Hepatitis – Awareness and Types

Updated 28/07/2020

WHAT IS HEPATITIS?

Hepatitis is Inflammation of the Liver (Hepa-Liver; itis-Inflammation). Inflammation is the response and damage caused in the body due to any injurious agent.

For the liver, the injuring agent can be infectious organisms like bacteria, viruses, parasites, fungi, or noxious substances like alcohol, tobacco, certain medicines/drugs and toxic substances.  Sometimes too much deposition of some substances like fats, or even iron and copper can cause long term injury to the liver. Injury can also be caused when there is lack of blood/oxygen supply or the body’s own immune system attacks a part of an organ due to a genetic programming error.

Inflammation can occur over a short period of time (acute) or over a long period of time (chronic) causing long term liver damage and loss of function.

CAUSES 

• Infections: most commonly due to Hepatitis virus (HV) types A,B,C,D,E
  • Hepatitis A and E spread by contaminated water/food. Hepatitis A is more common in children, but can rarely affect adults also in whom it causes more severe disease. Hepatitis E affects young adults, and can lead to complications including death in pregnant women.
  • Hepatitis B, and C spread by blood contact like infected needles, blood transfusion, sexual contact, and mother to child at birth). Hepatitis D virus causes co-infection with B virus.

• • Other infections: parasitic, bacterial, fungal, viral (like yellow fever)

• Alcoholic liver disease (ALD)
• Non-alcoholic (NAFLD : Non-Alcoholic Fatty Liver Disease) – diabetes, obesity, high fats (lipids) are risk factors
• Drugs and Toxins – due to certain medicines (DILI : Drug-Induced Liver Injury) and other toxic substances
• Other causes – Auto-immune (attack by own immune system) and Ischemic (lack of adequate blood supply)

Viral and Alcohol are the most common causes.

TYPES 

Acute Hepatitis

Duration: Usually lasts a few weeks (<6 months).

Symptoms: Fever, body ache, nausea, jaundice (yellowing of the white of the eye, and skin), dark urine, pain in the upper right part of the abdomen, loss of appetite

Common causes – Viral (HVA and HVE), Drugs/Toxins

Recovery in acute viral cases is usually spontaneous though rarely it can cause complications like liver failure (seen more in adults; Hepatitis E can especially be serious and even fatal in pregnant women)

Chronic Hepatitis

Duration: Prolongs for > 6 months

Symptoms: Initially weight loss, weakness, body ache, and decreased appetite.  Often there are no specific symptoms, and diagnosis is made on routine lab tests.

Common causes – Viral (HVB, HVC, HVD), Alcohol, NAFLD, and certain medicines/toxins.

There is gradually progressing damage and scarring of the liver (called Cirrhosis) which compromises liver function and leads to chronic liver failure.

Chronic Hepatitis also increases the risk of developing Liver cancer (Hepatocellular carcinoma)

MANAGEMENT

Vaccines 

Preventive vaccines are now available for Viral Hepatitis A and B and are regularly given to children as part of the immunization schedule. Adults prone to needle injuries like Doctors and Lab workers should be given the Hepatitis B vaccine.

A vaccine for Hepatitis E is available in China and is likely to soon be available in other countries. Vaccine for Hepatitis C is still in research stages.

Treatment

Acute Hepatitis (mainly due to Virus A and E common with water and food contamination in monsoons), is managed with rest, adequate fluids, dietary fat, and alcohol restriction and no drugs/medicines. It usually shows a full recovery in 3-4 weeks. Rarely it may present as a severe form spiraling quickly into liver failure. Adults especially the migrating population and pregnant women are most at risk for complications and fatality due to Hepatitis A and E.

Chronic Hepatitis if due to Virus B or C is managed with medicines now available. (Tenofovir and Entecavir for Hepatitis B, and Sofosbuvir, Ledipasvir, Daclatasvir and Velpatasvir for Hepatitis C). Usually, treatment continues for several months with regular monitoring with lab tests. Even after disease control or recovery, monitoring continues as there is an increased risk of developing Liver cancer.

Currently, there are no specific medicines to treat Alcohol liver disease or Non-alcoholic Fatty Liver Disease, though supportive therapy with tonics and nutrition therapy with antioxidants is often prescribed. Research on specific drugs is in progress.

Once cirrhosis sets in (usually screened for with Fibroscan; confirmed and staged with Liver Biopsy), the patient is regularly monitored for liver function, progression of cirrhosis and signs of liver failure. The patient is registered for Liver transplant and maybe advised some precautionary procedures like endoscopy and banding of the blood vessels of the food pipe.

Signs of  liver failure

• Jaundice
• Fluid in abdomen, and/or swelling of feet
• Superficial bruising/bleeding spots
• Reddening of palms and bulging club-like fingers
• Prominent tortuous blood vessels around the umbilicus
• Bleeding from vessels of food pipe and stomach
• Kidney failure
• Brain symptoms (Encephalopathy) – confusion, disorientation, delirium, tremors, progressing to coma   

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For any query, additional information or to discuss any case, write to info@drvarsha.com, and be assured of a response soon.

References

WHO Hepatitis July 2019,

CDC Hepatitis Goal 2020

Also read –

Water-Borne Diseases – Awareness and Health measures