Understanding Hepatitis – Overview

GlobalRPH student writer

Weighing in at approximately 2.4 to 3 pounds, the liver is the largest and one of the busiest internal organs. It’s also the only organ that can regenerate. It’s the liver that converts dietary nutrients into substances that the body can use. It filters the blood and helps with blood clotting. Long story short, a healthy liver is vital to overall health, and one of the biggest threats that can damage it is hepatitis – the liver tissue inflammation.

With that in mind, it’s probably (past) time to know more about the different hepatitis strains, the causes, the preventive measures, and the best treatments available today.

Acute vs. Chronic Infection vs. Fulminant hepatitis

Acute Hepatitis

In acute hepatitis, the infection usually goes away on its own. Hepatitis A causes only acute infection, but hepatitis B and C often leads to chronic infection. The phases of development are,

Prodromal phase: This is where the patient shows flu-like symptoms including fatigue, nausea, vomiting, poor appetite, or joint pain. A rise in body temperature is most common in Hepatitis A infection. Late in the prodromal phase, the patient may experience dark urine (choluria) or clay-colored stool.

Jaundice: Yellowing of the skin and sclera follows the initial prodromal phase and may last up to four weeks. The initial non-specific symptoms subside by this period, but the patient often develops right upper abdominal pain, sudden weight loss or an enlarged spleen.

The recovery phase: This is when the clinical symptoms start to resolve. All Hepatitis A and E fully resolve after one to two months; most Hepatitis B self-limit within three to four months; in case of Hepatitis C, some may even recover spontaneously.

Chronic Hepatitis

Some patients are unable to get rid of the virus even after six months and they are diagnosed as having chronic hepatitis. At first, it often does not cause any visible symptoms. Patients with symptoms most commonly complain of fatigue, poor appetite or joint pain. This, then worsens and in an advanced stage, the patients show symptoms including jaundice, dark urine, spontaneous bruises or bleeding, peripheral edema, and weight loss. Chronic hepatitis also leads to liver cirrhosis with portal hypertension and liver failure.

Corticosteroid drugs are used to treat chronic infections, and in advanced stages, liver transplantation is suggested.

Fulminant Hepatitis

Patients typically develop the symptoms seen in viral hepatitis. Then they rapidly develop severe, often life-threatening liver failure due to hepatic cell death. Fulminant hepatitis can occur in the case of hepatitis B, D, and E, in addition to drug-induced or autoimmune hepatitis. At first, it may start as tiredness, nausea, confusion, irritability, or stomach pain. Then within days or weeks, it may aggravate into jaundice, blood clotting issues, or fluid build-up in the abdominal cavity, arms, and legs.

Recovery is mostly determined by the cause; a liver transplant is also considered as a lifesaving option in some patients. Speaking of the mortality due to fulminant hepatitis, it is majorly due to cerebral edema, kidney failure, sudden kidney failure or internal bleeding.

Causes and Symptoms

There are many causes of hepatitis – virus, medications, drugs, toxins, and alcohol. Then there’s autoimmune hepatitis that develops when the body makes antibodies against liver tissue. Causes of hepatitis are classified into two broad categories: infectious and non-infectious.

Infectious Hepatitis

This is caused by pathogens including virus, bacteria or a parasite. Among these, viral hepatitis is the most common type and, five specific viruses are identified to cause the disease. It can be either acute (resolves within 6 months) or chronic (lasts longer than 6 months). Usually, chronic hepatitis leads to liver cirrhosis or liver cancer. Common forms of viral hepatitis include:

