For professionals:

• Virus (HBV, HCV, HDV), Drug, Toxin, Autoimmune, Cryptogenic

• Prevalence: different depends on geographical region, ethnic back ground, high risk behavior.

• Etiological viruses can be identified by serological tests.
  • 1. HBV:
    • Serum tests for HBsAg, HBeAg, HBV-DNA and histological verification of HBcAg.

    • Serum HBsAg ( + ), HBeAg ( + ), HBV-DNA ( + )¡Gpersisting replication of viruses .

    • Serum HBeAg ( - ), HBV-DNA ( - ) with anti-HBe ( + )¡Gusually present with milder clinical symptoms with less viruses --- usually seen in asymptomatic carrier.

    • HBV variant (precore or HBeAg negative mutant) --- Failure to produce HBeAg, but with persistent anti-HBe ( + ) and HBV-DNA ( + ) --- persistent progression of hepatic inflammation.

  • 2. HCV:
    • Serum anti-HCV and HCV-RNA (+) --- histplogical activity is related to degree of viral replication.

    • In some cases, there are production of autoantibodies such as: ANA, anti-LKM (anti-liver and kidney microsomes).

  • 3. HDV:
    • Serum anti-HDV and HDV-RNA ( + )

    • Serum HBsAg: usually ( + )

  • 4. Autoimmune:
    • Patients losing immunological tolerance of liver itself.

    • Various factors as: environment and varied contageous agents trigger the disease.

    • Female predominance.

    • Serum hypergammaglobulinemia: more predominant.

    • HLA Type: predominantly B8, DR3, DR4

    • Frequently associated with autoimmune diseases such as: thyroiditis, ulcerative colitis, Sjogren's syndrome.

    • With characteristic serum autoimmune antibodies such as: ANA, Anti-LKM antibody, anti-smooth muscle antibody, anti-soluble liver antigen antibody, anti-liver-pancreas antigen antibody, anti-asialoglycoprotein receptor antibody, anti-heptocyte plasma membrane antigen antibody.

    • Absence of serum markers of HBV, HCV and HDV infections and anti-mitochrondrial antibody.

    • Well respond to corticosteroid and/or immunosuppressive therapy.

    • Subgroups of autoimmune hepatitis:
      • Autoimmune hepatitis type 1: high titers of ANA or SMA.

      • Autoimmune hepatitis type 2: presence of anti-LKM-1 directed against cytochrome P-450 IID6.

      • Autoimmune hepatitis type 3: presence of soluble liver antigen antibodies in the absence of ANA or anti-LKM.

  • 5. Drug-induced chronic hepatitis:
    • drugs as a cause of liver injury.

  • 6. Cryptogenic chronic hepatitis:
    • without evidence of viral, drug-induced or autoimmune induced liver injuries.