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Hepatitis

Hepatitis

Hepatitis means inflammation of the liver. Many illnesses and conditions can cause inflammation of the liver, for example, drugs, alcohol, chemicals, and autoimmunediseases.

 

Many viruses, for example, the virus of mononucleosis and thecytomegalovirus can inflame the liver. Most viruses, however, do not primarily attack the liver; the liver is just one of several organs that the viruses affect.

 

When doctors speak of viral hepatitis, they usually are referring to hepatitis caused by a few specific viruses that primarily attack the liver.

 

There are several hepatitis viruses; they have been named types A, B, C, D, E, F (not confirmed), and G. As our knowledge of hepatitis viruses grows, it is likely that this alphabetical list will become longer. The most common hepatitis viruses are types A, B, and C.

 

The liver is located in the upper right hand side of the abdomen, mostly behind the rib cage. The liver of an adult normally weighs close to three pounds.

 

The liver performs the following vital functions:

 

  1. The liver helps purify the blood by changing harmful chemicals into harmless ones. The source of these chemicals can be external, such as medications or alcohol, or internal, such as ammonia or bilirubin. Typically, these harmful chemicals are broken down into smaller chemicals or attached to other chemicals that then are eliminated from the body in the urine or stool.
  2. The liver produces many important substances, especially proteins that are necessary for good health. For example, it producesalbumin, the proteinbuilding block of the body, as well as the proteins that cause blood to clot properly.
  3. The liver stores many sugars, fats and vitaminsuntil they are needed elsewhere in the body.
  4. The liver builds smaller chemicals into larger, more complicated chemicals that are needed elsewhere in the body. An example of this type of function is the manufacture of cholesterol.

 

When the liver is inflamed, it does not perform these functions well, which brings about many of the symptoms, signs, and problems associated with hepatitis.

 

What are the common types of viral hepatitis?

 

Hepatitis A

Viral hepatitis A (HAV) accounts for about 150,000 of the 500,000-600,000 new cases of viral hepatitis that occur each year in the United States. The hepatitis caused by HAV is an acute illness (acute viral hepatitis) that never becomes chronic. At one time, hepatitis A was referred to as "infectious hepatitis" because it could be spread from person to person like other viral infections.

 

Infection with hepatitis A virus can be spread through the ingestion of food or water, especially where unsanitary conditions allow water or food to become contaminated by human waste containing hepatitis A (the fecal-oral mode of transmission).

 

Hepatitis A typically is spread among household members and close contacts through the passage of oral secretions (intimate kissing) or stool (poor hand washing). It also is common to have infection spread to customers in restaurants and among children and workers in day care centers if hand washing and sanitary precautions are not observed.

 

Hepatitis B

There are 200,000-300,000 new cases of viral hepatitis B (HBV) infection each year in the United States. Type B hepatitis was at one time referred to as "serum hepatitis", because it was thought that the only way hepatitis B virus (HBV) could spread was through blood or serum (the liquid portion of blood) containing the virus.

 

It is now known that hepatitis B can spread by sexual contact, the transfer of blood or serum through shared needles in drug abusers, accidental needle sticks with needles contaminated with infected blood, blood transfusions, hemodialysis, and by infected mothers to their newborns.

 

The infection also can be spread by tattooing, body piercing, and sharing razors and toothbrushes (if there is contamination with infected blood). About 6-10% of patients with hepatitis B develop chronic HBV infection (infection lasting at least six months and often years to decades) and can infect others as long as they remain infected.

 

Patients with chronic hepatitis B infection also are at risk of developing cirrhosis, liver failure and liver cancer. It is estimated that there are 1.2 million people in the United States and 200-300 million people world-wide who suffer with chronic hepatitis B infection.

 

Hepatitis C

There are about 150,000 new cases of hepatitis C each year. Type C hepatitis was previously referred to as "non-A, non-B hepatitis", because the causative virus had not been identified, but it was known to be neither hepatitis A nor hepatitis B. The hepatitis C virus (HCV) usually is spread by shared needles among drug abusers, blood transfusion, hemodialysis, and needle sticks. Approximately 90% of transfusion-associated hepatitis is caused by hepatitis C.

 

Transmission of the virus by sexual contact has been reported, but is considered rare. An estimated 50-70% of patients with acute hepatitis C infection develop chronic HCV infection. Patients with chronic hepatitis C infection can continue to infect others. Patients with chronic hepatitis C infection are at risk for developing cirrhosis, liver failure, and liver cancer.

 

It is estimated that there are about 3.5 million people with chronic hepatitis C infection in the United States. For more, please see the Hepatitis C article.

 

Types D, E, F, and G Hepatitis

There also are viral hepatitis types D, E, F (not confirmed yet), and G. The most important of these at present is the hepatitis D virus (HDV), also known as the delta virus or agent. It is a small virus that requires concomitant infection with hepatitis B to survive.

 

HDV cannot survive on its own because it requires a protein that the hepatitis B virus makes (the envelope protein, also called surface antigen) to enable it to infect liver cells. The ways in which hepatitis D is spread are by shared needles among drug abusers, contaminated blood, and by sexual contact, essentially the same ways as for hepatitis B.

 

Patients who already have chronic hepatitis B infection can acquire delta virus infection at the same time as they acquire the hepatitis B infection or, alternatively, on top of a chronic hepatitis B infection. Patients with chronic hepatitis due to hepatitis B and hepatitis D viruses develop cirrhosis (severe liver scarring) rapidly. Moreover, the combination of delta and B virus infection is very difficult to treat.

