Hepatitis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at January 13, 2016
StartDiseasesHepatitis

Hepatitis is a medical condition in which the liver is inflamed. Commonly caused by viruses that are transmitted via food or bodily fluids, hepatitis can lead to serious health problems like cirrhosis and liver cancer.

Contents

Definition & Facts

The liver assists the body with removing toxins, digestion, and storing energy. Hepatitis can manifest as either acute hepatitis in which it lasts less than six months or chronic hepatitis in which it lasts longer than six months. Hepatitis can be caused by alcohol, the ingestion of certain drugs like acetominophen, and autoimmune disorders. Viral hepatitis is caused by one of five viruses: hepatitis A (HAV), hepatitis B (HBV), hepatitis C (HCV), hepatitis D (HDV), and hepatitis E (HEV). Hepatitis A, B, and C are the most common causes of liver damage.

Symptoms & Complaints

Many symptoms of acute hepatitis are similar to flu, such as fatigue, nausea, vomiting, and fever. Other symptoms include a dazed or confused feeling, dark urine, muscle pain, joint pain, itchiness, abdominal pain, headache, diarrhea, and loss of appetite. Some infected people also develop jaundice (yellowing of the skin or the whites of the eyes) and swollen lymph nodes, enlarged liver or enlarged spleen.

If the virus causing viral hepatitis goes untreated, symptoms can increase in severity and lead to cirrhosis or liver cancer. A small percentage of patients experience liver failure as the liver loses its ability to filter blood.

Common symptoms of chronic hepatitis include fatigue, weakness, easy bruising, swelling of the legs, jaundice, and weight loss. Women with autoimmune hepatitis, a type of chronic hepatitis, show symptoms including abnormal menstruation, acne, and scarring of the lungs.

Causes

The five hepatitis viruses vary in their causes. Hepatitis A often spreads through water or food contaminated with feces. This can occur by eating food handled by an infected person who has tiny amounts of fecal matter on their hands. Hepatitis A can also be a sexually transmitted disease, transmitted via a fecal-oral route. Hepatitis E is also often spread through contaminated water or food.

Hepatitis B, the most common cause of hepatitis worldwide, spreads through infected blood, semen, and other bodily fluids. This is often caused by sexual contact or sharing needles through intravenous drug use, but can also be transferred from a mother to a baby during childbirth.

Hepatitis C is caused by coming into contact with infected blood and transmission most often occurs when sharing needles. Sexual transmission is rare. Hepatitis D, an incomplete virus, only occurs in people already infected with hepatitis B.

Hepatitis can also be caused by excessive consumption of alcohol over many years. The symptoms of alcoholic hepatitis range from mild to severe, and the disease can lead to cirrhosis. Medications such as acetaminophen and antibiotics can cause drug-induced hepatitis after prolonged or excessive exposure to the medication.

Diagnosis & Tests

Doctors can conduct numerous tests to diagnose a patient with hepatitis. When diagnosing hepatitis A, a blood test identifies antibodies in the blood that the body produces in response to the hepatitis virus. Hepatitis B can also be diagnosed by a blood test.

To test for liver damage in patients with hepatitis B, doctors occasionally perform a liver biopsy by inserting a needle through the patient's skin and removing a small amount of liver tissue for testing.

Bilirubin, albumin, and prothrombin time blood tests are also used to check for potential damage to the liver. Alpha-fetoprotein (AFP) tests check for liver cancer. If the test reports high AFP levels, there is a chance of liver cancer.

Blood tests can diagnose hepatitis C as well as measure the quantity of the virus in the blood and determine the virus's genetic makeup. Many drugstores sell over-the-counter hepatitis C tests that people can take at home, but tests performed by a doctor are much more accurate and thorough.

If unsure of the cause of a patient's liver problems, a doctor may use paracentesis, a procedure in which abdominal fluid is removed through a needle and tested to discover the cause of the liver disease. Doctors may also use elastography, the use of sound waves to measure the stiffness of the liver.

Treatment & Therapy

The treatment used for those infected with viral hepatitis depends on the the type and severity of the infection. Hepatologists or gastroenterologists who specialize in liver disease will treat individuals who show more serious symptoms. The majority of individuals with hepatitis A, E, or B recover on their own with bed rest and plenty of fluids. Only medications that are absolutely necessary are given to patients with acute hepatitis because the impaired liver has difficulty eliminating the drugs.

Avoiding smoking and alcoholic beverages helps the treatment process for acute hepatitis. Usually patients recover from acute hepatitis A and hepatitis B in about six months with some small flare-ups occurring after.

For chronic hepatitis B, patients can use the antiviral drugs adefovir dipivoxil, entecavir, interferon, lamivudine, peginterferon, telbivudine, or tenofovir.

Patients with hepatitis C can use the antiviral drugs simeprevir or sofosbuvir. Both of these drugs block the proteins the hepatitis C virus needs to multiply and are effective in between 80 and 95 percent of patients.

Prevention & Prophylaxis

Hepatitis A and B are preventable with vaccines. Vaccines that build antibodies against hepatitis B also protect against hepatitis D.

Hepatitis A can also be avoided by drinking bottled water and avoiding undercooked meat in areas with poor sanitation and where the virus is common, as well as practicing good hygiene. Hepatitis B and C can be prevented by ensuring that any needles used for tattoos or body piercings are sterile, practicing safe sex, and avoiding illicit intravenous drug use.