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| Hepatitis (liver inflammation) |
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Reviewed by Dr Janice Main, senior lecturer and honorary consultant physician in
infectious diseases and general medicine
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What is hepatitis?
Hepatitis is the Latin word for liver inflammation. It is
characterised by the destruction of a number of liver cells and the presence of
inflammatory cells in the liver tissue.
Hepatitis can be caused by diseases that primarily attack the
liver cells. It can also arise as a result of a disease such as
mononucleosis.
Hepatitis can be divided into two subgroups according to its duration:
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acute hepatitis - lasting less than six
months
-
chronic hepatitis - lasting longer than six
months.
What can cause acute hepatitis?
Acute hepatitis has a number of possible causes.
-
Infectious viral hepatitis such as
hepatitis A,
hepatitis B,
hepatitis C,
hepatitis D and hepatitis E.
-
Other viral diseases such as:
mononucleosis and
cytomegalovirus.
-
Severe
bacterial
infections.
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Amoebic infections.
-
Medicines, eg
paracetamol
poisoning and halothane (an anaesthetic).
-
Toxins:
alcohol and fungal
toxins, eg toadstool poisoning.
What can cause chronic hepatitis?
Chronic hepatitis also has a number of different
causes.
-
Contagious viral hepatitis such as
hepatitis B,
hepatitis C and
hepatitis D.
-
Medicines.
-
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).
How do you get hepatitis?
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: it
can either occur 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.
What are the symptoms of hepatitis?
Acute hepatitis
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.
In 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 jaundice phase:
-
yellowing of sclerae (the white portions of the eyes), skin
and mucous membranes
-
dark urine
-
light-coloured stools
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around this time, the other symptoms subside.
The recovery phase:
-
tiredness that can last for weeks.
Chronic hepatitis
-
Many patients have no symptoms.
-
Tiredness, an increased need for sleep, aching muscles and
joints.
-
Periodic light pressure or pain below the right ribs -
enlarged liver.
-
Jaundice is a very
late symptom of chronic hepatitis. It is a sign that the disease has become
serious.
Who is at risk of hepatitis?
-
Patients with jaundice or other symptoms of
hepatitis.
-
People who are very likely to have contracted the hepatitis B
or the hepatitis C virus.
-
People who are at increased risk due to a hereditary type of
hepatitis in their families.
How can hepatitis be prevented?
-
By avoiding exposure to the infectious hepatitis
viruses.
-
By being vaccinated against
hepatitis A and
hepatitis B, if
you run a high risk of being infected.
-
By refraining from drinking large amounts of
alcohol.
What can be done at home?
-
Avoid drinking alcohol if you have symptoms of hepatitis or if
a
blood sample has
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 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. They will need to protect themselves by being
vaccinated against it.
Condoms should 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 having
injections of
gammaglobulin
(normal immunoglobulin).
-
If you have chronic hepatitis, you should have regular
examinations by your doctor.
How is hepatitis diagnosed?
The diagnosis is confirmed by blood samples, and, in some cases,
by a
tissue sample from
the liver. Some of the blood samples are used for establishing the cause of the
disease and excluding other known causes.
Other blood samples will reveal the degree of activity of the
inflammation at the time when the samples are taken.
In cases of chronic hepatitis, the extent of the damage to the
liver can only be established via a tissue sample from the liver.
Future prospects
Acute infectious viral hepatitis usually improves on its own.
Less than 1 in 300 patients develop liver failure and risk dying. Hepatitis B
and hepatitis C can become chronic. Hepatitis A never does.
Hepatitis caused by mononucleosis always improves on its
own.
Acute hepatitis caused by medicines or alcohol usually improves
once the liver is no longer exposed to these substances.
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.
How is hepatitis treated?
-
No medical treatment is available for acute viral
hepatitis.
-
Chronic hepatitis B can be treated with interferon alfa or
lamivudine (Zeffix).
-
Chronic hepatitis C can be treated with interferon alfa and
ribavirin
(tribavirin).
-
Autoimmune hepatitis can by treated with corticosteroids.
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Based on a text by Professor Court Pedersen, consultant and Professor Ove Schaffalitzky de Muckadell, consultant
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Last updated 02.06.2005
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