DISEASE

Hepatitis

OVERVIEW | CAUSES | RISK FACTORS | SYMPTOMS | COMPLICATION | DIAGNOSIS | TREATMENT | PREVENTION | REFERENCES

Hepatits

OVERVIEW

Hepatitis refers to an inflammatory condition of the liver. It’s commonly caused by a viral infection, but there are other possible causes of hepatitis. These include autoimmune hepatitis and hepatitis that occurs as a secondary result of medications, drugs, toxins, and alcohol. Autoimmune hepatitis is a disease that occurs when your body makes antibodies against your liver tissue.

Your liver is located in the right upper area of your abdomen. It performs many critical functions that affect metabolism throughout your body, including:

Bile production, which is essential to digestion
Filtering of toxins from your body
Excretion of bilirubin (a product of broken-down red blood cells), cholesterol, hormones, and drugs
Breakdown of carbohydrates, fats, and proteins
Activation of enzymes, which are specialized proteins essential to body functions
Storage of glycogen (a form of sugar), minerals, and vitamins (A, D, E, and K)
Synthesis of blood proteins, such as albumin
Synthesis of clotting factors

Treatment options vary depending on which type of hepatitis you have. You can prevent some forms of hepatitis through immunizations and lifestyle precautions.

CAUSES

Viral infections of the liver that are classified as hepatitis include hepatitis A, B, C, D, and E. A different virus is responsible for each type of virally transmitted hepatitis.

Hepatitis A is always an acute, short-term disease, while hepatitis B, C, and D are most likely to become ongoing and chronic. Hepatitis E is usually acute but can be particularly dangerous in pregnant women.

Hepatitis A

Hepatitis A is caused by an infection with the hepatitis A virus (HAV). This type of hepatitis is most commonly transmitted by consuming food or water contaminated by feces from a person infected with hepatitis A.

Hepatitis B

Hepatitis B is transmitted through contact with infectious body fluids, such as blood, vaginal secretions, or semen, containing the hepatitis B virus (HBV). Injection drug use, having sex with an infected partner, or sharing razors with an infected person increase your risk of getting hepatitis B.

Hepatitis C

Hepatitis C comes from the hepatitis C virus (HCV). Hepatitis C is transmitted through direct contact with infected body fluids, typically through injection drug use and sexual contact.

Hepatitis D

Also called delta hepatitis, hepatitis D is a serious liver disease caused by the hepatitis D virus (HDV). HDV is contracted through direct contact with infected blood. Hepatitis D is a rare form of hepatitis that only occurs in conjunction with hepatitis B infection. The hepatitis D virus can’t multiply without the presence of hepatitis B.

Hepatitis E

Hepatitis E is a waterborne disease caused by the hepatitis E virus (HEV). Hepatitis E is mainly found in areas with poor sanitation and typically results from ingesting fecal matter that contaminates the water supply.

Causes of noninfectious hepatitis

Alcohol and other toxins

Excessive alcohol consumption can cause liver damage and inflammation. This is sometimes referred to as alcoholic hepatitis. The alcohol directly injures the cells of your liver. Over time, it can cause permanent damage and lead to liver failure and cirrhosis, a thickening and scarring of the liver.

Other toxic causes of hepatitis include overuse or overdose of medications and exposure to poisons.

Autoimmune system response

In some cases, the immune system mistakes the liver as a harmful object and begins to attack it. It causes ongoing inflammation that can range from mild to severe, often hindering liver function.

RISK FACTORS

The risks are different for the different types of hepatitis. For example, with most of the viral types, your risk is higher if you have unprotected sex. People who drink a lot over long periods of time are at risk for alcoholic hepatitis.

SYMPTOMS

If you have infectious forms of hepatitis that are chronic, like hepatitis B and C, you may not have symptoms in the beginning. Symptoms may not occur until the damage affects liver function.

Signs and symptoms of acute hepatitis appear quickly. They include:

Fatigue
Flu-like symptoms
Dark urine
Pale stool
Abdominal pain
Loss of appetite
Unexplained weight loss
Yellow skin and eyes, which may be signs of jaundice

Chronic hepatitis develops slowly, so these signs and symptoms may be too subtle to notice.

COMPLICATIONS

Chronic hepatitis B or C can often lead to more serious health problems. Because the virus affects the liver, people with chronic hepatitis B or C are at risk for:

Chronic liver disease
Cirrhosis
Liver cancer

When your liver stops functioning normally, liver failure can occur. Complications of liver failure include:

Bleeding disorders
A buildup of fluid in your abdomen, known as ascites
Increased blood pressure in portal veins that enter your liver, known as portal hypertension
Kidney failure
Hepatic encephalopathy, which can involve fatigue, memory loss, and diminished mental abilities due to the buildup of toxins, like ammonia, that affect brain function
Hepatocellular carcinoma, which is a form of liver cancer
Death

People with chronic hepatitis B and C are encouraged to avoid alcohol because it can accelerate liver disease and failure. Certain supplements and medications can also affect liver function. If you have chronic hepatitis B or C, check with your doctor before taking any new medications.

DIAGNOSIS

History and physical exam

To diagnose hepatitis, first your doctor will take your history to determine any risk factors you may have for infectious or noninfectious hepatitis.

During a physical examination, your doctor may press down gently on your abdomen to see if there’s pain or tenderness. Your doctor may also feel to see if your liver is enlarged. If your skin or eyes are yellow, your doctor will note this during the exam.

Liver function tests

Liver function tests use blood samples to determine how efficiently your liver works. Abnormal results of these tests may be the first indication that there is a problem, especially if you don’t show any signs on a physical exam of liver disease. High liver enzyme levels may indicate that your liver is stressed, damaged, or not functioning properly.

Other blood tests

If your liver function tests are abnormal, your doctor will likely order other blood tests to detect the source of the problem. These tests can check for the viruses that cause hepatitis. They can also be used to check for antibodies that are common in conditions like autoimmune hepatitis.

Ultrasound

An abdominal ultrasound uses ultrasound waves to create an image of the organs within your abdomen. This test allows your doctor to take a close at your liver and nearby organs. It can reveal:

Fluid in your abdomen
Liver damage or enlargement
Liver tumors
Abnormalities of your gallbladder

Sometimes the pancreas shows up on ultrasound images as well. This can be a useful test in determining the cause of your abnormal liver function.

Liver biopsy

A liver biopsy is an invasive procedure that involves your doctor taking a sample of tissue from your liver. It can be done through your skin with a needle and doesn’t require surgery. Typically, an ultrasound is used to guide your doctor when taking the biopsy sample.

This test allows your doctor to determine how infection or inflammation has affected your liver. It can also be used to sample any areas in your liver that appear abnormal.

TREATMENT

Treatment for hepatitis depends on which type you have and whether it is acute or chronic. Acute viral hepatitis often goes away on its own. To feel better, you may just need to rest and get enough fluids. But in some cases, it may be more serious. You might even need treatment in a hospital.

There are different medicines to treat the different chronic types of hepatitis. Possible other treatments may include surgery and other medical procedures. People who have alcoholic hepatitis need to stop drinking. If your chronic hepatitis leads to liver failure or liver cancer, you may need a liver transplant.

PREVENTION

There are different ways to prevent or lower your risk for hepatitis, depending on the type of hepatitis. For example, not drinking too much alcohol can prevent alcoholic hepatitis. There are vaccines to prevent hepatitis A and B. Autoimmune hepatitis cannot be prevented.