Hepatitis

Definition

Hepatitis is a medical condition marked by inflammatory changes in the liver cells. Hepatitis can be of two types sudden onset (acute) mainly due to infections and long standing (chronic), due to chronic alcoholism, intake of certain drugs and immunological problems. It usually presents with nonspecific symptoms namely body ache, fever and nausea along with jaundice and abdominal pain. Hepatitis can resolve on its own, without any long term complications but sometimes there is permanent liver damage which may lead to cirrhosis, liver failure and death.

Symptoms

The symptoms of hepatitis are of two different types, acute and chronic.

Acute hepatitis

  • Sudden onset of non-specific flu-like symptoms such as generalized body ache, lethargy, nausea, vomiting  and loss of appetite.
  • Jaundice: yellowish discoloration of skin and mucous membrane along with passage of dark yellow urine.
  • Abdominal pain due to enlarged inflamed liver.

Sometimes there may be acute liver failure characterized by increased bleeding disorders, body swelling (edema), confusion and coma (hepatic encephalopathy).

Chronic hepatitis

  • Tiredness and fatigue.
  • Increased bleeding tendency presenting with easy bruising and bloody vomit (hematemesis) due to rupture of dilated veins in the esophagus.
  • Swelling of the entire body due to fluid accumulation.
  • Confusion, disorientation and even coma.
  • Deterioration of kidney function.

Often in chronic hepatitis there may not be any symptoms and the condition is detected only by blood tests.

Hepatitis may sometimes progress to permanent liver damage leading to liver failure. The liver is the principal organ of metabolism therefore defective liver function will lead to poor elimination of toxic metabolites from the body. These toxic metabolites may affect the brain (hepatic encephalopathy) leading to confusion, disorientation even coma and death.

Causes

Inflammatory changes in the liver cells occur due to injury of the cells by a number of factors which may lead to acute or chronic hepatitis. Factors causing acute hepatitis include :

Infections

  • Viral (mainly hepatitis A, B, C)
  • Bacteria (Babesia, Bartonella, Chlamydia)
  • Protozoa (Entamoeba, Cryptosporidium)
  • Parasite (Ascaris, Ancylostoma, Schistosoma)
  • Fungus (Aspergillus, Candida)

Non-Infective

  • Alcohol abuse.
  • Autoimmune diseases are conditions where the immune system of the body wrongly recognize self proteins as foreign and start producing antibodies against it thereby leading to damage of organs.
  • Drugs: paracetamol, TB drugs.
  • Ischaemic injury due to interrupted blood supply.
  • Wilson’s disease.
  • Pregnancy.
  • Toxins from mushrooms

Factors causing chronic hepatitis include :

  • Chronic alcoholism.
  • Autoimmune disease.
  • Drug-induced..
  • Viral, especially hepatitis B with or without D, C and E but hepatitis A does not cause chronic hepatitis.

Risk factors

  • Chronic alcoholism.
  • Consumption of contaminated water (hepatitis A, D and E).
  • Blood transfusion (hepatitis C and B).
  • Intravenous drug abusers.
  • Sexual partners suffering from hepatitis B infection.
  • Autoimmune diseases.
  • Intake of drugs known to cause hepatitis.

Treatment

Treatment of hepatitis depends upon the cause. In most of the cases, a viral infection is the cause of hepatitis which requires no specific treatment apart from maintenance of proper diet, rest and avoidance of hepatotoxic drugs are enough for recovery. However, in cases of hepatitis B and C infection there are antivirals available. Autoimmune hepatitis can be managed with immunosuppressant drugs like corticosteroids and azathioprine. In severe cases, a liver transplant may be recommended.

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