• Hepatitis A: An infection with the hepatitis A virus (HAV) results in Hepatitis A. It is most commonly transmitted by consuming food or water contaminated by feces of an infected patient. In most cases, HAV often passes on its own and most people make a complete recovery. HAV can be prevented by a vaccine.
• Hepatitis B: About 350 million people worldwide live with chronic Hepatitis B, says CDC. Hepatitis B is only transmitted through infectious body fluids. An infected mother will transmit it to her child, for example. Sharing needles or razors and having multiple sexual partners puts one at risk, too.
• Hepatitis C: Caused by the hepatitis C virus (HCV), Hepatitis C can be both acute and chronic. HCV is a blood-borne virus hence avoid unsafe injection practices and usage of unscreened blood for transfusion or surgeries. According to the stats, around 1 in 4 people with HCV get cirrhosis, which often leads to liver cancer.
• Hepatitis D: Also called delta hepatitis, hepatitis D is often seen in people with hepatitis B; HDV multiples only in the presence of HBD. Caused by the hepatitis D virus (HDV), this disease is contracted through direct contact with infected blood and, is a rare form.
• Hepatitis E: Predominant in underdeveloped countries/areas with poor sanitation, Hepatitis E is caused by water-borne Hepatitis E virus (HEV). The infection is acute which is self-limits and resolves within weeks. However, in pregnant women, it may cause serious effects and increase their risk of liver damage or death.

Certain protozoans and worms infect the liver and trigger an immune response. Trypanosoma cruzi, Leishmania species, and Plasmodium species are the protozoans that cause liver inflammation. Evidences say that Entamoeba histolytica can cause hepatitis with distinct liver abscesses.

Speaking of the worms, Echinococcus granulosus or the dog tapeworm infects the liver and results in hepatic hydatid cysts. The liver flukes Fasciola hepatica and Clonorchis sinensis in the bile ducts can cause progressive liver damage and liver fibrosis.

Non-infectious Hepatitis

Alcohol, toxins, medications, genetics, autoimmune disorders or reduced blood flow to the liver cause non-infectious disease. These are not contagious.

Alcohol

Binge drinking or years of heavy drinking causes alcoholic hepatitis. The liver breaks down alcohol to remove it from the body. Any excess alcohol circulates and injures the liver cells. Over time, the liver cells become inflamed, scarred and fatty. Stats show that up to 35 percent of alcoholics develop alcoholic hepatitis.

Drug-induced Hepatitis

The liver helps to break down medicines or drugs in the blood. But it fails to do so when there is excess drugs in circulation. This, in turn, results in the accumulation of drugs and can lead to drug-induced hepatitis. Drugs/Medicines responsible include,

• Acetaminophen
• Aspirin and over-the-counter pain and fever medicines
• Oral contraceptives
• Statins and sulfa medicines
• Anti-epileptic drugs
• Herbal medicines, including ephedra, Germander, Pennyroyal, etc.

 

Non-alcoholic Fatty Liver Disease (NAFLD)

Hepatic steatosis or fatty liver disease is nothing but excess fat in the liver. Obesity, type 2 diabetes, metabolic syndrome, and hepatitis C make one more likely to get it. Two types of non-alcoholic diseases are there:

• Simple fatty liver: There will be fat in the liver, but little or no inflammation or hepatic cell damage. It usually doesn’t get worse enough to cause liver failure. Simple fatty liver is common in most people with NAFLD.
• Non-alcoholic steatohepatitis (NASH): It means there is hepatic inflammation and the patient is in danger zone. The inflammation can lead to fibrosis, cirrhosis, and liver cancer. About 20 percent of people suffering from NAFLD also have NASH.

Autoimmune Hepatitis (AIH)

Due to some unknown reasons, the body’s defense mechanism turns against the liver. Some scientists believe that genes may have a role in it, as AIH can run in families. Some others believe that medicines such as statins, hydralazine, nitrofurantoin can cause AIH. It may also occur due to stress, viral hepatitis, herpes, Epstein-Barr virus, and measles.

There are two forms of AIH. Type 1, or classic AIH is the most common form. It affects women ages 15 to 40, although it can affect men or individuals of any age. Type 2 is less common and usually affects girls ages 2 to 14.

Having AIH also means, one may have (or is at high risk) ulcerative colitis, rheumatoid arthritis, Sjogren’s syndrome – all autoimmune diseases.

