Hepatitis refers to inflammation of the liver, which is the largest gland in the human body and an important component of the digestive and metabolic processes among other functions. Hepatitis can be caused by infection from bacteria and viruses (such as Hepatitis A, B, and C); an attack from the body's own immune system (autoimmune hepatitis); damage from drugs or alcohol; or in rare cases, an overdose of acetaminophen or other medications.
Hepatitis may acute (appears suddenly and resolves quickly) or chronic (develops slowly and lasts longer). The severity of the disease varies according to the underlying cause. Because some forms of hepatitis can lead to liver damage (cirrhosis), liver cancer, or liver failure, it is important to seek diagnosis and treatment if you exhibit symptoms of hepatitis. Many people recover fully from hepatitis, but the healing process can take several months. Long-term prognoses are largely dependent on the type and cause of the hepatitis, as well as any concurrent illnesses or conditions.
Common signs of heptatis include:
- Dark urine
- Pale-colored stools
- Painful or swollen abdomen
- Nausea and vomiting
- Appetite loss
- Weight loss
- Fatigue or weakness
- Jaundice (yellowing of the skin or eyes)
- Low-grade fever
- General itching
Some forms of hepatitis, including Hepatitis B and C, may not generate any symptoms until long after the initial infection. If you are at risk for these types of hepatitis, it is important to get tested regularly in order to detect the disease early and begin treatment.
Causes and Risk Factors
Hepatitis A, B, and C are caused by viruses and are the most common viral-based forms of hepatitis. The Heptatis A virus is generally contracted through close personal contact with an infected person or from consuming contaminated food or water. The Hepatitis B virus is spread through the exchange of bodily fluids with an infected person, such as through sexual contact or sharing drug needles with an infected person. Hepatitis C can be contracted through contact with an infected person’s blood, such as being pricked with a needle that has infected blood on it or through sexual activity.
Autoimmune hepatitis is uncommon and occurs when the body's own immune system begins to attack the liver. It is unclear what causes the immune system to do this, but researchers suspect that viral infections such as Epstein-Barr or the measles may play a role. Genetic abnormalities and certain drugs (such as acetaminophen, some antibiotics, and some high-blood pressure medications) might also be culprits in autoimmune hepatitis. Autoimmune hepatitis is more common in women, older adults, and people with a history of viral infections.
Finally, excessive alcohol abuse can cause liver damage and trigger alcoholic hepatitis. Genetic factors, obesity, malnutrition, and the presence of other forms of hepatitis increase the chances that a heavy drinker will develop for alcoholic hepatitis.
General risk factors for hepatitis include:
- Intravenous drug use
- Risky sexual activity (including unprotected sex and multiple sexual partners)
- Consuming contaminated food or water
- Travel in an area where hepatitis is common
- Alcohol abuse
- Taking too much acetaminophen
- Having HIV or AIDS
- Being an organ transplant recipient
- Having received a blood transfusion before 1990
- Being a newborn of a mother with hepatitis B or C
- Employment as a healthcare worker, including dentist and dental hygienist
- Living or working in a nursing home or rehabilitation center
- Having a family member who recently had hepatitis A
- Receiving a tattoo
Vaccines are available for Hepatitis A and B; vaccinations are recommended for children under the age of 18 and for adults who are at risk for exposure.
In addition to your medical history and any presenting symptoms such as yellowing of the skin, your physician may want to perform tests depending on the suspected cause of your hepatitis:
- Liver function test
- Hepatitis virus serology
- Liver biopsy (to determine the presence and severity of possible liver damage)
- Autoimmune blood marker
- Abdominal ultrasound
A proper diagnosis, including which particular form of hepatitis you have, is crucial for planning and executing an effective treatment plan.
Treatment plans will depend largely on the type of hepatitis you have contracted.
Hepatitis A: This form of hepatitis generally clears up on its own. You may need bedrest for several weeks and you should stay at home if possible in order to minimize the chance of spreading the virus. Alcohol should not be consumed during recovery, and your doctor may want to limit other medications.
Hepatitis B: If you know you've been exposed to the Hepatitis B virus, you may be able to prevent infection by immediately beginning a series of immunization shots. If you do develop a case of chronic Hepatitis B, your doctor may want to wait until you show signs of liver damage to begin a treatment regime. Antiviral medications such as interferon and nucleoside reverse transcriptase inhibitors (NRTIs) are the most common drugs used to treat Hepatitis B. A liver transplant may be necessary if you develop extensive liver damage or show signs of liver failure.
Hepatitis C: Treatment for Hepatitis C is usually initiated when you show the beginning signs of liver damage (determined through a biopsy) and detectable levels of the virus in your bloodstream. Your doctor might then start you on the antiviral medication peginterferon, either alone or in combination with ribavirin. If you have certain medical conditions such as cirrhosis, depression, or an autoimmune disorder, antiviral medications might not advised. Severe liver damage as a result of Hepatitis C may take as long as twenty years to occur. However, if you do develop end-stage liver failure, a liver transplant may become necessary.
Autoimmune hepatitis: The immune-suppressant prednisone is most commonly prescribed for autoimmune hepatitis; it may be used alone or in conjunction with azathioprine, another immune suppressant. You will likely start out on a high dosage, which is lowered as signs of improvement appear. Most people need a long-term course of prednisone, and some people must take it for life. Because it can cause serious side effects such as diabetes, osteoporosis, and glaucoma, your physician will want to monitor you carefully for these conditions. If medication does not work, you may require a liver transplant.
Alcoholic hepatitis: The single most important step in treating alcoholic hepatitis is to permanently abstain from consuming alcohol. Counseling can play an important role in maintaining sobriety and should be included in the treatment regimen if needed. Other options for treatment include nutritional therapy, antioxidant supplements, and lifestyle changes such as maintaining a healthy weight. In cases where severe liver damage is present, a liver transplant may become necessary.
Irreversible scarring of the liver is known as cirrhosis. The scar tissue replaces healthy liver tissue, blocking blood flow and impairing the liver's ability to function normally. Because the liver performs many essential roles in keeping the body healthy, cirrhosis can be a life-threatening disease with severe complications. In fact, it is currently the 12th leading cause of death in the United States.
Cirrhosis generally develops slowly and rarely exhibits symptoms in its early stages. However, as greater amounts of scar tissue build up, signs begin to appear including:
- Appetite loss
- Weight loss
- Abdominal pain
- Spider-like blood vessels (spider angiomas) that develop on the skin
- Jaundice (yellowing of the skin or eyes)
- Fluid build up in the legs or abdomen
Causes and Risk Factors
Cirrhosis is caused by many conditions, but most commonly develops as a result of long-term alcohol abuse, alcoholic hepatitis, or certain forms of viral hepatitis. People who have experienced autoimmune hepatitis may also be at risk. Certain inherited diseases such as cystic fibrosis or Wilson's disease might cause cirrhosis as well. Blocked bile ducts, reactions to certain prescription drugs, and exposure to environmental toxins are also thought to be triggers of cirrhosis, although these are rarer.
If your physician suspects cirrhosis based on your medical history and symptoms, he or she may order blood tests and imaging tests such as ultrasound, computerized tomography (CT) scan, or Magnetic resonance imaging (MRI).Ultimately a liver biopsy will be necessary to examine liver damage and determine that cirrhosis is present.
While liver scarring cannot be reversed, it is possible to prevent further damage from occurring. Treatment regimes will largely depend on the underlying condition that triggered the cirrhosis originally. In all cases, patients should abstain from alcohol and maintain a healthy lifestyle to ease the burden on the liver. When liver damage becomes extreme, a liver transplant may be necessary.
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