An Overview of Hepatitis

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Hepatitis is a disease caused by inflammation of the liver. It usually results from exposure to a virus, but there are also non-viral forms of the disease, including hepatitis brought on by the use of certain drugs, alcohol abuse, and autoimmune disease.

Hepatitis can be acute (lasting just a few weeks to a few months), cause few if any symptoms, and resolve on its own. The disease also can be chronic, meaning inflammation persists for six months or longer and can lead to serious and even life-threatening complications.

Treatment for hepatitis varies depending on the cause, symptoms, and severity of the disease. It's important to note that there are effective vaccines for two of the viral forms, hepatitis A and hepatitis B.

Symptoms

Many people who have hepatitis do not develop symptoms—or at least do not have symptoms that suggest they have liver disease.

When symptoms do develop, it's usually only when hepatitis is chronic and has begun to do damage to the liver.

"If symptoms occur with an acute infection, they can appear anytime from 2 weeks to 6 months after exposure. Symptoms of chronic viral hepatitis can take decades to develop," according to the U.S. Centers for Disease Control and Prevention (CDC).

When caused by a virus, early symptoms of hepatitis often resemble the flu and include fever, headache, joint pain, and nausea.

As it progresses or becomes chronic, hepatitis can bring on more distinct symptoms:

  • Jaundice (yellowing of the skin and whites of the eyes)
  • Darkened urine (choluria)
  • Clay-colored stools
  • Enlarged liver
  • Abdominal pain or discomfort (typically in the right upper quadrant beneath the ribs)
  • Appetite loss
  • Extreme fatigue

These symptoms usually are self-limiting, although recovery tends to take around a month or so. In the case of hepatitis B, it can take a full four months for symptoms to fully resolve.

Complications

Progressive inflammation of the liver can have severe and even life-threatening repercussions. Complications of chronic hepatitis include:

  • Fibrosis. Severe fibrosis, a build-up of scar tissue on the liver, can impede the flow of blood into and out of the organ and impair the proper function of the liver.
  • Cirrhosis. As scar tissue accumulates, the liver can become smaller and harder as nonfunctioning tissue replaces healthy tissue.
  • Liver cancer. There are several types of liver cancer associated with chronic hepatitis, including cancer of certain liver cells and cancer that affects the bile ducts.
  • Liver failure
  • Glomerulonephritis. This kidney disorder most commonly is associated with untreated chronic hepatitis B or hepatitis C infections.
  • Cryoglobulinemia. Most often linked to chronic hepatitis B or hepatitis C infections, this rare disease is caused by an abnormal cluster of proteins that blocks small blood vessels, leading to circulation.problems.
  • Hepatic encephalopathy. This inflammation of the brain can occur as a complication of severe loss of liver function.
  • Portal hypertension. When the liver's portal circulation system is blocked, blood can't return to the liver from the digestive system and pressure increases. Portal hypertension is a serious complication that can be fatal.
  • Porphyria cutanea tara. This rare complication of chronic hepatitis C, in which the body has trouble processing chemicals called porphyrins, leads to blistering of the hands and face.
  • Viral co-infection. Hepatitis can weaken the immune the system, making it less able to fight off other infections. Human immunodeficiency virus (HIV)

Causes

The causes of hepatitis are diverse, ranging from viral infections to genetic disorders and excessive alcohol use. The three most common causes can be broadly categorized as infectious, metabolic, and autoimmune.

Infectious

Viral hepatitis is the most common form of hepatitis worldwide. There are five distinct viruses that can cause hepatitis.

  • Hepatitis A: The hepatitis A virus (HAV) is most commonly transmitted through food or water contaminated with feces infected with HAV.
  • Hepatitis B: The virus that causes hepatitis B virus (HBV) is spread via HBV-infected blood, semen, or saliva. It can be transmitted during sex or by sharing needles or syringes to inject drugs, using someone else's razor, or unsanitary tattooing. Mothers infected with HBV can pass the virus to a baby through breastmilk as well.
  • Hepatitis C: Hepatitis C is caused by the hepatitis C virus (HCV) and is transmitted predominantly through drug use, but can also be transmitted through sexual contact and from mother to child during pregnancy.
  • Hepatitis D: Only someone who already is infected with HBV can become infected by the hepatitis D virus (HDV). It's primarily spread through injecting drug use and has a 20 percent fatality rate, the highest of all viral hepatitis. Rare in the U.S., hepatitis D is seen predominantly in developing countries in sub-Saharan Africa, the Middle East, and northern South America. Studies show that around 15 million of the estimated 240 million people in the world with chronic hepatitis B infection also are infected with HDV.
  • Hepatitis E: Hepatitis E is most prevalent in India, Southeast Asia, Central America, and northern and central Africa. The virus that causes it, hepatitis E virus (HEV) is spread primarily through contaminated water in areas with poor sanitation.

