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Hepatitis

Hepatitis

Alternate Names

  • viral hepatitis
  • Biliary System

Definition

Hepatitis is a general term for inflammation of the liver from any infectious or non-infectious cause. Because the functions of the liver are so varied and crucial to the body's well-being, hepatitis has many different symptoms and signs.

What is going on in the body?

The liver is an important organ in the body located in the upper right quadrant of the abdomen. It is responsible for:
  • filtering the blood
  • making bile, a substance that aids in digestion of fats and that excretes certain fatty substances from the body
  • processing and hooking fats to carriers (cholesterol) and storing sugars (glycogen), helping the body transfer and store energy
  • making important proteins, such as those involved in blood clotting
  • metabolizing many medications, such as barbiturates, sedatives, and amphetamines
  • storing vitamins A, B12, D, and several of the B-complex vitamins. The liver also stores iron and copper.
  • making important proteins such as albumin that regulate fluid transport in the blood vessels and kidneys.
  • helping break down and recycle red cells.
If the liver becomes inflamed, its ability to perform these functions may be impaired. Liver disease can be caused by a variety of conditions including viral infections, bacterial infections, medication or drug ingestion, other diseases, or an inherited tendency to injury (called autoimmune hepatitis) as well as chemical or physical changes within the body (obese people can harm the liver from excess fat deposition called "fatty liver" or steatosis).
Symptoms of hepatitis may be acute, occurring suddenly, or chronic, developing slowly over a long period of time. Hepatitis may range from mild to severe depending on the cause of hepatitis.

There are 5 common forms of viral hepatitis, each named for the type of virus causing the inflammation. These are:
  • hepatitis A, which usually causes disease limited to the liver. It is primarily spread through food or water that is contaminated by the hepatitis A virus from an infected person (called fecal-oral spread). Hepatitis A often occurs in epidemic settings or in developing countries. Infection can be prevented by immune globulin and/or vaccination.
  • hepatitis B, which has been found in blood, saliva, semen, and vaginal fluids. It can be spread through sexual contact with an infected individual, passed on to a newborn from an infected mother during childbirth, or transmitted from contact with infected blood or bodily fluids. It can be prevented by immune globulin and/or vaccination.
  • hepatitis C, which may be spread by infected IV drug users, by blood transfusions that were not screened for hepatitis, and by some organ transplants. Sharing contaminated personal hygiene items, such as toothbrushes and razors, may also cause the spread of hepatitis C. Exposure to blood or body fluids by healthcare workers or tattoos may be sources of hepatitis C infection. There is no vaccination to prevent hepatitis C.
  • hepatitis D, which is spread through contaminated needles or sexual contact. Hepatitis D cannot survive in the body unless the person is also infected with the hepatitis B virus. Preventing Hepatitis B (immune globulin or vaccination) will prevent hepatitis D.
  • hepatitis E, which is found primarily in underdeveloped countries with poor sanitation. It is primarily spread through food or water contamination.
Hepatitis B, C, and D can cause chronic, sometimes lifelong illness due to injury to the liver as well as to other parts of the body. The liver disease can progress to cirrhosis and liver cancer.
Liver inflammation/hepatitis can also be caused by drugs or medications (like "ecstasy"), medications (like methotrexate), poisonous mushrooms, alcohol, bacterial infections (such as those from a blocked duct with gall bladder disease), and can be inherited (autoimmune hepatitis).

Risks

What are the causes and risks of the disease?

The causes, risks, and modes of transmission of hepatitis vary depending on the type of hepatitis. These may include:
  • sexual contact with a person who is infected by the virus
  • shared IV drug needles
  • intranasal cocaine use
  • exposure of and to infected healthcare workers, including dentists
  • contamination of a healthcare worker during patient care
  • contaminated blood transfusions or blood products (like in hemophiliacs) that were given prior to the screening for hepatitis B and C
  • food or water that has been contaminated by feces from an infected person
  • contaminated water and food consumed during travel to developing countries
  • exposure to the infected mother during childbirth (called vertical transmission)
  • organ transplantation
  • sharing contaminated personal hygiene items, such as razors, toothbrushes, or nail clippers that may contain blood.
Causes of non-infectious hepatitis need to be completely avoided (poison mushrooms, ecstasy). Medications such as methotrexate should be stopped, if possible, when evidence of hepatitis has appeared.

Prevention

What can be done to prevent the disease?

