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The liver is the largest and one of the most important organs in the human body. Located in the central position of the abdomen, its role is to help your body digest food, store energy and remove toxins. However, your liver can be affected by pathogenic conditions which impair its functioning. One of the most common liver ailments is hepatitis.
Hepatitis is an inflammation or injury of the liver that makes it unable to work properly. Hepatitis can be acute or chronic (persists longer than 6 months), and can be caused by bacteria, virus, immune disorder, alcohol, certain medicaments and other diseases.
Hepatitis Causes and Risk Factors
Acute Hepatitis usually lasts less than 6 months, and result from different factors:
Bacteria – Bacterial hepatitis tend to result from diseases caused by bacteria such as tuberculosis, brucellosis (also called undulant fever), leptospirosis (also called canicola fever, Weil’s disease) or Schistosomiasis (also called bilharzia or bilharziosis). The disease can also occur in those living with AIDS due to certain pathogenic microorganisms such as cryptococcus neoformans, an encapsulated yeast-like fungus that can live in both plants and animals.
Alcohol – alcoholic hepatitis is a liver disorder resulted from heavy alcohol consumption. Although alcoholic hepatitis can also occurr in moderate alcohol users, it is mostly caused by severe liver toxicity due to excessive alcohol use. Once the toxicity gains control of your liver, it leads to inflammation and brutal cell death more or less extensive. If you do not stop using alcohol and have an appropriate treatment, the disease may aggravate to destruction of your liver tissue, resulting in cirrhosis and/or liver failure.
Medications – Drug induced hepatitis occurs when you take certain types of medications such as antibiotics, antituberculosis drugs, certain acetaminophens (painkillers) or hormones. Your liver is a vital organ performing hundred jobs in your body, including carbohydrate metabolism. Once in your blood, those drugs pass through your liver, which metabolizes them and allows their evacuation. However, abuse of those drugs may lead to deterioration in the function of the liver preventing it from getting rid of their harmful chemicals. As toxins build up, your liver develops a medical condition called Drug Induced Hepatitis. In addition, certain mineral fibers such as asbestos can impair or totally destroy your liver.
Some of the drugs known to cause hepatitis include:
- Allopurinol
- Amitriptyline
- Amiodarone
- Atomoxetine
- Azathioprine
- Halothane
- Hormonal contraceptives
- Nonsteroidal Antiinflammatory Drugs (NSAIDs)
- Isonicotinyl hydrazine (INH)
- Rifampicin (RIF)
- pyrazinamide
- Ketoconazole
- Loratadine
- Methotrexate
- Methyldopa)
- Minocycline
- Nifedipine
- Nitrofurantoin
- Antiepileptic drugs (Phenytoin and valproic acid)
- Troglitazone
Autoimmune Disorders – autoimmune hepatitis is a chronic inflammatory disease of the liver characterized by the presence of antibodies that mistakenly attack and damage specific tissues or organs of your body; this hormonal disorder is called autoantibodies. In this condition, your body’s immune system attacks your normal liver tissue. These antibodies, initially produced to protect your bdy by fighting against bacteria or viruses, become aggressive organisms.
Those autoantibodies can also be the result of autoimmune diseases, which are in 2 types:
- Type I Autoimmune Hepatitis is characterized by the presence of anti-smooth muscle and Anti-nuclear It is often associated with other autoimmune diseases: ulcerative colitis, (inflammation and sores in the lining of your rectum and colon) thyroiditis (inflammation of your thyroid gland), Graves’ disease (a rare thyroid-specific autoimmune disorder), Sjögren’s syndrome (autoimmune disorder that causes dryness in your mouth and eyes), autoimmune hemolytic anemia (your body’s immune system attacks and destroys its own red blood cells), and lupus erythematosus. Although Type I Autoimmune Hepatitis can affect both men and women, it is more common among women.
- Type II Autoimmune Hepatitis, unlike the type I, Type II Autoimmune Hepatitis is less common, but more severe. It is more frequent in girls between ages 2 to 14. It is characterized by presence of antibodies directed against the endoplasmic reticulum , Anti-liver Microsomes Autoantibodies).
Viral hepatitis, the most common of acute hepatitis, is infection of the liver due to viral infection. Some agents that are essentially responsible for this disease are Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis E, Epstein-Barr virus, cytomegalovirus or yellow fever. There are different types of viral hepatitis, and each type has slightly different symptoms. Some of them include:
– Hepatitis A: is an acute form of infectious liver disease caused by the hepatitis A virus (HAV). It is the most common type of viral hepatitis. Around 70 % of adult population over 50 years is immunized for having imperceptibly contracted it. Its transmission is mostly via fecal-oral route.
