Hepatitis – The Inflammation Of Liver

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HEPATITIS

Hepatitis means inflammation of the liver. The liver is a vital organ that processes nutrients, filters the blood, and fights infections. There are several  possible causes of hepatitis. These include autoimmune hepatitis and hepatitis that occurs as a secondary result of medications, drugs, toxins, and alcohol. Autoimmune hepatitis is a disease that occurs when your body makes antibodies against your liver tissue. Heavy alcohol use, toxins, some medications, and certain medical conditions can cause hepatitis.

When the liver is inflamed or damaged, its function can be affected.  Your liver is located in the right upper area of your abdomen. It performs many critical functions that affect metabolism throughout your body, including:

  • bile production, which is essential to digestion
  • filtering of toxins from your body
  • excretion of bilirubin (a product of broken-down red blood cells), cholesterol, hormones, and drugs
  • breakdown of carbohydrates, fats, and proteins
  • activation of enzymes, which are specialized proteins essential to body functions
  • storage of glycogen (a form of sugar), minerals, and vitamins (A, D, E, and K)
  • synthesis of blood proteins, such as albumin
  • synthesis of clotting factors

Type of Hepatitis?

There are different types of hepatitis, with different causes:

  • Viral hepatitis is the most common type. It is caused by one of several viruses — hepatitis viruses A, B, C, D, and E. In Nigeria, Hepatitis A, B, and C are the most common.
  • Alcoholic hepatitis is caused by heavy alcohol use
  • Toxic hepatitis can be caused by certain poisons, chemicals, medicines, or supplements
  • Autoimmune hepatitis is a chronic type in which your body’s immune system attacks your liver. The cause is not known, but genetics and your environment may play a role.

How does the viral hepatitis spread?

Hepatitis A and hepatitis E usually spread through contact with food or water that was contaminated with an infected person’s stool. You can also get hepatitis E by eating under-cooked pork, deer, or shellfish.

Hepatitis B, hepatitis C, and hepatitis D spread through contact with the blood of someone who has the disease. Hepatitis B and D may also spread through contact with other body fluids. This can happen in many ways, such as sharing drug needles or having unprotected sex.

What are the symptoms of hepatitis?

Many people with hepatitis do not have symptoms and do not know they are infected. If symptoms occur with an acute infection, they can appear anytime from 2 weeks to 6 months after exposure. Symptoms of chronic viral hepatitis can take decades to develop. Symptoms of hepatitis can include: fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored stools, joint pain, clay-colored bowel movements and jaundice.

What other problems can hepatitis cause?

Chronic hepatitis can lead to complications such as cirrhosis (scarring of the liver), liver failure, and liver cancer. Early diagnosis and treatment of chronic hepatitis may prevent these complications.

Can hepatitis be prevented?

There are different ways to prevent or lower your risk for hepatitis, depending on the type of hepatitis. For example, not drinking too much alcohol can prevent alcoholic hepatitis. There are vaccines to prevent hepatitis A and B. Autoimmune hepatitis cannot be prevented.

Nevertheless, ways to prevent hepatitis transmission will depend on the type.

For those at higher risk,  regular screening for hepatitis B and C is recommend. Also, doctors routinely screen for hepatitis B and C during pregnancy is very vital.

Means of prevention by type

Hepatitis A

Hepatitis A mostly spreads through infected food and water.

Some ways of preventing infection include:

  • washing the hands carefully after using the bathroom and before eating
  • ensuring that food is fully cooked and appropriately stored
  • drinking only bottled water when traveling
  • avoiding or peeling fruits and vegetables that may have been washed or grown in contaminated water

A person may wish to ask their doctor about the hepatitis A vaccine, especially if they are traveling to an area where the virus is prevalent.

Hepatitis B and C

To minimize the risk of transmission:

  • A person should talk openly with any sexual partners about any viruses they may have.
  • Use a barrier method, such as a condom, during sex.
  • Only use previously unused, clean needles.
  • Avoid sharing toothbrushes, razors, and manicure instruments.
  • Check that any tattoo or acupuncture equipment is sterile.

People with a high risk of exposure to hepatitis B can ask their doctor about a vaccination, but there is no vaccination for hepatitis C.

Anyone who believes that they may have any type of hepatitis should seek medical help, as a doctor can advise on how to reduce the risk of complications and avoid transmitting the virus.

In people with HIV, there is a higher risk of contracting a hepatitis B or C infection. The impact can also be more severe, as the body is less able to fight the infection.

To lower their risk of hepatitis infection and complications, people with HIV should:

  • take precautions to prevent infection and transmission of hepatitis
  • attend all health checks
  • adhere to their treatment plan

Immunization can prevent hepatitis A and B, but not C. Treatment is available for hepatitis B and C, but not A.