Preventing types A and B hepatitis is possible by receiving the hepatitis A or the hepatitis B vaccine (or immunoglobulin for exposure in unvaccinated individuals). Other ways to decrease the risk of hepatitis include:
  • practicing good hygiene, such as washing hands well after using the restroom or changing diapers (for those viruses spread by fecal-oral routes like Hepatitis A)
  • avoiding drinking or using tap water when traveling to under-developed nations).
  • avoiding behaviors like sharing drug needles, or having unprotected sexual intercourse with anyone who may be infected
  • avoiding the sharing of personal hygiene items, such as razors or nail clippers
  • avoiding toxic substances, illegal drugs, and decreasing/avoiding alcohol consumption
  • an injection of immune globulin after exposure to hepatitis A or B, which may prevent the infection from developing in unvaccinated individuals. Vaccine can be given at the same time.
  • the use of safety precautions by healthcare and day care workers

Diagnosed

How is the disease diagnosed?

Hepatitis should be suspected if gastrointestinal symptoms and jaundice are accompanied by a history of exposure to a hepatitis virus, travel, a medication exposure or drug use. Physical examination may reveal a liver that is enlarged and tender. Liver function tests, performed on a blood sample, will reveal elevated levels of enzymes from damaged liver cells. Sometimes, tests such as ultrasounds, CT scans or liver-spleen scans may be done to rule out related disease processes such as gall bladder disease or cancer.
A liver biopsy may be recommended in some cases. This involves obtaining a tiny piece of liver tissue with a needle for evaluation. Liver biopsy specimens can be graded in terms of severity. Liver biopsies may have to be done repeatedly to detect progression of the disease or response to therapy (such as for hepatitis B or C).

Long Term Effects

What are the long-term effects of the disease?

Chronic hepatitis can lead to:
  • cirrhosis and liver failure.
  • illnesses in other parts of the body, such as kidney damage or low blood counts
  • cancer of the liver
  • increased risk of death in people with HIV

Other Risks

What are the risks to others?

Viral hepatitis can be highly contagious and spread to others. The risk of exposure to others will depend on the type of hepatitis. Other varieties (such as from reactions to medication) are not contagious. Autoimmune hepatitis can be inherited.

Treatments

What are the treatments for the disease?

Treatment of hepatitis varies according to the type and severity of the disease, but may include:
  • bed rest
  • drinking extra fluids to prevent dehydration
  • avoiding unnecessary medications, especially those metabolized in or toxic to the liver (such as acetaminophen)
  • avoiding alcohol
  • eating a well balanced diet for liver disease
  • medications to relieve nausea
Further treatment will depend on the type of hepatitis and the extent of the infection. For example, treating hepatitis B, C, and D may involve the use of medications such as the antiviral medication alpha interferon. Other medications may include ribavirin (i.e., Copegus, Rebetol, Ribasphere), lamivudine (i.e., 3TC, Epivir), and antibiotics.
Acute fulminant hepatitis can cause life-threatening liver failure. This condition involves a bleeding disorder, neurological problems, and special nutritional needs that must be treated in a hospital. In some cases, the only effective treatment for fulminant hepatitis is a liver transplant.

Side Effects

What are the side effects of the treatments?

Side effects will depend on the treatments used. Side effects of interferon include a flu-like illness, with fever and body aches, serious mood disorders, changes in blood counts. Liver transplant can cause many complications, including failure or rejection of the new liver. After a liver transplant, a person will need to take powerful anti-rejection medications for the rest of his or her life. Because these medications interfere with immune system function, they increase the risk for infections and certain cancers.

After Treatment

What happens after treatment for the disease?

What occurs after treatment will depend on the type of hepatitis and the response to treatment. For example, with Hepatitis A and hepatitis E, people will not usually need medication after the disease has been resolved. They can return to a normal lifestyle when symptoms are gone.
A person with hepatitis B, C, and D will be monitored for side effects and benefits during and after medication treatment. A person who has received a liver transplant will need close professional care for the rest of his or her life. Some liver toxins may seriously damage they liver or lead to death after a single exposure.

Monitor

How is the disease monitored?

Monitoring of hepatitis will depend on the type of hepatitis. Periodic visits to the healthcare provider and liver function tests will be used to monitor the hepatitis and to see how the liver is working. The status of the liver may require a liver biopsy. Decisions for further treatment or liver transplantation are frequently made based on these tests. Any new or worsening symptoms should be reported to the healthcare professional.

Sources

http://www.liverfoundation.org/html/livheal.dir/livheal.htm/ http://www.niddk.nih.gov/health/digest/pubs/hep/index.htm/ Harrison's Principles of Internal Medicine, Fauci ET al, 1998

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