Inflammation of the liver of any cause is referred to as hepatitis. It may be caused by viruses, drugs, or alcohol, although the most common cause is viruses, termed viral hepatitis. There are several types of viral hepatitis, the most common of which are hepatitis A, B, and C. You may hear about an outbreak of hepatitis A due to contaminated food, for example.
Very frequently the onset of hepatitis, the acute phase, is not associated with symptoms or signs, but when they do occur they are usually general and include fatigue, nausea, decreased appetite, mild fever, or mild abdominal pain. Later signs more specific for liver disease may occur, specifically, yellowing of the skin and eyes (jaundice) and darkening of the urine. If the infection becomes chronic as is the case with hepatitis B and C, that is, infection lasting longer than months, the symptoms and signs of chronic liver disease may begin. At this point, the liver often is badly damaged.
Viral diseases generally are contagious. Hepatitis A is highly contagious. It usually is spread from person to person via a fecal-oral route, meaning via fecal contamination of food. It usually is a mild hepatitis, and many people do not know they are infected. The virus is eliminated by the body rapidly, and it does not cause long-term damage. Good hand washing hygiene helps prevent hepatitis A.
Hepatitis A is spread from person to person via fecal contamination because the virus is present in the stool. It is spread via contaminated food or water by an infected person who gets small amounts of stool on his or her hands, does not wash his or her hands, and passes the stool onto food that is eaten by others. An example of this is outbreaks of hepatitis A in daycare centers for young children when employees don't wash their hands after changing diapers, and they then pass the viruses to the next child they feed. In addition, fecal contamination of water in which shellfish live can contaminate the shellfish, and the shellfish can pass the virus to people who eat the shellfish raw.
Travelers to countries with high infection rates and the inhabitants of those countries are at higher risk for developing hepatitis A. The Centers for Disease Control issues travel advisories that identify the countries with outbreaks or endemic hepatitis A. Eating raw or uncooked foods increases the risk for hepatitis A.
A majority of adults who contract hepatitis B have none to mild symptoms, and then the virus resolves spontaneously; however, about 5% of people are not able to eliminate the hepatitis B virus and develop chronic infection. If a chronically infected mother gives birth, 90% of the time her infant will be infected and develop chronic hepatitis B, usually for life. This may give rise to serious complications of liver disease later in life such as liver damage, liver failure, and liver cancer.
Persons infected with hepatitis B can pass the virus to others through blood or body fluids. In the U.S., the most common way of becoming infected is through unprotected sex, although sharing an infected person's needles to inject illicit drugs also is quite common. Less common ways are by contaminated razors or toothbrushes. As previously mentioned, hepatitis B is passed from infected mother to infant in over 90% of cases.
Although unprotected sex is the most common way of becoming infected with hepatitis B, infection is more likely for people who have multiple sex partners. Shared needles also are an important means of spreading hepatitis B. Other risk factors are being a health care worker, but infection usually is related to needle sticks. There also is a risk of becoming infected by living with someone who has chronic hepatitis B, in part due to sexual transmission.
Is hepatitis C a virus? Yes. With acute hepatitis C, the virus is eliminated in 25% of people. The rest of the people become chronically infected and later may develop serious complications such as liver failure and liver cancer. There is treatment, however, for hepatitis C that usually can prevent the complications.
Hepatitis C is transmitted primarily by infected blood, for example by sharing needles when injecting illicit drugs. The virus is spread much less commonly with tattoos or body piercing with a contaminated needle. Mothers pass the virus to their infants at birth, and the infant becomes chronically infected. The risk of spreading hepatitis C with unprotected sex is small, but having multiple sex partners, HIV, or rough sex increases the risk.
It only takes one exposure to hepatitis C to become chronically infected, so people who have injected illegal drugs even one time or many years previously could have chronic hepatitis C, and not know it since there are often no symptoms. People with blood transfusions prior to 1992 - when they started testing blood for transfusion for hepatitis C - also may have become chronically infected.
Chronic hepatitis slowly attacks the liver over many years without causing symptoms. If the infection is not diagnosed and treated, many people will develop damaged livers. If suspected, viral hepatitis of all types can be diagnosed easily by blood tests.
It is important to test people with symptoms or exposure to hepatitis as well as people at high risk such as illicit drug users and people with multiple sex partners. There is a high prevalence of chronic hepatitis individuals of Asian heritage, and they also should be tested. It is estimated the 10% of Asians living in the U.S. have chronic hepatitis that probably has been present from birth.
If testing discloses that you have viral hepatitis there are steps to prevent your passing the viruses to family and friends. Washing the hands helps prevent transmission of hepatitis A. Not sharing needles, razors, nail clippers, or toothbrushes also will reduce transmission of viral hepatitis. Everyone should be vaccinated against hepatitis B.
No treatment is needed for hepatitis A since the infection almost always resolves on its own. Nausea is common, though transient, and it is important to stay hydrated. It is recommended that strenuous exercise be avoided until the acute illness is over.
For hepatitis B, treatment is aimed at controlling the virus and preventing damage to the liver. Antiviral medications are available that will benefit most people, but the medications need to be chosen carefully, and the treatment needs to be monitored in order to assure successful treatment and to prevent or treat medication-related side effects. For some individuals, the risks of treatment may not be justified.
