Hepatitis

What is Hepatitis?

Liver is the largest gland in the body and it is located at the right upper quadrant of the abdomen. It is one of the body's most important organs; it is a vital organ and currently there are no ways to compensate for the absence of liver. The liver has a large range of functions from hormone production to glycogen storage and bile production, performing both regulatory and metabolic roles.

Hepatitis occurs due to a liver injury as a consequence of chronic or persistent inflammation. In most cases, the inflammation is the result of an infection caused by a virus, and this is the most rampant type of hepatitis. There are four major types of viruses: hepatitis A, hepatitis B, hepatitis C and hepatitis D.

Hepatitis A is an acute hepatitis. It is also known as infectious hepatitis because it is particularly infectious to humans. Although the disease is preventable by administration of vaccines, it is still frequently diagnosed in the United States.

Hepatitis B is also known as serum hepatitis. Most adults who are infected with hepatitis B recuperate and develop immunity. However, people who do not develop immunity become carriers of the hepatitis B virus.

Hepatitis C is also known as non-A or non-B hepatitis. Most individuals carrying the virus are completely unaware of that fact. Contrary to hepatitis B patients, hepatitis C patients do not recover rapidly, nor do they easily develop immunity to the virus. The hepatitis C virus will cause chronic infection leading to chronic inflammation and scarring of the liver.

Hepatitis D is an infection that is difficult to treat and is associated with the highest mortality rate of all hepatitis types. Hepatitis D virus (HDV) needs to co-infect host cells with hepatitis B virus (HBV) in order to achieve the viral replication stage. Co-infection results in the acute case of Hepatitis B and D, that may evolve to chronic Hepatitis D in about 5% of the cases. Hepatitis D can also occur as a super-infection in a person with chronic Hepatitis B. This will result in a more intense acute phase of Hepatitis D infection and higher likelihood of developing a chronic infection which is also more severe.

Hepatitis can also result from an autoimmune disorder. Autoimmune hepatitis happens when the body's immune system mistakenly attacks the liver cells leading to inflammation of the liver. It is more common in women than in men. There are two types of autoimmune hepatitis: Type 1 autoimmune hepatitis or classic, and Type 2 autoimmune hepatitis. Type 1 and 2 autoimmune hepatitis can affect anybody at any age. However, Type 2 autoimmune hepatitis is more rampant in young girls.

What Causes Hepatitis?

The causes of hepatitis will depend on what type of hepatitis is present.

Hepatitis A is caused by a virus called the hepatitis A virus (HAV) which can spread through a fecal-oral route by ingesting contaminated objects, food (like shellfish) or water. It can also be spread through unprotected intercourse and living in close contact with an infected person.

Hepatitis B is caused by a virus called the hepatitis B virus (HBV). The hepatitis B virus (HBV) can be spread though unprotected intercourse, hemodialysis, sharing needles or razors, unintentional contaminated needle pricks or injury (common in health care providers), blood transfusion, maternal-fetal route, or sharing a toothbrush with infected blood.

Hepatitis C is caused by a virus called the hepatitis C virus (HCV).  The hepatitis C virus can spread through unintentional contaminated needle pricks or injury that is common in health care providers. Other common forms of transmission include: hemodialysis, sharing needles or razors, blood transfusion and tattoos and piercing with unsanitary equipment. Patients that received organ transplant before 1992 were at an increased risk of contracting the infection.  Sexual transmission and maternal-fetal transmission is rare.

Hepatitis D is caused by a virus called the hepatitis D virus (HDV), or also known as the delta virus or agent. It is the most uncommon, but nonetheless, the most dangerous form of viral hepatitis.

Autoimmune hepatitis may be caused by one of the following conditions: ulcerative colitis, proliferative glomerulonephritis, type 1 diabetes, hemolytic anemia, rheumatoid arthritis, thyroiditis or other autoimmune diseases. There are medications that can, in rare cases, cause autoimmune hepatitis such as atorvastatin, a cholesterol drug, and the antibiotic minocycline.

Hepatitis can also be caused by non-biological agents that cause liver damage, such as alcohol abuse.

Symptoms of Hepatitis

People who have hepatitis A, B or C may not show symptoms while others do. The symptoms will depend on what type of hepatitis is present.

General symptoms include:

• Fatigue
• Abdominal discomfort
• Fever (low grade)
• Weight loss
• Joint pain (arthralgia)
• Abdominal pain (upper quadrant of the abdomen)
• General itching or pruritus
• Nausea and vomiting
• Tiredness
• Jaundice
• Diarrhea or constipation
• Muscle pain (myalgia)
• Urine color is dark
• Gynecomastia – breast enlargement in male
• Anorexia or loss of appetite
• Dark clay colored stool
• Abnormal blood vessels on the skin (spider angiomas) – autoimmune hepatitis.

Common or serious complications include:

• Liver failure
• Hepatic cancer
• Esophageal varices
• Scarring of liver  or cirrhosis
• Kidney failure or other kidney problems
• Vasculitis
• Pernicious anemia
• Celiac disease
• Thrombocytopenic purpura
• Rheumatoid arthritis
• Ulcerative colitis
• Autoimmune thyroiditis (Hashimoto's thyroiditis)
• Hemolytic anemia
• Portal hypertension
• Ascites (from autoimmune hepatitis)

Diagnosis of Hepatitis

Initially, the doctor will likely ask the patient several questions that include personal information, family history, past and present medical history, previous medication use, and dietary and lifestyle history. Then the doctor will perform a physical examination to assess the patient's body and check for any signs and symptoms of hepatitis.

