Hepatitis: types, causes, symptoms and treatments

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Hepatitis is a term used to describe inflammation of the liver. Find out more about the causes, symptoms and treatment.

By Dr Roger Henderson

Hepatitis is the term used to describe inflammation of the liver, and can be divided into two subgroups: acute hepatitis and chronic hepatitis.

There are various causes of hepatitis, but the most common causes are viruses that attack the liver, such as hepatitis A and hepatitis B.

Dr Roger Henderson looks at what hepatitis is, the causes and symptoms, and treatments.

What is hepatitis?

Hepatitis describes liver inflammation that is characterised by the destruction of a number of liver cells and the presence of inflammatory cells in the liver tissue.

There are a number of different types of hepatitis, as well as various causes but they are typically caused by viruses that primarily attack the liver cells, such as hepatitis A and hepatitis B.

Patients with glandular fever, caused by the Epstein-Barr virus, can also suffer from an attack of hepatitis.

Hepatitis can be divided into two subgroups according to its duration:

  • acute hepatitis – lasting less than six months
  • chronic hepatitis – lasting longer than six months.

How the liver works

The liver is found tucked up under the ribcage on the right-hand side of the abdomen, and you should not normally be able to feel it. It is a large organ, typically weighing between 1200 and 1500 grams, usually being slightly heavier in men.

The liver is vital to good health, being responsible for:

  • Processing proteinand fat
  • Making bile, which breaks down fats in food so it can be absorbed from the gut.
  • Storing body fuel (glycogen) which is made from sugar, and broken down into readily available glucose to be released into the bloodstream when needed.
  • Helping make clotting factors that help the blood to clot.
  • Removing toxic substances from the body such as alcohol and poisons.
  • Processing medication.

Hepatitis causes

A person can develop hepatitis if they contract one of the viruses that can cause liver inflammation, or as a result of exposure to substances that can cause hepatitis – alcohol, fungal toxins and certain medicines.

There are two ways in which medicines can lead to hepatitis: either as a result of medicine poisoning through overdoses of a medicine (eg paracetamol), or it can occur as a result of an abnormal reaction of the liver to a normal dose (eg halothane, the anaesthetic). Fortunately, the latter type of hepatitis is rare.

Acute hepatitis causes

Acute hepatitis has a number of possible causes:

  • Infectious viral hepatitis, such as hepatitis Ahepatitis Bhepatitis C, hepatitis D and hepatitis E. Hepatitis Ais usually a short-lived illness that is caused by eating or drinking something that has been contaminated with the virus. Hepatitis B is acquired through bodily fluids (including blood) such as during sex or by sharing contaminated needles. Although usually an acute problem, it can become chronic and cause long-term liver damage. Hepatitis C is spread in a similar way to hepatitis B but is more likely to become a longer-term problem. Hepatitis D is spread like B and C but only affects people with hepatitis B, whereas Hepatitis E is a short-term illness similar to hepatitis A.
  • Other viral diseases, such as glandular feverand cytomegalovirus.
  • Severe bacterialinfections.
  • Amoebic infections.
  • Medicines, eg paracetamolpoisoning and the anaesthetic gas halothane (for this reason halothane is not recommended for use in anaesthetics in adults in developed countries and is a concern in some underdeveloped countries where it is still used as alternatives are more expensive).
  • Toxins: alcoholand fungal toxins, eg toadstool poisoning.

Chronic hepatitis causes

Chronic hepatitis has a number of different causes:

  • Infectious hepatitis, such as hepatitis Bhepatitis Cand hepatitis D.
  • Drug reactions.
  • Toxins, such as alcohol.
  • Autoimmune hepatitis. This is a disease in which a number of liver cells are destroyed by the patient’s own immune system. Autoimmune hepatitis can also sometimes occur as acute hepatitis. The cause is unknown.
  • Inborn metabolic disorders, such as Wilson’s disease(disorder of the body’s copper metabolism) and haemochromatosis (disorder of the body’s iron metabolism).
  • Non-alcoholic fatty liver disease.

Acute hepatitis symptoms

The symptoms of acute hepatitis vary considerably from person to person. Some patients have no symptoms at all, and in most cases, children only show mild symptoms.

The early stages

  • tiredness, general malaise, slight fever
  • nausea, poor appetite, changes in taste perception
  • pressure or pain below the right ribs caused by an enlarged liver
  • aching muscles and joints, headache, skin rash.