How is hepatitis diagnosed?

The symptoms of the different types of hepatitis are similar, but laboratory tests can identify the specific type a person has.

To diagnose hepatitis, your health care provider will perform a physical examination and ask questions about your symptoms and medical history.

They may recommend blood tests or nucleic acid tests. Blood tests can detect antibodies and assess liver function, while nucleic acid tests can — for hepatitis B and C — confirm the speed at which the virus is reproducing in the liver, which will show how active it is. Your health care provider may need to do a liver biopsy to get a clear diagnosis and check for liver damage.

There are three types of blood tests for evaluating patients with hepatitis: liver enzymes, antibodies to the hepatitis viruses, and viral proteins or genetic material (viral DNA or RNA).

Liver enzymes:   Among the most sensitive and widely used blood tests for evaluating patients with hepatitis are liver enzymes, called aminotransferases. They include aspartate aminotransferase (AST or SGOT) and alanine aminotransferase (ALT or SGPT). These enzymes normally are contained within liver cells. If the liver is injured (as in viral hepatitis), the liver cells spill the enzymes into the blood, raising the enzyme levels in the blood and signaling that the liver is damaged.

The normal range of values for AST is from 5 to 40 units per liter of serum (the liquid part of the blood) while the normal range of values for ALT is from 7 to 56 units per liter of serum. (These normal levels may vary slightly depending on the laboratory.) Patients with acute viral hepatitis (for example, due to HAV or HBV) can develop very high AST and ALT levels, sometimes in the thousands of units per liter. These high AST and ALT levels will become normal in several weeks or months as the patients recover completely from their acute hepatitis. In contrast, patients with chronic HBV and HCV infection typically have only mildly elevated AST and ALT levels, but these abnormalities can last years or decades. Since most patients with chronic hepatitis are asymptomatic (no jaundice or nausea), their mildly abnormal liver enzymes are often unexpectedly encountered on routine blood screening tests during yearly physical examinations or insurance physicals.

Elevated blood levels of AST and ALT only means that the liver is inflamed, and elevations can be caused by many agents other than hepatitis viruses, such as medications, alcohol, bacteria, fungi, etc. In order to prove that a hepatitis virus is responsible for the elevations, blood must be tested for antibodies to each of the hepatitis viruses as well as for their genetic material.

Viral antibodies: Antibodies are proteins produced by white blood cells that attack invaders such as bacteria and viruses. Antibodies against the hepatitis A, B, and C viruses usually can be detected in the blood within weeks of infection, and the antibodies remain detectable in the blood for decades thereafter. Blood tests for the antibodies can be helpful in diagnosing both acute and chronic viral hepatitis.

In acute viral hepatitis, antibodies not only help to eradicate the virus, but they also protect the patient from future infections by the same virus, that is, the patient develops immunity. In chronic hepatitis, however, antibodies and the rest of the immune system are unable to eradicate the virus. The viruses continue to multiply and are released from the liver cells into the blood where their presence can be determined by measuring the viral proteins and genetic material. Therefore, in chronic hepatitis, both antibodies to the viruses and viral proteins and genetic material can be detected in the blood.

Examples of tests for viral antibodies are:

  • anti-HAV (hepatitis A antibody)
  • antibody to hepatitis B core, an antibody directed against the inner core material of the virus (core antigen)
  • antibody to hepatitis B surface, an antibody directed against the outer surface envelope of the virus (surface antigen)
  • antibody to hepatitis B e, an antibody directed against the genetic material of the virus (e antigen)
  • hepatitis C antibody, the antibody against the C virus

Viral proteins and genetic material: Examples of tests for viral proteins and genetic material are:

  • hepatitis B surface antigen
  • hepatitis B DNA
  • hepatitis B e antigen
  • hepatitis C RNA

Other tests: Obstruction of the bile ducts, from either gallstones or cancer, occasionally can mimic acute viral hepatitis. Ultrasound testing can be used to exclude the possibility of gallstones or cancer.

What are the treatments for hepatitis?

Treatment for hepatitis depends on which type you have and whether it is acute or chronic. Acute viral hepatitis often goes away on its own. To feel better, you may just need to rest and get enough fluids. But in some cases, it may be more serious. You might even need treatment in a hospital.

There are different medicines to treat the different chronic types of hepatitis. Possible other treatments may include surgery and other medical procedures. People who have alcoholic hepatitis need to stop drinking. If your chronic hepatitis leads to liver failure or liver cancer, you may need a liver transplant.

 

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