections, untested blood transfusions, unprotected sex, or mother-to-child transmission at birth.
Other risk factors include unsafe healthcare procedures in regions with poor infection control, drug use, and close contact with infected individuals.
People with weakened immune systems, pregnant women (especially with hepatitis E), and those with other chronic liver diseases are at increased risk of severe disease progression¹.
Symptoms
The clinical presentation of hepatitis varies greatly depending on the cause, the type of virus, and whether the disease is acute or chronic. Many patients experience few or no symptoms, particularly in the early stages.
The classic course of viral hepatitis can be divided into four phases:
Viral replication phase: The patient has no symptoms, but blood tests may show evidence of viral infection.
Prodromal phase: Symptoms such as loss of appetite (anorexia), nausea, vomiting, fatigue, itching (pruritus), rash (urticaria), joint pain (arthralgia), and general malaise occur. Many patients are initially misdiagnosed with gastroenteritis or a common viral infection at this stage.
Icteric phase: Dark urine, pale stools, jaundice (yellowing of skin and eyes), pain in the upper right abdomen (over the liver), and hepatomegaly may appear.
Convalescent phase: Symptoms gradually subside, and liver function tests return toward normal.
Typical symptoms of different forms of hepatitis:
Hepatitis A: Often resembles a gastrointestinal infection or influenza: fatigue, nausea, fever, jaundice, loss of appetite, and dark urine. The illness usually resolves spontaneously.
Hepatitis B: Often begins with loss of appetite, fatigue, pain in the upper abdomen, followed later by jaundice and an enlarged, tender liver. The course ranges from rapid recovery to prolonged fluctuating disease, and in some cases, severe acute liver failure.
Hepatitis C: Usually asymptomatic in the acute phase, but may cause symptoms similar to hepatitis B. About 80% of infected individuals do not develop jaundice and may therefore be unaware of the infection¹.
Diagnosis
The diagnosis of hepatitis is based on symptoms, medical history, and diagnostic tests.
Blood tests:
Detect the virus directly or antibodies against the specific virus
Assess liver function and damage (e.g., ALT, AST, bilirubin)
May also indicate other injury or ongoing inflammation
Imaging:
Ultrasound, CT, or MRI can evaluate liver size, structure, and possible tumors or fibrosis. These tests do not detect the virus itself but help assess complications and the extent of liver damage.
Liver biopsy:
A thin needle is used to obtain a small tissue sample from the liver. The sample is examined under a microscope to evaluate inflammation, fibrosis, and possible malignant changes. Biopsy is especially useful when the diagnosis is unclear or advanced damage is suspected¹.
Differential diagnoses include other causes of liver disease, such as cholestasis, alcoholic liver disease, fatty liver (steatosis), autoimmune conditions, and rare metabolic disorders.
Treatment and Medical Management
Treatment of hepatitis depends on the cause and severity:
Hepatitis A and E: No specific treatment exists. The condition usually resolves spontaneously, and supportive care with rest, fluids, nutrition, and symptom relief is most important.
Hepatitis B and C: Preventive vaccination is available for hepatitis B, along with antiviral therapy. Chronic hepatitis B can be managed with antivirals that suppress viral load and slow disease progression. Hepatitis C can now be cured in most cases with modern direct-acting antiviral medications¹.
Severe cases: In rapidly progressing liver failure, hospitalization, intensive care, and, in rare cases, liver transplantation may be necessary.
Other forms of hepatitis (toxic, autoimmune) are treated based on the underlying cause—for example, discontinuing harmful medications or initiating immunosuppressive therapy.
Prognose og forløp
Prognosen avhenger av hvilken type hepatitt det er, hvor alvorlig sykdommen er, og pasientens generelle helsetilstand.
Akutt hepatitt A og E: Går som oftest over uten varige mén.
Hepatitt B og C: Kan gi kronisk infeksjon hos noen, med risiko for utvikling av skrumplever, leversvikt og leverkreft over tid.
Rask og alvorlig utvikling av leversvikt er sjelden, men kan være livstruende.
Ved vellykket behandling og tett oppfølging har mange med kronisk hepatitt god prognose, men det krever langvarig medisinsk og tverrfaglig oppfølging.
