566 Hepatitis Overview

Hepatitis includes a broad range of conditions, each with distinct management. Family physicians often see patients with a mild elevation in transferase levels, which may be the first indication of underlying liver disease with important long-term implications. This edition of FP Essentials provides a practical framework for evaluating common and less common causes of hepatitis.

Section One addresses metabolic dysfunction–associated steatotic liver disease, an increasingly prevalent condition and one of the leading causes of end-stage liver disease. Section Two focuses on viral hepatitis, reviewing prevention; screening; and the expanding treatment options for chronic viral hepatitis, which can prevent progression to hepatocellular carcinoma. Section Three discusses substance-induced hepatitis, including alcohol-associated liver disease and hepatotoxicity caused by prescription and over-the-counter medications, herbal products, and dietary supplements. Section Four examines less common but clinically significant causes: autoimmune hepatitis, Wilson disease, and hemochromatosis. Early recognition and treatment of these conditions are essential for preventing end-organ damage. Advances in diagnostic testing continue to expand the role of the family physician in early detection and management of liver disease.

We hope you find this edition practical and clinically useful. As always, we welcome your feedback and suggestions for future topics.

Michelle Nelson, MD, FAAFP, DipABLM
Associate Medical Editor
Clinical Assistant Professor
Department of Family Medicine
Michigan State University
College of Human Medicine, Lansing

Karl T. Rew, MD, Associate Medical Editor
Clinical Professor
Departments of Family Medicine and Urology
University of Michigan Medical School, Ann Arbor

Jama M. Darling, MD, is a transplant hepatologist with more than 20 years of experience and an assistant professor of medicine at the University of North Carolina at Chapel Hill. She started the transplant hepatology fellowship while a faculty member at the university and remains passionate about teaching liver disease management to diverse learners. She is active in the Carolina Hepatitis Academic Mentoring Program, which expands access to viral hepatitis care in North Carolina. She has led clinical trials in viral hepatitis and autoimmune liver diseases and authored multiple papers. Dr. Darling completed an internal medicine residency at the University of Texas Southwestern Medical Center, Dallas, and a gastroenterology fellowship at Stanford University Medical Center, California. She was an American Association for the Study of Liver Diseases hepatology fellow at the University of California San Francisco.

Ellen W. Green, MD, PhD, is a fellow in gastroenterology at the University of North Carolina at Chapel Hill, having completed training in addiction medicine at the University of New Mexico Albuquerque, and in internal medicine at the Oregon Health and Science University, Portland. She will start a year of training in transplant hepatology at the University of Wisconsin, Madison, in the summer of 2026. She ultimately hopes to return to her home state of New Mexico as a physician scientist in preventive hepatology to collaborate with rural communities in expanding access to addiction and hepatology care.

Jonathan T. Mitchell, MD, is an assistant professor in the Department of Family Medicine at the University of North Carolina at Chapel Hill. He previously worked for the Indian Health Service in Winslow, Arizona. He is credentialed as an HIV Specialist by the American Academy of HIV Medicine and has a Certificate of Knowledge from the American Society of Tropical Medicine and Hygiene. His professional interests include chronic liver disease, chronic disease management, HIV, and travel medicine.

Richard A. Moore II, MD, AAHIVS, is a clinical associate professor in the Department of Family Medicine at the University of North Carolina at Chapel Hill and the medical director for the North Carolina Department of Health and Human Services Viral Hepatitis Program. Since 2014, he has worked for the Rural Health Group, a Federally Qualified Health Center in northeastern North Carolina, where he directs the HIV and viral hepatitis programs. He cofounded the Carolina Hepatitis Academic Mentorship Program, which has trained more than 400 clinicians in the delivery of viral hepatitis care.

Claire L. Porter, MD, is a career development fellow and chief resident in the Department of Family Medicine at the University of North Carolina at Chapel Hill. She completed her family medicine residency at the University of North Carolina with special focus in HIV and viral hepatitis care and addiction medicine. Dr. Porter’s clinical interests include novel approaches to rural health care delivery and viral hepatitis care via the primary care medical home. She has published work on viral hepatitis vaccination coverage for Native American populations.

Author disclosure: No relevant financial relationships.