What is Hepatitis?
Hepatitis is swelling and inflammation of the liver.
Hepatitis is most commonly caused by a viral infection. There are, however, other causes of hepatitis. These include autoimmune hepatitis (a disease occurring when the body makes antibodies against the liver tissue) and hepatitis that occurs as a secondary result of medications, drugs, toxins and alcohol.
The liver is located on the upper right side of the abdomen. It performs many critical functions that affect metabolism throughout the body, including:
- bile production that is essential to digestion
- filtering of toxins from the body
- excretion of bilirubin, cholesterol, hormones, and drugs
- metabolism of carbohydrates, fats, and proteins
- activation of enzymes (specialized proteins essential to metabolic functions)
- storage of glycogen, vitamins (a, d and k), and minerals
- synthesis of plasma proteins, such as albumin
- synthesis of clotting factors
According to the Centers for Disease Control and Prevention, there are 4.4 million Americans living with chronic hepatitis, and many more are unaware that they have it (CDC).
Viral infections of the liver that are classified as hepatitis are: hepatitis A, B, C, D, and E viruses. Hepatitis A is a milder version of the disease, whereas hepatitis D is more severe. Treatment options vary depending on what form of hepatitis is diagnosed, and what caused it. Some forms of hepatitis are preventable.
The Five Types of Viral Hepatitis
This type derives from an infection with the Hepatitis A virus (HAV). This type of hepatitis is most commonly transmitted by consuming food or water that has been contaminated by feces.
This type derives from an infection with the Hepatitis B virus (HBV). This type is transmitted through puncture wounds or contact with infectious bodily fluids (such as blood, saliva or semen). Injection drug use, sex with an infected partner, or sharing razors with an infected person is activities that increase risk. It is estimated that 1.25 million people in the United States have chronic hepatitis B and 350 million people worldwide live with this chronic disease (CDC).
This type comes from the Hepatitis C virus (HCV). This type of hepatitis is transmitted through direct contact with infected bodily fluids (typically through injection drug use and sexual contact). HCV is among the most common blood borne viral infections in the United States. According to the CDC, 3.2 million Americans and 170 million people worldwide are living with a chronic form of this infection (CDC).
This is also called “delta hepatitis.” Hepatitis D is a serious liver disease caused by the Hepatitis D virus (HDV), which is contracted through puncture wounds or contact with infected blood. This is a rare form of hepatitis that occurs in conjunction with hepatitis B infection, and it is very uncommon in the United States.
Hepatitis E is a waterborne disease caused by the Hepatitis E virus (HEV). Hepatitis E is mainly found in areas with poor sanitation and is typically caused by ingesting fecal matter. This disease is uncommon in the U.S.. However, cases of Hepatitis E have been reported in the Middle East, Asia, Central America, and Africa (CDC).
Hepatitis A and E are normally contracted from eating contaminated food or drinking contaminated water. Hepatitis B, C, and D are contracted through contaminated blood. These forms of hepatitis can be either acute or chronic, although types B and C usually become chronic.
Causes of Non-Viral Hepatitis
Hepatitis can be caused by liver damage from excessive alcohol consumption. This is sometimes referred to as “alcoholic hepatitis.” The alcohol causes the liver to swell and become inflamed. Other toxic causes include overuse of medication or exposure to poisons.
The immune system may mistake the liver as a harmful object and begins to attack it, hindering liver function.
Common Symptoms of Hepatitis
If you have forms of hepatitis that are usually chronic (hepatitis B and C), you may not have symptoms in the beginning. Symptoms may not occur until liver damage occurs.
Signs and symptoms of acute hepatitis appear quickly. They include:
- flu-like symptoms
- dark urine
- pale-colored stool
- abdominal pain
- loss of appetite
- unexplained weight loss
- yellow skin and eyes (may be signs of jaundice)
Since chronic hepatitis develops slowly, these signs and symptoms may be too subtle to notice.
How is Hepatitis Diagnosed?
During a physical examination, your doctor may press down gently on your abdomen to see if there is pain or tenderness. He or she can also feel if the liver is enlarged. If your skin or eyes are yellow, your doctor will note this during the exam.