Genetic Factors

Gene mutations can trigger hepatic damage, say studies. For example, a co-dominant mutation in the alpha-1-antitrypsin gene causes the accumulation of alpha-1-antitrypsin within liver cells, leading to liver damage. Abnormal mineral storage in the liver occurs due to Hemochromatosis and Wilson’s disease, the autosomal recessive diseases.

Ischemic Hepatitis

Here the liver isn’t inflamed. Rather, the liver cell dies because of poor hepatic blood flow. Cardiac arrest, high blood pressure, or thrombosis (blood clot in the artery) can also reduce the blood flow. A dramatic rise in serum transaminases – Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) is the indication of ischemic hepatitis.

How To Diagnose

Viral hepatitis, such as HAV, HBV, and HCV, are diagnosed by the symptoms, a physical exam and blood tests. Imaging techniques such as a sonogram or a CAT scan and a liver biopsy can also confirm hepatitis.

The comprehensive metabolic panel (CMP)

The CMP is a group of tests to evaluate liver health and to detect hepatitis. They include:

• Alanine aminotransferase (ALT) – A damaged liver releases ALT into the circulation, usually before clinical symptoms (jaundice) occur. This is why the ALT test is suggested for the early detection of liver damage.
• Aspartate aminotransferase (AST) – Another hepatic enzyme marker for detecting liver damage due to hepatitis. AST, however, is not specific for the liver because it is also present in heart and muscle cells.
• Alkaline phosphatase (ALP) – ALP levels vary when there is damage to the bile duct. However, the ALP test is positive for bone disorders, too – hence not liver-specific.
• Bilirubin – Bilirubin levels rise when there is liver damage, causing jaundice and dark urine.
• Albumin – Liver produces albumin and its decreased level indicates liver damage.
• Total protein – Severe liver disease decreases serum albumin and other protein levels.

Treatment

Hepatitis treatment depends on the type and severity of the disease. Most acute infections by hepatitis A, B, C, and E viruses will resolve on their own within one to two months, according to the NIH. Antiviral drugs such as lamivudine can treat severe cases of acute hepatitis B.

Speaking of Hepatitis D, no antiviral medications are available.

Vaccination can prevent hepatitis A; it cannot be re-infected once recovered. For Hepatitis and B and C, doctors recommend drugs including adefovir, entecavir, interferon, lamivudine, telbivudine, tenofovir and more.

Liver Transplantation may be an option that fails to respond to treatment due to severe liver damage.

Ways To Healthy a Liver

Here are the best ways to keep the liver healthy:

• Drinking in moderation is the key to a healthy liver. Overdoing alcohol – more than two drinks a day for men, one a day for men – is detrimental to liver cells. Over time, alcohol damages liver cells and leads to the swelling or scarring that results in cirrhosis.
• The liver loves a healthy diet-regular exercise combo. Weight management also helps prevent non-alcoholic fatty liver disease (NAFLD), a condition that leads to cirrhosis if it gets worse.
• A rainbow diet is good for the liver. A bit of fish, dairy, meat, monounsaturated and polyunsaturated fats from seeds, vegetable oils, etc are also liver-friendly.
• Drinking a few cups of coffee may lower the risk of developing scarring, fibrosis or cirrhosis. Studies show that it even slows down the severity.
• Taking meds right is vital to keep the liver in good shape. Statins, acetaminophen, amoxicillin, and clindamycin in excess are harmful. Acetaminophen is present in more than 600 medicines including cold and flu drugs. Some meds are even more harmful to the liver when combined with other drugs.
• Pyrrolizidine Alkaloids present in supplements affect the liver. Similarly, there is no science-backed evidence for the effectiveness of many herbal liver remedies. Better to stay away!
• Hepatitis B easily transmits through sex, but there are precautions like safe sex to avoid transmitting HBV.
• A simple way to keep liver healthy: wash hands with soap and water before cooking or after every trip to the toilet. Remember: Hepatitis A spreads through contaminated food or water.
• Some household cleaning products, aerosol sprays, and insecticides have liver-damaging chemicals. Avoiding direct contact may protect liver cells.
• Last but not least, alcoholics and people with a family history must do regular check-ups