Treatment of chronic hepatitis C has evolved, rendering many earlier drugs obsolete. The drugs currently used include pegylated interferon, ribavirin, elbasvir, grazoprevir, ledipasvir, sofosbuvir, paritaprevir, ritonavir, ombitasvir, dasabuvir, simeprevir, daclatasvir. These are always used in various combinations, never alone. Interferon is given by injection while the other medications are pills. Studies have shown that combinations of these drugs can cure all but a small proportion of patients; however, serious side effects of treatment can occur.
Treatment options need to be discussed with a knowledgeable physician, as the appropriate combination is dependent upon multiple factors. These include genotype (there are 6), prior treatment and results, drug intolerances, presence of compensated liver disease or uncompensated cirrhosis, presence of HIV co-infection, other complicating conditions and liver transplantation.
Monitoring of the progression of liver disease and its treatment are the cornerstones of managing hepatitis B and C. Doctors regularly follow blood tests to determine how well the liver is functioning. Ultrasound examinations and CT scans can determine if there are complications such as cirrhosis or liver cancer that can be treated more effectively if found early. Some people will not need treatment.
Liver function tests and imaging can also help identify problems like hepatic steatosis (hepatic lipidosis), hepatic encephalopathy (hepatic coma), hepatic cysts, hepatic adenoma, hepatic hemangioma, diffuse hepatic steatosis, hepatic lesions, hepatic fibrosis, and fulminant hepatic failure.
Imaging helps doctors see the hepatic portal vein, hepatic portal system, hepatic vein, hepatic artery (common hepatic artery), hepatic duct (common hepatic duct), and hepatic lobes.
Cirrhosis is the most common complication of chronic hepatitis. Cirrhosis can be detected with simple tests, but the liver biopsy is the best way to diagnose it. Cirrhosis occurs as the liver is destroyed and it is associated with liver failure, a life-threatening condition. The signs of cirrhosis include retention of fluid (swelling of the abdomen or lower extremities, fatigue, nausea, and weight loss. Later, confusion and jaundice occur due to the accumulation of chemicals normally removed by a healthy liver.
The major cause of liver cancer is hepatitis B and C, and can develop silently as the liver becomes cirrhotic. Blood tests, ultrasound examinations, CT and MRI scans can identify the cancers (seen here in green). Biopsy of the liver is needed to definitely make a diagnosis of cancer. If the cancers are found early, a small proportion of patients can be cured.
The liver serves many functions including the manufacture and removal of chemicals that allow cells to function normally, digestion of food, elimination of toxic chemicals, and the production of many proteins that the body needs. Thus, if a large portion of the liver is damaged, the liver cannot perform these critical functions; it is impossible to live without a liver. If the liver fails, a liver transplant may be the only hope, but it is not easy to find a healthy liver to transplant.
Vaccines can protect against hepatitis A and B. The Centers for Disease Control recommends hepatitis A vaccination for children 12 to 23 months of age and for adults who travel or work in locations with a higher prevalence of hepatitis A infection. Vaccination for hepatitis A also should be given to people with hepatitis B and C. If the mother has chronic hepatitis B, the infant should receive the hepatitis B vaccine as well as hepatitis B immune globulin to prevent the development of chronic hepatitis B. There is no vaccine for hepatitis C.
If you have chronic hepatitis, you should prevent further damage to your liver, for example, by not drinking alcohol. Since some medications and supplements can damage the liver, before taking them you should discuss it with your doctor. Regular appointments for follow-up are important. Early progression of the disease or complications are likely to change treatment.
IMAGES PROVIDED BY:
- Ingram Publishing, Medical RF.com
- Garry Watson/Photo Researchers Inc
- Katz Arni
- Richard Ross/Photographer's Choice
- Chad Ehlers
- Sam Edwards/OJO Images
- Gregor Schuster/Iconica
- James Cavallini/Photo Researchers Inc
- Robert Ginn/Index Stock Imagery
- Digital Vision
- M Fermariello/De Agostini Editore
- Jupiter Images
- Polka Dot Images
- Olivier Voisin/Photo Researchers Inc
- Philippe Garo/Photo Researchers Inc
- Arthur Glauberman/Photo Researchers Inc
- Du Cane Medical Imaging Ltd./Photo Researchers Inc
- Publiphoto/Photo Researchers Inc
- Jeffrey Hamilton/Lifesize
- Image Source
- Advanced Critical Care: "Drug-Induced Liver Injury."
- Annals of Internal Medicine: "The Changing Burden of Hepatitis C Virus Infection in the United States: Model-Based Predictions."
- CDC: "Hepatitis A Outbreaks in the United States." "Hepatitis C: What to Expect When Getting Tested." "What Is Viral Hepatitis?"
- Hepatitis B Foundation: "Prevention Tips."
- National Institute on Alcohol Abuse and Alcoholism: "Hepatitis C and Alcohol."
- NIH National Institute of Diabetes and Digestive and Kidney Diseases: "Cirrhosis."
- Radiology: "Pitfalls in Liver Imaging."
- UpToDate: "Hepatic Hydrothorax," "Surveillance for Hepatocellular Carcinoma in Adults."
- U.S. Department of Veterans Affairs: "Viral Hepatitis and Liver Disease."
- World Journal of Gastroenterology: "Hepatitis B Virus Infection and Alcohol Consumption."
- Wiley-Blackwell: Viral Hepatitis, 4th Edition