A liver biopsy is a minimally invasive test that involves the doctor taking a sample of tissue from your liver. This is closed procedure. In other words, it can be done through the skin with a needle and does not require surgery. This test allows the doctor to determine if an infection or inflammation is present or if or liver damage has occurred.
Liver Function Tests
Liver function tests use blood samples to determine how efficiently the liver works. These tests check how the liver clears blood waste, protein, and enzymes. High liver enzyme levels may indicate that the liver is stressed or damaged.
An abdominal ultrasound uses ultrasound waves to create an image of the organs within the abdomen. This test will reveal fluid in the abdomen, an enlarged liver, or liver damage.
Blood tests used to detect the presence of hepatitis virus antibodies and antigen in the blood will indicate or confirm which virus is the cause of the hepatitis.
Viral Antibody Testing
Further viral antibody testing may be needed to determine if a specific type of the hepatitis virus is present.
How is Hepatitis Treated?
The treatment options are determined by the type of hepatitis present, and whether the infection is acute or chronic.
Hepatitis A isn’t usually treated. Bed rest may be recommended if symptoms cause a great deal of discomfort. If you experience vomiting or diarrhea, you will be put on a special diet created by your doctor to prevent malnutrition or dehydration. Vaccination can also prevent HAV infections by helping your body produce the antibodies that fight this type of infection. Most children receive the vaccination between ages 12 and 18 months. Vaccination is also available for adults.
Acute hepatitis B doesn’t require specific treatment. Chronic hepatitis B is treated with anti-viral medications. This form of treatment can be costly, since the treatment must be followed for several months or years. Treatment for chronic hepatitis B also requires regular medical evaluations and monitoring to determine if the virus is progressing. The CDC recommends vaccinations for hepatitis B for all infants at birth. The vaccine is also recommended for all health care and medical personnel (CDC).
Antiviral medications are used to treat both acute and chronic forms of hepatitis C. People who develop chronic hepatitis C are typically treated with a combination of antiviral drug therapies. They may also need further testing to determine the best form of treatment. People who develop cirrhosis (scarring of the liver) or liver disease as a result of chronic hepatitis C may be candidates for liver transplantation.
Hepatitis D is treated with a medication called alpha interferon. According to the Public Health Agency of Canada, between 60 to 97 percent of people develop hepatitis D again even after treatment (PublicHealthAgencyofCanada).
There are currently no specific medical therapies to treat hepatitis E. Because the infection is often acute, it typically resolves on its own. People with this type of infection are often advised to get adequate rest, drink plenty of fluids and nutrients, and avoid alcohol.
Tips to Prevent Hepatitis
Practicing good hygiene is the main way to avoid catching hepatitis.
If you are travelling to a country with low sanitary standards, avoid:
- drinking local water
- sea food
- raw fruit and vegetables
Hepatitis contracted through contaminated blood can be prevented by:
- not sharing drug needles
- not sharing razors
- not using someone else’s toothbrush
- not touching spilled blood
Vaccinations are available to prevent the development of hepatitis A and B. Experts are currently developing vaccines against hepatitis C, D, and E.
Complications of Hepatitis
Chronic hepatitis B or C can often lead to more serious health problems. Because the virus primarily affects the liver, people with chronic hepatitis B or C are at risk for:
- chronic liver disease
- cirrhosis (scarring of the liver)
- cancer of the liver (in rare cases)
When the liver stops functioning normally liver failure can occur. Complications of liver failure include:
- bleeding disorders
- build-up of fluid in the abdomen (the liver can no longer rid the body of toxins and fluids; fluid can become infected)
- increased blood pressure in portal veins that enter the liver (due to overall fluid retention)
- kidney failure (decrease kidney function occurs in patients with liver failure and toxins build up in body)
- hepatic encephalopathy (fatigue, memory loss, diminished mental abilities due to build up of toxins that affect the brain, especially ammonia)
- hepatocellular carcinoma, liver cancer (occurs in 80 percent of patients with cirrhosis and is commonly seen as a result of viral hepatitis)
People with chronic hepatitis C are encouraged to avoid alcohol because it can accelerate liver disease. Certain supplements, prescription, and over-the-counter medications can also affect liver function. If you have chronic hepatitis C, check with your doctor before taking any new medications.