Although the disease can affect anyone, hepatitis A tends to affect certain groups of individual:
- Gay men
- Intravenous drug users
- People living with an infected person
- Polygamists ( individual who have more than one partner)
- children and daycare staff
- people who are disabled or are in the armed forces.
– Hepatitis B: caused by hepatitis B virus (HBV), Hepatitis B is often considered as the most serious form of viral hepatitis. It is transmitted through sexual contact, blood transfusion, or saliva. Hepatitis B requires intensive medical attention; its complication can lead to cirrhosis of the liver, liver cancer, liver failure, or death. Pregnant women with chronic hepatitis B have a high risk of contamination to the fetus (mother – child contamination).
– Hepatitis C: this is a silent blood-borne infectious liver disease caused by the hepatitis C virus (HCV). Its transmission is made by blood-to-blood contact. Although the cause of the disease is not well known, it is more common among the following groups:
- People who had blood transfusion or dialysis
- Gay men
- Drug addicts (by sharing contaminated needles),
- People who have sexual intercourse during menstruation periods
– Hepatitis E – this is a less severe inflammation of the liver caused by hepatitis E virus (HEV). Although children can be affected, the disease is more common in adults between the ages of 15 and 40. Hepatitis E is most commonly found in underdeveloped countries and transmitted via fecal-oral route. When associated with hepatitis B and C, hepatitis E can present major complications.
Hepatitis Warning Signs and Symptoms
At early stage, most types of hepatitis have no symptoms (asymptomatic). When finally occur, symptoms vary depending on the form of the hepatitis. If you have hepatitis, you likely to experience these symptoms:
- Fatigue
- Nausea
- Jaundice
- Fever
- Loss of appetite
- Headache
- Dark urine
- Pain in joints and muscles.
Alcoholic hepatitis tend to combine these symptoms with hepatic encephalopathy, ascites (excess of peritoneal fluid), and upper gastrointestinal bleeding (hematemesis). Jaundice is common to all hepatitis. See the table below for more signs and symptoms.
Hepatitis Diagnosis
In addition to physical exam and your medical history, blood test is the prime medical exam your doctor will consider to diagnosis your hepatitis. The test can reveal abnormal high levels of Liver enzymes, called transaminases: alanine transaminase and aspartate transaminase. If the elevation of the liver transaminases is between 5 and 10 times the normal level, your doctor may also perform a liver biopsy to confirm absence or presence of cirrhosis. Additional tests may include liver ultrasound.
Liver Ultrasound – Ultrasound of your liver is one of the best ways to objectify liver metastases and other liver abnormalities such as hepatitis. During the ultrasound, abnormal tissues of the liver become more visible, which allows your physician to detecting presence of diseases related to alcohol cirrhosis and fatty liver.
Hepatitis Treatment and Prevention
Treatment of hepatitis Varies depending on its causes and symptoms. The treatment is primarily based on taking painkillers and anti-inflammatory drugs to control inflammation and pain; transfusion, in case there are episodes of bleeding; portacaval anastomosis (also known as portal systemic anastomosis) in case of portal hypertension, jaundice, and fatigue.
Viral hepatitis requires immediate cessation of consumption of alcohol or drugs metabolized by the liver. Certain form of acute liver failure (fulminant hepatitis) can be rapidly fatal; the treatment can require transplantation.
However, the best treatment is prevention through vaccination. In adults, it is said that there is a risk of degenerative neurological disease. Unlike in adults, the vaccination has no side effects on children; it has the advantage of immunity for life.
Alcoholic hepatitis requires immediate cessation of consumption of alcohol, and hospitalization if there are signs of liver failure: brain disorders, drowsiness, confusion, episodes of bleeding due to blood clotting, etc. The efficiency of the treatment is essentially based on the discontinuation of alcohol intoxication.
To treat autoimmune hepatitis, your doctor may prescribe you corticosteroids, which are effective in 85% of cases. It may also prescribe immunosuppressors such as azathioprine (Imuran) and cyclosporine. If none of these procedures works, liver transplantation can be considered.
Bacterial hepatitis usually heals quickly with an appropriate antibiotherapy.
Drug induced hepatitis can disappear on its own with discontinuation of treatment or drugs associated with the development of the disease.
What are the complications of hepatitis?
It is important to treat any form of hepatitis. An untreated hepatitis can lead to Permanent liver damage, liver failure, or liver cancer.
- G. Bain and M. Ma, Acute Viral Hepatitis, Chapter 14, First principle of gastroenterology (an online text book)
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- Online Etymology Dictionary
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- Figure 7.12 (Some causes of acute parenchymal damage), Parveen, M.D. Kumar (Editor)
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