Acute hepatitis

Etiology

Causes of acute hepatitis

• Viral: hepatitis A, B, C*, D (in presence of B), E, infectious mononucleosis, CMV, HSV, parvovirus B19
• Other infections, e.g., leptospirosis, secondary syphilis, brucellosis, Q fever
• Alcoholic hepatitis
• Toxins (predictable): acetaminophen, Amanita mushrooms, tetracycline, valproic acid
• Toxins (idiosyncratic): INH, NSAIDs, statins, azole antifungals, halothane, ecstasy, kava
• Vascular: right-sided CHF, shock liver, portal vein thrombosis, Budd-Chiari syndrome
• Metabolic: Wilson’s disease, acute fatty liver of pregnancy, Reye’s syndrome
• Autoimmune hepatitis*
• Lymphoma or metastatic cancer*

* generally do not present acutely

Causes of cholestasis (selected)

• Extrahepatic: choledocholithiasis, pancreatic tumor, biliary stricture, primary sclerosing cholangitis (intra- and extrahepatic)
• Intrahepatic: primary biliary cirrhosis, autoimmune cholangitis, infiltrative disease (e.g., TB, sarcoidosis, lymphoma, amyloidosis), drugs