Differensialdiagnoser
Ved symptomer som gulsott, mørk urin, magesmerter og trøtthet må man alltid vurdere andre tilstander som kan gi lignende symptomer:
Gallestase (gallestein eller gallesykdom)
Alkoholisk leversykdom
Fettlever (ikke-alkoholisk steatohepatitt)
Autoimmune leversykdommer
Metabolske eller arvelige tilstander
Maligne tilstander (svulster i lever eller galleveier)
Grundig sykehistorie, klinisk undersøkelse, blodprøver og billeddiagnostikk brukes for å skille disse fra hepatitt.
Prognosis and Disease Course
The prognosis depends on the type of hepatitis, severity of the disease, and the patient’s overall health.
Acute hepatitis A and E: Usually resolve without lasting damage.
Hepatitis B and C: Can lead to chronic infection in some patients, with risk of cirrhosis, liver failure, and liver cancer over time.
Rapid and severe progression to liver failure is rare but potentially life-threatening.
With successful treatment and regular follow-up, many patients with chronic hepatitis have a good prognosis, but this requires long-term medical and multidisciplinary care.
Differential Diagnoses
In patients with jaundice, dark urine, abdominal pain, and fatigue, it is important to consider other conditions that can present with similar symptoms:
Cholestasis (gallstones or biliary disease)
Alcoholic liver disease
Fatty liver (non-alcoholic steatohepatitis)
Autoimmune liver disease
Metabolic or hereditary conditions
Malignancies (tumors in the liver or biliary tract)
A thorough history, clinical examination, blood tests, and imaging are essential to distinguish hepatitis from these conditions.
Treatment and Medical Management
The treatment of viral hepatitis is always based on an individualized, comprehensive approach aimed at limiting or halting further liver damage and rapidly identifying and treating complications¹. Because hepatitis has different causes and courses, management must be tailored according to virus type, disease stage, patient age, comorbidities, and risk factors.
The first step is prevention, to avoid infection and reduce transmission. Preventive measures are critical to limit new cases and prevent outbreaks. Key strategies include:
Vaccination against hepatitis A and B
Avoiding unnecessary or unsafe injections and blood transfusions
Avoiding contact with contaminated needles, syringes, or equipment
Condom use to reduce sexual transmission
Not sharing personal items such as razors or toothbrushes
Avoiding tattoos, piercings, or acupuncture with non-sterile equipment
Practicing good personal hygiene, including handwashing and washing food before use
Drinking safe, clean water and ensuring adequate sanitation
Avoiding injectable drug use
Safe disposal of medical waste²
Antibiotics are ineffective against hepatitis since it is a viral infection—management relies on antivirals when appropriate. For all forms of viral hepatitis, general recommendations include rest, adequate nutrition and hydration, and symptom relief. Alcohol, over-the-counter drugs, supplements, and herbal remedies can often worsen liver damage and should always be discussed with a physician³.
Hepatitis A: Usually requires only supportive care, as the disease typically resolves spontaneously within weeks to months. Symptoms are managed with rest, fluids, and diet adjustments.
Hepatitis B: Can be treated with antiviral drugs that suppress viral replication and reduce liver damage. Newer therapeutic strategies include immunomodulating and gene-targeted treatments. For some patients, the goal is disease control, while for others, complete viral eradication may be achievable⁴.
Hepatitis C: Today, most patients can be cured with modern direct-acting antivirals. Subtypes of HCV require slightly different approaches, but all regimens are highly effective. Follow-up also includes counseling to prevent transmission and regular monitoring of liver function.
In severe cases—such as acute liver failure, worsening general condition, or suspected malignancy—hospitalization is required. Intensive treatment may be necessary, and in extreme cases, liver transplantation may be indicated. This involves replacing the diseased liver with a donor organ and carries significant risks⁵.
Complications are managed according to severity and clinical presentation. Patients with chronic hepatitis must undergo regular follow-up to detect progression to cirrhosis, liver failure, or liver cancer as early as possible.
