Hepatitis & Its Causes (2024)

What are the signs and symptoms of hepatitis?

Hepatitis can be stealthy. It doesn’t always cause noticeable symptoms at first. You might notice:

Upper abdominal pain or soreness, especially on the right side.
Nausea or loss of appetite.
Fatigue and malaise (feeling generally unwell).
Fever (if you have a viral infection).

You might notice additional symptoms when hepatitis begins to interfere with your liver functioning. This can happen in more severe cases of acute hepatitis and in cases of chronic hepatitis that have been going on for a long time. When your liver isn’t able to process bile as it usually does, bile doesn’t go where it needs to in your body and instead overflows into your bloodstream. This may cause:

Jaundice (a yellow tint to your skin and eyes).
Dark-colored pee (urine) and light-colored poop (stool).
Pruritus (itchy skin).
Confusion, disorientation or drowsiness (hepatic encephalopathy).

How do you get hepatitis?

Hepatitis has many causes. Most of them can cause either acute or chronic hepatitis, depending on how long they’re affecting your liver. Healthcare providers classify common causes into types of hepatitis.

Viral hepatitis

Viral hepatitis is caused by viruses that infect and damage your liver cells, which leads to inflammation (a response from your immune system). Viral infections that cause hepatitis include:

Toxic hepatitis

Toxins in your bloodstream can cause toxic hepatitis, especially in higher doses and when your liver is already stressed for another reason. Your liver filters toxins from your blood every day, but if the toxic load gets too heavy, these toxins can slow it down or even damage its cells. The damage can be acute or chronic, depending on how severe it is and how often or how long you’re exposed. Causes include:

Industrial chemicals, including vinyl chloride, carbon tetrachloride and certain pesticides and herbicides.
Over-the-counter (OTC) medications, especially high doses of nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen (Tylenol®).
Prescription drugs, including statins, certain antibiotics and anti-seizure medications.
Non-prescribed drugs such as ecstasy, cocaine or off-label use of anabolic steroids.
Some herbs and supplements in large or frequent doses, especially when combined with other factors that may be stressing your liver.

Alcohol-induced hepatitis

Alcohol-induced hepatitis can be chronic or acute. You can get acute hepatitis after a short drinking binge or chronic hepatitis from chronic, heavy alcohol use. Alcohol is always toxic to your liver, but most people can tolerate a certain amount. How much is too much can vary, however. While most people develop hepatitis from heavy drinking, some people are more sensitive to alcohol than others.

Metabolic dysfunction-associated steatohepatitis

Steatohepatitis means hepatitis from fat. It’s an advanced stage of fatty liver disease. That means your liver has begun storing extra fat in its tissues. Alcohol use is one common cause of fat storage in your liver. When it’s not alcohol-related, it’s called metabolic dysfunction-associated steatotic liver disease. When this excess fat builds up enough, it can cause metabolic dysfunction-associated steatohepatitis. This is related to:

Hyperlipidemia (excess fats in your blood).
Overweight and obesity (BMI of 25 or higher).
High blood sugar, insulin resistance and Type 2 diabetes.
High blood pressure and cardiovascular disease.

Autoimmune hepatitis

Some people develop chronic hepatitis as an autoimmune disease. That means their immune systems mistakenly attack their own liver tissues. Autoimmune diseases often develop for no apparent reason. While autoimmune hepatitis causes liver inflammation directly, other autoimmune diseases can affect the bile ducts that run through your liver (primary biliary cholangitis or primary sclerosing cholangitis).

Other causes

Other possible causes of hepatitis include:

Cholestasis. Cholestasis means that bile flow has stalled within your biliary tract. Your liver is part of your biliary system: It makes and delivers bile through your bile ducts. When bile flow stalls, bile can back up into your liver and cause hepatitis. This can happen suddenly (acute), due to a bile duct obstruction, or gradually (chronic), due to a chronic disease or condition.
Inherited metabolic disorders. Rare genetic disorders that affect your metabolism can also affect your liver. For example, Wilson disease and hemochromatosis are both conditions that cause toxic levels of metals to build up in your liver. Gaucher disease and glycogen storage disease (GSD) cause metabolic waste products to build up in your blood, which your liver filters.
Ischemia. Ischemia is a sudden or gradual loss of blood flow to one of your organs. It can cause acute or chronic inflammation anywhere in your body. Common causes include sudden vasoconstriction, occlusions such as blood clots and arterial diseases that narrow your arteries. Sometimes, ischemia is a response to shock from a severe infection or organ failure.

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Is hepatitis contagious?

Viral hepatitis is contagious. Other types of hepatitis aren’t. Viruses, however, are the most common cause of hepatitis worldwide. And viruses, by nature, are all contagious. There are at least five distinct hepatitis viruses — hepatitis A, B, C, D and E — as well as other viral infections that can cause hepatitis. These different viruses spread in different ways. Some of the ways viral hepatitis can spread include:

Food poisoning. Hepatitis A and E commonly spread through contaminated food and water.
Contaminated blood. Hepatitis B, C and D can spread through contact with blood from an infected person. This commonly happens when sharing needles for intravenous drug use.
Bodily fluids. Hepatitis B and D can spread through other bodily fluids as well as blood. They commonly spread through sexual contact and from parent to child during childbirth.

What are the risk factors for acquiring hepatitis?

Risk factors for acquiring hepatitis include:

Intravenous drug use.
Heavy use of substances such as alcohol.
Overuse of prescription or over-the-counter medications.
Metabolic syndromes, such as high cholesterol, high blood sugar and obesity.
Living in or travelling to places with lower levels of public sanitation.
Workplace exposure to toxic chemicals.

What are the possible complications of hepatitis?

Severe or persistent hepatitis can lead to:

Cirrhosis. Cirrhosis is scarring of your liver, which can occur after many years of chronic hepatitis. Chronic inflammation and swelling in your liver tissues cause progressive scarring. As healthy liver tissue is gradually replaced with scar tissue, your liver gradually loses its ability to function. Cirrhosis can eventually lead to chronic liver failure.
Portal hypertension. While cirrhosis is a gradual process and not everyone will progress to liver failure, other complications can develop, including portal hypertension. Scar tissue compressing the portal veins that run through your liver causes other veins in your stomach and esophagus to expand. These enlarged veins (varices) can rupture, causing serious internal bleeding.
Liver cancer. Chronic hepatitis and cirrhosis are both risk factors for developing primary liver cancer (hepatocellular carcinoma). Inflammation itself is one risk factor. Viral hepatitis may also be involved in changing the DNA in your liver cells, turning healthy cells into cancer cells. More than half of people who develop liver cancer have chronic hepatitis B or C.
Liver failure. Liver failure means that your liver begins to lose its ability to function. Like hepatitis, liver failure can also be acute or chronic. Severe toxic overload can cause acute liver failure, while chronic liver failure can develop after many years of chronic hepatitis and cirrhosis. Acute liver failure is sometimes reversible, but chronic liver failure isn’t. Both can be fatal.