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Hepatitis

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Dr. Santosh Palve
Gastroenterologist

verified

Liver is one of the vital organs of your body sitting right under your rib cage at the right-hand side of the abdomen. It performs some of the most important physiological functions of the body starting from flushing out toxins and processing nutrients to filtering out blood and fighting infection. Any major damage to this organ can be life threatening.  Your liver can be affected by many factors like genetic issues, immunological disorders, cancer, lifestyle disorders like poor eating habits and alcohol habits and viral infections. Hepatitis is the one of the most common conditions that damage the liver. Simply put, it is a condition that leads to inflammation in the liver.

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Types

Hepatitis can be infectious and non-infectious:

Infectious hepatitis

Hepatitis can be triggered by infections caused by five different viruses: Hepatitis A, B, C, D, and E.


  • Hepatitis A: You get this condition when your liver is infected by hepatitis A virus (HAV). The virus gets transmitted if you happen to eat food or water contaminated by the faeces of a person infected with it. Hepatitis A is not a severe condition. Usually, the person recovers on their own in a few months; however, in certain instances, it can turn life-threatening and result in liver failure.

  • Hepatitis B: This is a life-threatening infection caused by the hepatitis B virus (HBV). It spreads via body fluids contaminated by the virus. Fluids include blood, vaginal secretions, or semen. Sharing needles and razors with an infected person or having sex with a person affected by this virus can increase your risk of catching hepatitis B. Recovery is observed in a majority of patients infected with hepatitis B. The diagnosis of hepatitis B earlier in life increases the risk of it developing into a life-long chronic condition.

  • Hepatitis C: Triggered by hepatitis C virus (HCV), this condition is transmitted in the same way as Hepatitis B. Most patients with hepatitis C develop in the long term; it is a chronic infection that ultimately leads to cirrhosis and liver cancer and is usually asymptomatic.

  • Hepatitis D: This is a blood-borne condition caused by the hepatitis D virus (HDV). It is known as delta hepatitis; it is a serious but rare liver disease that hits you only in association with hepatitis B infection. This is because hepatitis D virus requires HBV to multiply. Moreover, the Hepatitis B vaccine provides protection against hepatitis D.

  •  Triggered by the hepatitis E virus (HEV), it is a waterborne disease common in areas with poor sanitation.


Non-infectious hepatitis

In addition to viral infections, there could be other triggers behind hepatitis:

  • Autoimmune system response: You may get hepatitis if your immune system starts identifying your liver as a harmful object and invades it. More common in women than men, this form of hepatitis can manifest via mild or severe symptoms.


Alcohol and other toxins: When inflammation in the liver is caused by overindulging in alcohol, it is known as alcoholic hepatitis. Because this intoxicant directly affects liver cells, prolonged alcohol abuse may lead to liver failure or cirrhosis. Moreover, it can result in thickening and scarring of liver tissue. The overdose of certain drugs and medicines and exposure to poisons may lead to hepatitis.

Symptoms

Chronic liver inflammation is caused by HBV, HCV, autoimmune response, excessive alcohol consumption and other factors. In such cases, the symptoms may be subtle; however, acute, infectious hepatitis may itself manifest quickly. Some symptoms include:

Causes And Risk Factors

Causes

Hepatitis can be attributed to viruses and factors such as an autoimmune response, overdose of certain medicines, alcohol abuse and exposure to certain drugs and poisons. In infectious, viral hepatitis, the route of transmission could be contaminated food and water, infected blood and body fluids such as semen.

 

Risk Factors

 

The following are the risk factors of hepatitis:

 


  • Having multiple sex partners

  • Unprotected sex

  • Heavy alcohol consumption

  • Working in hospitals, daycare or public safety

  • Travel to countries with poor sanitation and access to clean drinking water

  • Exchanging needles for drugs

  • Weak immune system

  • Dialysis because of chronic kidney disease

  • Children of mothers infected with hepatitis B, C or E

Diagnosis

Based on symptoms, the doctor will conduct a physical examination to look for the enlargement of the liver, yellowing of the skin, and fluid presence in the abdomen. During physical examination, your doctor may gently press your stomach to see if there is pain or any tenderness:

Blood tests: Multiple blood tests are performed to look for the presence of viruses that cause hepatitis and antibodies commonly found for autoimmune hepatitis. Your doctor may suggest blood work for a liver function test. They will verify the levels of certain liver enzymes in your bloodstream. High volumes indicate that there is impairment in your liver function or it is damaged.