Symptoms

Acute

Initial features are of nonspecific flu-like symptoms, common to almost all acute viral infections and may include malaise, muscle and joint aches, fever, nausea or vomiting, diarrhea, and headache. More specific symptoms, which can be present in acute hepatitis from any cause, are: profound loss of appetite, aversion to smoking among smokers, dark urine, yellowing of the eyes and skin (i.e., jaundice) and abdominal discomfort.

 

Physical findings are usually minimal, apart from jaundice in a third and tender hepatomegaly (swelling of the liver) in about 10%. Some exhibit lymphadenopathy (enlarged lymph nodes, in 5%) or splenomegaly (enlargement of the spleen, in 5%).

 

Acute viral hepatitis is more likely to be asymptomatic in younger people. Symptomatic individuals may present after convalescent stage of 7 to 10 days, with the total illness lasting 2 to 6 weeks. 

 

A small proportion of people with acute hepatitis progress to acute liver failure, in which the liver is unable to clear harmful substances from the circulation (leading to confusion and coma due to hepatic encephalopathy) and produce blood proteins (leading to peripheral edema and bleeding). This may become life-threatening and occasionally requires a liver transplant.

 

Chronic

Chronic hepatitis often leads to nonspecific symptoms such as malaise, tiredness and weakness, and often leads to no symptoms at all. It is commonly identified on blood tests performed either forscreening or to evaluate nonspecific symptoms. The occurrence of jaundice indicates advanced liver damage. On physical examination there may be enlargement of the liver.

 

Extensive damage and scarring of liver (i.e. cirrhosis) leads to weight loss, easy bruising and bleeding tendencies, peripheral edema (swelling of the legs) and accumulation of ascites (fluid in the abdominal cavity).

 

Eventually, cirrhosis may lead to various complications: esophageal varices (enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction).

 

Acne, abnormal menstruation, lung scarring, inflammation of the thyroid gland and kidneys may be present in women with autoimmune hepatitis

Causes

Acute

 

Viral hepatitis: Hepatitis A, B, C, D, and E.

  • Yellow fever.
  • KIs-V.
  • adenoviruses.

 

Non-viral infection

  • toxoplasma.
  • Leptospira.
  • Q fever.
  • rocky mountain spotted fever.

 

Alcohol

  • Toxins: Amanita toxin in mushrooms, carbon tetrachloride, asafetida.
  • Drugs: Paracetamol, amoxycillin, antituberculosis medicines, minocycline and many others (see longer list below).
  • Ischemic hepatitis (circulatory insufficiency).
  • Pregnancy.
  • Auto immune conditions, e.g., Systemic Lupus Erythematosus (SLE).
  • Metabolic diseases, e.g., Wilson's disease.

 

Chronic

Viral hepatitis: Hepatitis B with or without hepatitis D, hepatitis C (neither hepatitis A nor hepatitis E causes chronic hepatitis).

 

Autoimmune

Autoimmune hepatitis

  • Alcohol.
  • Drugs.
  • methyldopa.
  • nitrofurantoin.
  • isoniazid.
  • ketoconazole.
  • Non-alcoholic steatohepatitis.
  • Heredity.
  • Wilson's disease.
  • alpha 1-antitrypsin deficiency.

 

Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic hepatitis

Treatment

There is no specific treatment for hepatitis A. The doctor will recommend the abstinence of alcohol and drugs during recovery. Most cases of hepatitis A resolve themselves spontaneously.

 

The only treatment for hepatitis B is rest, combined with a high protein/high carbohydrate diet to repair damaged liver cells and protect the liver. If hepatitis B persists, the doctor may recommend an antiviral agent called interferon.

 

The only approved treatment for hepatitis C virus, and the only one with demonstrated efficacy, is interferon alfa-2b (Intron A).

 

Currently, there is not effective treatment for hepatitis D and E.

 

For treatment of nonviral hepatitis, the doctor will first remove the harmful substance by flushing out the stomach via inducing vomiting or hyperventilation. If necessary, the patient with drug-induced hepatitis will be treated with corticosteroids.

 

Prevention of Hepatitis

 

To prevent hepatitis A, remember to:

  • Wash hands well after using any washroom.
  • Eat only freshly cooked foods.
  • Drink only commercially bottled water or boiled water in places where sanitation and the water supply are questionable and do not eat non-peelable raw fruits or vegetables unless cleaned thoroughly.
  • Get a hepatitis A vaccination before traveling to areas such as Mexico, eastern Europe and developing countries.

 

To prevent hepatitis B, remember to:

  • Tell your sex-partners if you are a carrier.
  • Practice safe sex.
  • Don't share needles, razors, toothbrushes, manicure tools or other items that could bear contaminated blood.
  • Get the hepatitis B vaccination series if you are at risk.
  • Don't allow yourself to be pierced with non-sterile equipment.

 

To prevent hepatitis C, remember to:

  • Cover open wounds, don't share razors or manicure tools.
  • Practice safe sex.
  • Don't share needles, razors, toothbrushes, manicure tools or other items that could bear contaminated blood.
  • Don't allow yourself to be pierced with non-sterile equipment.
  • Limit alcohol intake.
  • Never share IV drug needles or other drug equipment.

 

To prevent hepatitis D:

  • Since the hepatitis D virus cannot infect on its own without hepatitis B, use the preventive measures outlined in hepatitis B.

 

To prevent hepatitis E, remember to:

  • Wash hands well after using any washroom.
  • Eat only well and freshly cooked foods.
  • Drink only commercially bottled water or boiled water in places where sanitation and the water supply are questionable, and don't eat non-peelable raw fruits or vegetables unless cleaned thoroughly.

 

To prevent alcoholic hepatitis, remember to:

  • Limit the amount of alcohol consumption.
  • Be aware of the lethal contents of all chemicals.
  • Face the spray away from the body.
  • Wear protective equipment if applicable.
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