Blood tests will ensue to check for markers of hepatitis. The doctor will check the levels of billirubin, aspartate aminotransferase (AST or SGOT) and alanine aminotransferase (ALT or SGPT) to determine if the liver is functioning well. The prothrombin time and the albumin level are checked as well. Hepatitis serology tests help to identify the presence of Hepatitis A, B, C, & D, an autoimmune antibody found in the blood of infected patients. Antinuclear antibody panel is a blood test that checks the presence of antinuclear antibodies (ANA) that are created by the immune system to attack the tissue of the body – present in autoimmune hepatitis.

A liver biopsy may be used to verify the diagnosis of hepatitis and to identify the degree and nature of liver damage. This procedure is performed in an ambulatory care setting and performed through the skin with local anesthesia.

The doctor may perform an abdominal ultrasound. The ultrasound uses sound waves and captures images from inside the body. This will allow the doctors to check for any liver abnormalities.

Treatment of Hepatitis

The treatment of hepatitis will depend on what the causes of the disease are and the severity of the inflammation. The goal is to promote healing and restoration, to prevent complications and to allow the liver to rest and recover.

Specific treatments apply to hepatitis of different etiology:

Hepatitis A: When a person has hepatitis A, usually there is no treatment needed since it disappears by itself. The only thing a person can do is to have enough rest. For nausea, do not eat fatty foods and large meals, rather eat small snacks frequently. Also, do not take any medications or drink alcoholic beverages to allow the liver to rest.

Hepatitis B: The doctor will prescribe antiviral drugs such as lamivudine and adefovir for chronic hepatitis. For acute hepatitis, there are no medications available, the doctor will rather manage the symptoms that the patient is experiencing. Currently, there are vaccination options to prevent the appearance or recurrence of the infection.

Hepatitis C: This condition is not curable. There are no treatments that can cure hepatitis C, but there is a combination of therapy available that can help restrain the causative virus. This therapy is composed of oral ribavirin and subcutaneous interferon.

Hepatitis D: The prescribed medication for this condition is alpha interferon. Currently, there are no other drugs approved for treatment of Hepatitis D.

Autoimmune hepatitis: The prescribed drug for this condition is an immunosuppressant medication. This medication is used to reduce the immune system's response. Immunosuppressant drugs include azathioprine, cyclosporine, prednisone and tacrolimus.

Other, more general treatments, may apply depending on the extent and severity of the liver damage. If liver damage is extensive and the liver function is compromised (scarring resulting in liver failure), a transplant may be considered. The surgeon will make an incision on the patient's abdomen to remove the damaged liver. The surgeon will then extract the patient's liver and replace it with a healthy liver from a donor. The new liver is connected to the bile duct and blood vessels.

In cases of severe nausea, anti-emetic medications help to relieve this symptom. Rest alternated with periods of mild activity is generally recommended for healing and recovery.

Alternative Treatment

Milk thistle is an herbal treatment that helps in alleviating liver disorders. This is also used to treat jaundice, a condition often observed in hepatitis patients.

Diet therapy is very helpful in the management of hepatitis. The objective is not to overwhelm the injured and/or recovering liver with large amount of food. Small frequent meals are better than eating large portions.

Prognosis of Hepatitis

There are many factors that need to be considered when making a prognosis. The prognosis will depend on what caused the hepatitis, on the recovery of the person as well as the presence of complications and co-morbidities. Although, there are people who recover from this disease, there are a substantial number of patients who do not recover and their condition progresses to liver failure or liver cancer.

Preventing Hepatitis

There are many ways to prevent hepatitis from happening or from recurring. Vaccination can help prevent hepatitis A and B. Avoid sharing needles, razors, toothbrushes or other personal objects. Avoid contact with blood or blood products and always use extreme caution when handling needles or blood. Immediately clean any blood spills with diluted bleach. When getting a tattoo or piercing, make sure the equipment is clean and sterile. Always use proper hygiene procedures, such as hand washing before handling food and after going to the bathroom (particularly in public places). Avoid drinking alcohol and consuming uncooked meat or fish. If you travel to foreign countries and are unsure of the water quality, always drink bottled water.

Living with Hepatitis

A person with hepatitis should not approach the disease with negative thoughts. It is very important to stay positive and strong. Gathering helpful information regarding hepatitis will help you learn about your disease and will help you understand and decide on what course of treatments to choose from. Talking to people like your family, friends or partner about this disease will help you cope with the disease. You can find comfort in a support group since they understand what you are going through, because they also experienced or are experiencing the condition. Changing your lifestyle habits, exercising everyday and getting sufficient rest are very important. Also, do not take medications that are not recommended by the doctor, and avoid from getting sick to prevent recurrence of diseases or complications. When you have a sexually active partner, always wear condoms during intercourse to protect you and your partner.

Current Research of Hepatitis

Hepatitis is a condition of diverse etiology that has associations with other disease agents. Therefore, the research on hepatitis is multi-faceted and involves multiple disciplines.  In general, research efforts are being directed to clarify molecular mechanisms of infection and disease, the role of new drugs for treatment and management of hepatitis, and the association with hepatic cancer.

A new oral vaccine called V5 Immunitor oral vaccine has been recently tested in clinical trials.  Clinical researchers found that the vaccine is effective in treating chronic hepatitis B and hepatitis C.