The jaundiced phase

  • yellowing of sclerae (the whites of the eyes), skin and mucous membranes
  • dark urine
  • light-coloured stools
  • around this time, the other symptoms subside.

The recovery phase

  • tiredness that can last for weeks.

Chronic hepatitis symptoms

Many patients with chronic hepatitis have no symptoms. However, common symptoms may include:

  • Tiredness, an increased need for sleep, aching muscles and joints.
  • Periodic light pressure or pain below the right ribs – enlarged liver.
  • Jaundiceis a very late symptom of chronic hepatitis. It is a sign that the disease has become serious.

Hepatitis risk factors

The following people may be at a higher risk of hepatitis:

  • Patients with jaundice or other symptoms of hepatitis.
  • People in high risk groups.
  • People who are at increased risk due to a hereditary type of hepatitis in their families.

Tips to prevent hepatitis

  • Avoiding exposure to the infectious hepatitis viruses.
  • Being vaccinatedagainst hepatitis A and hepatitis B, if you have a high risk of being infected.
  • Refraining from drinking large amounts of alcohol.
  • Practising safe sex

General advice

  • Avoid drinking alcohol if you have symptoms of hepatitis or if a blood samplehas shown that the disease is active. If alcoholism is the cause, you must stop drinking completely and see your doctor. Eat a well-balanced diet.
  • If you have symptoms of acute hepatitis, you may need to slow down. However, if you feel fine, there is no reason why you should not go to work and keep up your other activities.
  • If you have hepatitis A and your job involves food handling, your doctor will advise you on when it is safe to return to work.
  • If you have chronic hepatitis, try to lead a normal life as far as possible.
  • People with hepatitis B must inform their family and their sexual partners about it. Sexual and other close contacts will need to protect themselves by being vaccinatedCondomsshould be used until the vaccine has begun to work.
  • If you have hepatitis A, you must inform your family, so that they can protect themselves against it by practising good hygiene and seek advice on vaccination and other preventive measures.
  • If you have chronic hepatitis, you should have regular clinic review by your specialist.

Hepatitis diagnosis

Blood tests will help determine the cause and severity of the hepatitis.

Further information may be obtained from ultrasound and other types of liver scans.

In certain situations, a liver biopsy may be recommended. This involves taking a tiny piece of the liver to look at under the microscope. The procedure is generally done under local anaesthetic as a day case in a specialist unit.

Hepatitis outlook

Acute infectious viral hepatitis usually improves with no specific treatment, and a self-limiting acute infection is rarely life threatening. Although hepatitis B and hepatitis C can become chronic, hepatitis A does not.

Acute hepatitis caused by medicines or alcohol usually improves once the liver is no longer exposed to these substances. However, about one fifth of the patients with chronic hepatitis B and C are at risk of developing cirrhosis or cancer of the liver. (Cirrhosis can also be caused by other types of chronic hepatitis.)

Hepatitis treatment

  • No medical treatment is generally required for acute viral hepatitis, although it is important that you seek medical advice.
  • The World Health Organisation(WHO) recommends the use of oral treatments – tenofovir or entecavir – as the most potent drugs to suppress the hepatitis B virus. They rarely lead to drug resistance compared with other drugs, are simple to take (1 pill a day), and have few side effects, so require only limited monitoring. Only a proportion of people with chronic hepatitis B will require treatment, and the hepatitis B vaccine remains the mainstay of hepatitis B prevention
  • There is currently no effective vaccine available for hepatitis C but the WHO recommend therapy with pan-genotypic direct-acting antivirals (DAAs) with the aim of cure. DAAs can cure most persons with HCV infection, and treatment duration is short (usually 12 to 24 weeks), depending on the absence or presence of cirrhosis. A new infection with HCV does not always require treatment, as the immune response in some people will clear the infection but when HCV infection becomes chronic, treatment is necessary.
  • Autoimmune hepatitis can by treated with corticosteroidsand sometimes with the treatment azathioprine.
  • Hepatitis is usually treated by gastroenterology or liver specialists who work in conjunction with your GP for managing long term care. If medication does not halt the progress of the disease or if irreversible scarring (cirrhosis) or liver failure develops then the remaining option is a liver transplant.

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