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. It can also 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 they 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 two weeks to six months after exposure," notes the Centers for Disease Control and Prevention (CDC). "Symptoms of chronic viral hepatitis can take decades to develop."

When caused by a virus, early symptoms of hepatitis often resemble the flu and include:

  • Fever
  • Headache
  • Joint pain
  • Nausea

As it progresses or becomes chronic, hepatitis can bring on more distinct symptoms, including (but not limited to):

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

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.

Progressive inflammation of the liver can have severe and even life-threatening repercussions. A few examples of complications of chronic hepatitis include a build-up of scar tissue on the liver (severe fibrosis), cirrhosis, liver cancer, and liver failure.

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.

*Rare in the United States

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

Hepatitis A and B Vaccines

These vaccines are included in the recommended childhood immunization schedule. Either HAVRIX or VAQTA, HAV vaccines, is given in two doses, six to 12 months apart. In certain cases, the CDC advises that adults who have not received the HAV vaccine do so, such as before travel. An HBV vaccine, either Recombivax HB or Engerix-B, requires three or four shots given over six months.

Metabolic

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

  • Alcoholic hepatitis (the greatest cause of cirrhosis in the United States)
  • Drug-induced hepatitis
  • Non-alcoholic fatty liver disease (NAFLD)

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 ages 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

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 cases 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. A well-known examples is Interferon (interferon alpha-2b or pegylated interferon).

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, such as Harvoni (ledipasvir, sofosbuvir) and Mavyret (glecaprevir/pibrentasvir).

Treatment options for HEV are limited, although there has been success using Copegus (ribavirin).

Surgery

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

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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