|Classification according to ICD-10|
|K75.9||Inflammatory liver disease, unspecified|
|ICD-10 online (WHO version 2019)|
As Hepatitis (plural: hepatitis; from ancient Greek ἧπαρ hepar , German , liver ' ) is an inflammation of the liver called, may be responsible for numerous causes. If another underlying disease leads to this inflammation of the liver, it is called accompanying hepatitis.
Clinically, one differentiates between acute hepatitis and chronic hepatitis (= hepatitis that has not healed after six months).
Hepatitis always starts with damage and destruction of the liver cells ( hepatocytes ). The causes of this damage are very diverse, there can be a purely mechanical or physical impairment (radiation hepatitis, bruise , blood flow disturbance , etc.), or toxic substances (drugs, drugs, poisons) and pathogens ( viruses , bacteria , parasites ) can directly affect the liver cell to destroy. The different forms of hepatitis differ in terms of the original damage to the liver cells only in terms of severity and duration. The result of the damage and inflammation is almost always the same:
- Release of inflammatory mediators , especially cytokines , immigration of leukocytes and macrophages into the liver tissue: Signs of inflammation in the body: leukocytosis , fever , increased erythrocyte sedimentation reaction , C-reactive protein (CRP)
- Impairment or death ( necrosis ) of the liver cells, release of proteins and enzymes from dead liver cells: increase in transaminases ("liver enzymes")
- Limitation of the metabolic functions of the liver: Disturbance of hemoglobin and bile acid metabolism with accumulation of unconjugated, i.e. H. of albumin bound, bilirubin in the blood and consequent jaundice ( icterus ). The disturbed energy metabolism ( glycogen ) can result in a feeling of weakness. Since the synthesis of blood coagulation factors is reduced, there is an increased tendency to bleed. Furthermore, the removal of free ammonia from the bloodstream is impaired, which causes encephalopathy with the end stage of liver coma ( coma hepaticum ).
- If the inflammation does not heal without consequences ( restitutio ad integrum ), the submerged liver tissue is replaced by scar tissue: fibrosis of the liver, liver cirrhosis
Types of inflammation of the liver
The most common causes of hepatitis are viral infections ( viral hepatitis ) and autoimmune hepatitis .
- The "classic" viral hepatitis:
- Hepatitis A , in Germany 2002–2018 less than 2000 cases per year
- Hepatitis B , in Germany 2000–2018 less than 5000 cases per year
- Hepatitis C.
- Hepatitis D (only in connection with hepatitis B)
- Hepatitis E.
- Hepatitis with non-classical hepatitis viruses:
- Herpesvirus family viruses :
- Epstein-Barr virus ( Pfeiffer glandular fever )
- Herpes simplex virus (for herpes sepsis )
- Varicella zoster virus (chickenpox, shingles)
- Mumps virus
- Rubella virus (rubella)
- Adenoviruses , also known as hepatitis contagiosa canis (canine hepatitis) in dogs
- Enteroviruses / Coxsackieviruses (enterovirus hepatitis in newborns)
- Yellow Fever Virus and Other Hemorrhagic Fever Viruses
- Herpesvirus family viruses :
- Bacterial pathogens and fungi:
- Coxiella burnetii : Q fever
- Mycobacterium tuberculosis ( tuberculosis )
- Treponema pallidum ( syphilis ): congenital or acquired
- Salmonella and Shigella
- Candida yeast
- Parasitic pathogens:
- Plasmodia ( malaria )
- Leishmania ( leishmaniasis )
- Toxoplasma gondii ( toxoplasmosis )
- Liver fluke
- Schistosoma ( pair of leeches ) ( schistosomiasis / schistosomiasis)
The following forms of toxic hepatitis are known:
- Alcohol-toxic hepatitis ( alcohol hepatitis )
- Drug and drug-induced hepatitis: e.g. B. diclofenac , chlorpromazine , isoniazid , paracetamol , methotrexate , chelidonium , isotretinoin
- Hepatitis in case of poisoning (solvents, fungal poisons: aflatoxins )
- Radiation hepatitis (after radiation therapy )
- Post-traumatic hepatitis (liver contusion , contusion )
- Inflammation of the biliary tract ( cholangitis )
- Cardiac hepatitis (congestive hepatitis)
- Non-alcoholic steatohepatitis (NASH, fatty liver hepatitis )
- Hemochromatosis (iron storage disease)
- α 1 -antitrypsin deficiency
- Wilson's disease (copper storage disease)
Every acute viral hepatitis is a reportable disease under German law in accordance with Section 6 of the Infection Protection Act . In Austria, according to Section 1 (1) of the 1950 Epidemic Act, only infectious [e] hepatitis (hepatitis A, B, C, D, E) is notifiable . In Switzerland, too, hepatitis A, B, C, D and E are subject to mandatory reporting according to numbers 19-21a of Annex 1 of the FDHA Ordinance on the reporting of observations of communicable diseases in humans .
- Gert Frösner: Modern hepatitis diagnostics. Kilian, Marburg 2001, ISBN 3-932091-50-7 .
- Hartwig Klinker: infections caused by hepatitis viruses. In: Marianne Abele-Horn (Ed.): Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , pp. 297-301.
- Hans Adolf Kühn: diseases of the liver. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition, ibid. 1961, pp. 847-875, here: pp. 854-870.
- Competence network hepatitis. German Liver Foundation
- Hepatitis diagnosis scheme. In: Laborlexikon. medweb24 GmbH
- Hepatitis in Austria. In: ages.at. Austrian Agency for Health and Food Safety, AGES for short, July 26, 2019.