Ultrasound: With the help of this imaging test, your doctor takes a closer look at your liver as well as other organs. An ultrasound reveals the presence of fluid in your abdomen, damage or enlargement in the liver, abnormality in your gallbladder, and the culprit behind the impaired liver function.

Liver biopsy: This invasive procedure helps your doctor see if there is any infection, inflammation or abnormality in your liver. For a liver biopsy, your doctor will collect a liver tissue sample with the help of a needle or via surgery.

Treatment

The underlying cause behind hepatitis and the severity of condition determines the line of treatment. Acute liver inflammation caused by hepatitis A and E viruses mostly resolve on their own. They are short-term illnesses that require complete bed rest, plenty of fluids, a closely-monitored diet, and abstinence from alcohol. While acute hepatitis B resolves in 90% patient with long-term immunity, the chronic form of this liver inflammation necessitates antiviral medications on a long-term basis. People with hepatitis C are treated with antiviral drug therapies. However, if this condition leads to scarring of the liver, a transplant may be required. Currently, there is no medicine for hepatitis D. For autoimmune hepatitis, doctors prescribe corticosteroids and immunosuppressants. The treatment for alcoholic hepatitis is aimed at providing symptomatic relief and prevent disease progression.

Lifestyle/management

Hepatitis Diet

For managing hepatitis, a healthy diet should be followed. Depending on the cause of liver inflammation, though the dietary recommendations may vary, certain golden rules help in the healing process:


  • Load up on fruits and vegetables such as cauliflower, broccoli, beans, apples, and avocados

  • Include traditional Indian spices such as garlic and onion in your meals

  • Drink plenty of fluids, including fresh fruit juices

  • Cut back on alcohol, wheat-based foods, junk foods, white flour, hydrogenated oils, dairy products, processed foods and artificial sweeteners

  • Chew your food well before gulping it down to ease the digestion process 

  • Eat four small meals frequently rather than having a large one.

Prevention

Vaccines can prevent both hepatitis A and B. The immunisation for HBV can protect you against hepatitis D because it develops along with hepatitis B. However, there are no vaccines for hepatitis C and E. For hepatitis A, there is a series of two vaccines available for children between 12 and 18 months and adults. For hepatitis B, there is a set of three vaccines recommended for new-borns. The dosage is completed within the first 18 months of life.

In addition to vaccines, there are other ways to keep hepatitis at bay:


  • Do not share your razors, toothbrushes and needles with others

  • Be careful about equipment used while going for a tattoo

  • Ensure body piercings are done with clean equipment

  • Practise safe sex

  • Wash your hands well after using the restroom and before eating meals

  • Avoid street food

  • Wash raw produce well before having them. Ensure the water you use for washing is clean

  • Get vaccinated before travelling to a foreign country

  • Stop alcohol consumption to prevent the development of alcoholic hepatitis

References


  1. Cleveland Clinic. Viral Hepatitis [Internet] [Updated on June 1, 2020] Available at: https://my.clevelandclinic.org/health/diseases/4245-hepatitis-viral-hepatitis-a-b--c.  (https://my.clevelandclinic.org/health/diseases/4245-hepatitis-viral-hepatitis-a-b--c)

  2. NHS. Hepatitis [Internet] [Updated on February 4, 2019] Available at: https://www.nhs.uk/conditions/hepatitis/. (https://www.nhs.uk/conditions/hepatitis/)

  3. CDC. Hepatitis C [Internet] [Updated on July 28, 2020] Available at: https://www.cdc.gov/hepatitis/hcv/index.htm. (https://www.cdc.gov/hepatitis/hcv/index.htm)

  4. Winchester Hospital. Risk factors for viral hepatitis [Internet] Available at: https://www.winchesterhospital.org/health-library/article?id=19580#:~:text=People%20who%20have%20many%20sex,hepatitis%20B%2C%20C%2C%20or%20E. (https://www.winchesterhospital.org/health-library/article?id=19580#:~:text=People%20who%20have%20many%20sex,hepatitis%20B%2C%20C%2C%20or%20E.)

  5. John Hopkins Medicine. Alcoholic Hepatitis [Internet] Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/hepatitis/alcoholic-hepatitis. (https://www.hopkinsmedicine.org/health/conditions-and-diseases/hepatitis/alcoholic-hepatitis) Medline Plus. Hepatitis [Internet] Available at: https://medlineplus.gov/hepatitis.html. (https://medlineplus.gov/hepatitis.html)

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