Besides viruses, liver inflammation can be caused by bacteria such as Salmonella and E. coli, as well as parasites that directly attack the liver.

Metabolic

Metabolic causes of hepatitis are related to the consumption of certain substances or with factors such as obesity, insulin resistance, and diabetes that incease the risk of liver inflammation and/or injury.

  • Alcoholic hepatitis, an extension of alcoholic liver disease, is the greatest cause of cirrhosis in the United States, affecting 10 to 20 percent of people who drink excessively (defined as more than 80 grams of alcohol per day in men and 40 grams per day in women). Excessive alcohol use also can exacerbate complications of viral hepatitis, particularly hepatitis B and C.
  • Drug-induced hepatitis can be caused by the excessive use of a number of toxins or medications a person including Tylenol and other versions of acetaminophen and certain over-the-counter herbal and dietary supplements. Prescription medications associated with liver injury include anti-tuberculosis drugs, seizure drugs, HIV medications, statin drugs, oral contraceptives, and anabolic steroids.
  • Non-alcoholic fatty liver disease (NAFLD) is associated with metabolic syndrome, a cluster of medical conditions that include abdominal obesity, (aka belly fat), high blood pressure, and elevated lipid, glucose, and cholesterol levels. NAFLD is the third most common cause of liver disease in the U.S.

    Autoimmune Disease

    Autoimmune hepatitis occurs when the body’s immune system attacks the cells of the liver. Believed to be genetic, it occurs most often in women between 15 and 40.

    Diagnosis

    Hepatitis that is asymptomatic often goes undiagnosed. However, certain tell-tale signs, such as jaundice, may prompt a doctor to perform certain blood tests. These include:

    • Liver enzyme tests that can detect the presence of enzymes that can "escape" into the bloodstream because a damaged liver isn't functioning as it should to prevent this from happening.
    • Antibody tests that look for substances produced by the immune system in response to certain viruses—specifically HAV, HBV, and HCV.
    • Direct viral measures, in which the exact amount of HBV or HCV are evaluated.

    More advanced tests for hepatitis may be necessary in some cases, such as ultrasound, computerized axial tomography (CT) scans, or magnetic resonance imaging (MRI.

    Sometimes a liver biopsy is necessary to definitively diagnose hepatitis.

    Treatment and Prevention

    Often, acute viral hepatitis does not need to be treated: Like many viral infections, such as the common cold, these diseases get better on their own.

    Certain types of hepatitis can benefit from prescription medications, however—particularly those that are chronic. And there are vaccinations available for several hepatitis viruses.

    Prescriptions

    The medications prescribed to treat hepatitis depend largely on the type of virus that causes it. For example, corticosteroid drugs, including prednisone and budesonide, often are used to treat chronic hepatitis A.

    There are six FDA-approved drugs for treating chronic HBV infection. While none can clear the virus, they can effectively prevent it from replicating and causing damage to the liver. Since the hepatitis D virus can only affect people who are already infected with hepatitis B, treatment for both infections are the same.

    For HCV, there are several drugs approved by the FDA. These are:

    Treatment options for HEV are limited, although there has been success ribavirin.

    Surgery

    Chronic hepatitis that advances to the stage of liver failure due to cirrhosis typically requires a liver transplant. For example, according to research, an estimated that 35 percent to 40 percent of all liver transplants in the U.S. are due to cirrhosis caused by HCV.

    Vaccines

    There are vaccines for hepatitis A virus and hepatitis B virus, both of which are included in the recommended childhood immunization schedule.

    HAV vaccine: There are two, HAVRIX and VAQTA, both of which are available for anyone 1 year old or older and are given in two doses between six and 12 months apart.

    HBV vaccine: The two vaccines that protect against hepatitis B are Recombivax HB and Engerix-B. Both require three or four shots given over six months.

    In certain cases, the CDC advises that adults who have not received the HAV vaccine do so, such as before travel.

    A Word From Verywell

    The multiple causes and complications of hepatitis can make it a complicated disease to understand. Once you've been diagnosed with any type of chronic hepatitis, however, being compliant with your treatment plan will help prevent serious disease or damage to your liver.

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