Physiotherapy and Follow-up
Physiotherapy in hepatitis management focuses on supporting patients in maintaining optimal physical function and preventing complications related to reduced activity and muscle mass. Hepatitis can lead to fatigue, muscle weakness, and decreased endurance, especially in those with prolonged or severe disease. While no specific physiotherapy intervention can cure the infection itself, several important aspects of physiotherapeutic care are emphasized:
Functional assessment: Evaluation of muscle strength, endurance, balance, mobility, and overall health status.
Education and patient counseling: Providing knowledge about the disease, risk factors, the role of physical activity, and how physical condition influences disease progression.
Prevention of inactivity: Tailoring exercise programs and activity levels to the patient’s condition to counteract muscle loss and reduced cardiovascular fitness.
Gradual progression: For patients with fatigue or low functional levels, activity is increased stepwise with adequate rest between sessions.
Strength and endurance training: General resistance training and moderate aerobic exercise are recommended to rebuild capacity and enhance well-being.
Symptom monitoring: Physiotherapists must watch for signs of fatigue or disease worsening and adjust or stop training when needed.
Energy conservation: Teaching patients to manage energy wisely throughout the day and rest when necessary.
In acute hepatitis A, rest is most important during the illness, and physical activity should only be resumed gradually after recovery. In chronic hepatitis, regular, gentle exercise benefits both physical and mental health and helps prevent further complications⁶.
Infection Control and Healthcare Measures
To prevent transmission when a patient with hepatitis is admitted to healthcare facilities, the following precautions must be strictly observed:
Patient isolation with access to a private toilet
Regular disinfection of the environment
Use of gloves and protective equipment by all healthcare staff when in contact with body fluids
Strict hand hygiene before and after patient contact
Proper cleaning or disinfection of all equipment, bedding, and textiles
Disposal of all waste and sharp objects in approved containers
Avoiding contact with the patient’s blood and body fluids
These measures are essential to protect both other patients and healthcare workers.
Complications
The most important complications of viral hepatitis include:
Chronic infection: Especially in hepatitis B and C, where the virus may persist for years and gradually damage the liver.
Chronic active hepatitis: Persistent liver inflammation leading to fibrosis and loss of liver function.
Cirrhosis: Advanced scarring of the liver with functional impairment and increased risk of liver cancer.
Liver failure: Acute or progressive inability of the liver to detoxify the body and produce vital substances.
Liver cancer (hepatocellular carcinoma): Particularly high risk in patients with long-standing hepatitis B or C.
Extrahepatic manifestations: For example, vasculitis, kidney disease, skin involvement, or joint inflammation (especially with hepatitis C).
Fulminant liver failure: Acute, severe loss of liver function, often with high mortality.
Approximately 1% of patients with acute hepatitis B may develop life-threatening liver failure with high mortality in the absence of transplantation. In chronic hepatitis C, 75–85% develop persistent infection, and about 20% of these eventually progress to cirrhosis with an increased risk of liver cancer⁷.
Sources
WHO. Hepatitis. Available from: https://www.who.int/news-room/q-a-detail/hepatitis
Centers for Disease Control and Prevention. Information for the public: Frequently asked questions about hepatitis B. Available from: http://www.cdc.gov/hepatitis/b/bFAQ.htm#statistics
Mehta P, Reddivari AK. Hepatitis. 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554549/
Zignego AL, Gragnani L, Giannini C, Laffi G. Hepatitis C virus infection as a systemic disease. Internal and Emergency Medicine. 2012;7(Suppl 3):S201–S208.
Verywell Health. Hepatitis. Available from: https://www.verywellhealth.com/hepatitis-diagnosis-1759919
WHO. Hepatitis C. Available from: http://www.who.int/mediacentre/factsheets/fs164/en/
CDC. Medical management of chronic hepatitis B and C. Available from: http://www.cdc.gov/idu/hepatitis/manage_chronich_hep_b-c.pdf
Almeida PH, Matielo CE, Curvelo LA, Rocco RA, Felga G, Della Guardia B, Boteon YL. Update on management and treatment of viral hepatitis. World Journal of Gastroenterology. 2021;27(23):3249.
WHO. Hepatitis A. Available from: http://www.who.int/mediacentre/factsheets/fs328/en/
