Hepatitis / Liver Disease


Hepatitis is an inflammation of the liver that can be caused by viruses, chemicals, drugs, alcohol, inherited diseases, or the patient’s own immune system. This inflammation can be acute, flaring up and then resolving within a few weeks to months, or chronic, enduring over many years. Chronic hepatitis may simmer for 20 years or more before causing significant symptoms related to progressive liver damage such as cirrhosis (scarring and loss of function), liver cancer, or death.

The liver is a vital organ located in the upper right-hand side of the abdomen. It performs many functions in the body, including processing the body’s nutrients, manufacturing bile to help digest fats, synthesizing many important proteins, regulating blood clotting, and breaking down potentially toxic substances into harmless ones that the body can use or excrete. Inflammation may (in severe cases) interfere with these processes and allow potentially toxic substances to accumulate.

The symptoms of hepatitis are the same, regardless of the cause, but vary from person to person and may vary over time. With acute hepatitis, many people have few or mild symptoms that may be mistaken for the flu. These may include fatigue, nausea, loss of appetite, fever, and abdominal pain. Others may experience jaundice, itching, dark colored urine, and light colored stools. A physical examination may reveal a liver that is tender and enlarged. Chronic hepatitis usually causes no symptoms or may be noticeable as only a loss of energy and tiredness. In some people, chronic hepatitis can gradually damage the liver and, after many years, cause liver failure. The chronic form typically lasts for many years and only rarely goes away without treatment.

Viral Hepatitis The most common cause of hepatitis is an infection with a virus. The viruses primarily associated with hepatitis are named in the order of their discovery: A, B, C, D, and E (see Viral Hepatitis Table).

• Hepatitis A is spread through infected water and food that have been contaminated with fecal material. The Centers for Disease Control and Prevention (CDC) estimates that as many as one third of the U.S. population becomes infected with hepatitis A at some point in their life. Symptoms may be flu-like and are frequently not identified as being due to hepatitis. Most patients recover fully within about six months.
• Hepatitis B is the most common cause of acute viral hepatitis. It can be spread by exposure to blood, infected needles, through sexual relations, and from mother to baby. The number of new cases in the U.S. each year is approximately 73,000, a decline from the 1980s when the average was 260,000. Most people will get better without any intervention, but about 1-3% become carriers - chronically infected and able to continue to infect others. Newborns are especially vulnerable to chronic infection, with up to 90% of those exposed becoming carriers. With the advent of screening pregnant women for hepatitis B and the vaccination of newborns, the number of infected babies has fallen. Most chronic hepatitis B infections are now seen in people born in parts of the world (particularly southern and eastern Asia, southern Europe, and Africa) where infection among newborns still remains common.
• Hepatitis C is spread by exposure to contaminated blood. Some mechanisms of exposure include the sharing of needles or other 'works' used in consuming drugs such as cocaine or heroin; use of contaminated equipment for activities such as body piercing and tattooing; occupational exposure of healthcare workers to used needles or other sharp objects; through sexual activity that results in tissue tears; from mother to baby during childbirth; or from cuts sustained during athletic or other activity. It is less common than hepatitis B as a cause of acute hepatitis but is the most common cause of chronic hepatitis. According to the CDC, about 55% to 85% of those exposed to the virus develop chronic hepatitis.
• Hepatitis D and E are rare in the U.S. Hepatitis D only causes an infection when hepatitis B is present and can make that infection more severe. It is usually spread by exposure to blood or infected needles. Hepatitis E is spread in a similar fashion to hepatitis A and is found primarily in Asia, Africa, and South America.

Chemically-Induced Hepatitis
The liver is responsible for the metabolism of alcohol, drugs, and environmental toxins. It breaks them down into substances that can be used and then excreted by the body. Some drugs or chemicals cause liver damage whenever a person is exposed to high levels of them. Acetaminophen, which is found in many over-the-counter and prescription medications, is an example of this. In therapeutic doses, it is a useful pain reliever, but in very high dosages or in combination with alcohol, it has the potential to cause life-threatening acute liver failure. Excessive consumption of alcohol, by itself, is also toxic to the liver and is one of the most common causes of chemical hepatitis.

Many drugs have the potential to cause hepatitis in a few people, in a seemingly random fashion. Their effect cannot be foreseen and appears to be related to an allergic reaction to the medication. Drugs that have had this affect in some people include anesthetics, antibiotics, anabolic steroids, and seizure medications.

Inherited Forms of Hepatitis
Several inherited diseases can become apparent primarily by causing acute or chronic hepatitis. The most common of these is hemochromatosis, an inherited disease associated with accumulation of too much iron in the body. The liver is one of the principal organs damaged, and chronic hepatitis may be due to hemochromatosis. Deficiency of alpha-1-antitrypsin is also a relatively common inherited disease, and in children who have this deficiency state, both acute and chronic hepatitis are common. In adults, the liver involvement is often hard to detect, but cirrhosis and liver cancer are both more common in those with alpha-1-antitrypsin deficiency. A more rare inherited disorder, Wilson’s disease, is associated with an accumulation of excess copper in the liver, brain, and in other tissues. This disease may cause both acute and chronic hepatitis. Unless Wilson's disease is treated, it becomes progressively worse and is eventually fatal.

Non-Alcoholic Fatty Liver Disease (NAFLD) and Chronic Hepatitis
One of the most common causes of chronic hepatitis is accumulation of excess fat in the liver. This is most commonly seen in people with the metabolic syndrome, a combination of problems such as obesity (especially too much fat in the belly), hypertension, high triglyceride levels, low HDL cholesterol, and insulin resistance or type 2 diabetes. The more severe form of hepatitis is sometimes also termed non-alcoholic steatohepatitis (NASH). There are no laboratory tests that can make the diagnosis of NAFLD or NASH other than a liver biopsy.

Autoimmune Hepatitis
Autoimmune hepatitis is usually a chronic form of hepatitis that frequently leads to progressive damage of the liver; in about 25% of cases, it may present like acute hepatitis. It is more common in women than men; in fact, according to the American Liver Foundation, 70% of those affected are female. For reasons that are not fully understood, the body’s immune system targets and attacks the liver. Autoimmune hepatitis may be found in association with other autoimmune disorders, such as type 1 diabetes, ulcerative colitis, and Sjogren’s syndrome.