Chronic Hepatitis: Causes, Symptoms, Signs, Treatment, Prevention, Prognosis, Investigations
What is Chronic Hepatitis?
Hepatitis is a medical disorder where the liver gets inflamed with inflammatory cells present in its tissue. The term "Hepatitis" is derived from Greek where "hepa" means liver and "itis" means inflammation. Hepatitis can resolve on its own or can develop into fibrosis and cirrhosis.
A patient suffering from hepatitis may be asymptomatic or have few symptoms. This condition usually results in anorexia, jaundice and malaise. If hepatitis is present for less than 6 months, then it is termed as acute hepatitis. When it persists for more than 6 months, then it is known as chronic hepatitis. Majority of the hepatitis is caused by a group of viruses which are the hepatitis viruses; however, there are other causes also, such as toxic substances like alcohol, some medications, industrial organic solvents etc. , autoimmune diseases and certain infections.
Many laypersons are quite aware of Hepatitis B today, due its increasing incidence. If this condition persists, then it results in Chronic Hepatitis B, which is a more severe form of Hepatitis B and is caused by a hepatitis B virus. This virus attacks the liver resulting in inflammation of the liver tissues. Chronic Hepatitis B is more common in Africa and Asia and is transmitted when body fluids such as blood, lymph, tears, saliva, semen, vaginal fluids and urine etc. are exposed to the viral DNA. Pre-natal infection can also lead to this condition. It can also be transmitted via blood transfusions, dialysis, acupuncture, tattooing etc. Bear this in mind that this disease cannot be transmitted through casual contact. Hence, it is highly recommended to get your children vaccinated as soon as possible.
Coping with Hepatitis
There are some types of hepatitis which resolve quite fast; whereas there are some types which can persist for decades. The latter type needs close monitoring by your physician by maintaining regular medical appointments and following the treatment plan which your doctor has charted out for you. Other than medications, you should also modify your lifestyle by giving up or limiting alcohol intake, exercising and losing extra weight. All these things help in preventing any further worsening of the disease. Additionally, try to find out about other people who are suffering from hepatitis. There are many support groups present which help in educating and assisting you and your families. Better knowledge on this condition and good support system and a little help; all these things go a long way in helping people with hepatitis to enjoy full and complete lives.
Causes of Chronic Hepatitis
The most common cause of chronic hepatitis is viruses. Viruses which causes hepatitis include:
- Hepatitis B and C: About two-thirds of cases of chronic hepatitis are caused by these viruses. Individuals who have hepatitis C are at a higher risk of developing chronic hepatitis. Patients may experience only mild symptoms when affected by these viruses. Gradually, maybe after a decade or more, both these may lead to other serious complications, such as cirrhosis, which occurs due to constant destruction of liver cells and the subsequent scarring. A small percentage of patients having cirrhosis can also develop liver cancer after a period of time.
- Hepatitis D: Patients who are already infected with hepatitis B get infected by hepatitis D. Flare up of active hepatitis is the common result of this infection.
Other More Commonly Diagnosed Causes of Non-Infectious Chronic Hepatitis are:
- Alcohol: Alcohol may cause chronic hepatitis, especially if the patient's nutrition is inadequate. Other than this, even moderate alcohol intake can worsen chronic hepatitis resulting from other causes, especially hepatitis C resulting in an increased risk of developing into cirrhosis.
- Non-Alcoholic Steatohepatitis (NASH): Nowadays, nonalcoholic steatohepatitis or NASH has become a quite common cause of unrelenting liver inflammation. Majority of the patients do not have symptoms. This condition is generally discovered during routine blood tests where the liver enzymes are found to be elevated than their normal level.
- Autoimmune Hepatitis: This is a type of chronic hepatitis where the immune system mistakenly kills the body's very own liver cells. The cause of this not known. If this condition is not treated, then due to its progressive nature, it can cause cirrhosis.
- There are certain medications which can also lead to chronic hepatitis such as methyldopa (Aldomet, Amodopa) for hypertension (high blood pressure), isoniazid (Laniazid, Nydrazid) for tuberculosis, Macrodantin for UTIs (urinary tract infections) and phenytoin (Dilantin) for seizure disorders. However, chronic hepatitis caused by medications is quite rare. Regular blood tests are required if the patient is on medications which are known to cause hepatitis. Discontinuation of the medication often reverses early liver inflammation.
- There are some rare, inherited metabolic disorders which may also cause chronic hepatitis such as: Wilson's disease, hemochromatosis and sarcoidosis.
Signs and Symptoms of Chronic Hepatitis
Initially, chronic hepatitis may not cause any symptoms. Patients having symptoms commonly complain of feeling fatigue which worsens as the day goes on and which may even become incapacitating. Other common symptoms of chronic hepatitis include:
- Mild discomfort in the upper abdomen.
- Appetite loss.
- Pain in the joints.
Symptoms Of Severe Chronic Hepatitis Include:
- Swelling of the abdomen.
- Weight loss.
- Muscle weakness.
- Dark colored urine.
- Bleeding easily and easy bruisability.
- Confusion which may progress to coma.
Treatment for Chronic Hepatitis
- The aim of treatment is preventing further worsening of the disease and preventing cirrhosis and liver failure. Treatment may not be required in mild cases of chronic hepatitis from hepatitis B or hepatitis C, as the condition may not worsen. If there is active infection, or if a liver biopsy indicates early signs of damage, then treatment is required to eliminate active infection. Not all patients are suitable for treatment because of the side effects and the risk of recurrent active infection.
- Antiviral medications are given for treating viral hepatitis. These include: Interferon alpha and ribavirin for hepatitis C. Lamivudine, tenofovir, adefovir and entecavir for hepatitis B. Common side effects of interferon include: Fatigue, headaches, muscle aches, nausea and vomiting, weight loss, fever, irritability and depression.
- If the patient has hepatitis C, then he/she is given vaccine for hepatitis A and B, as the patient is more likely to develop serious infection from hepatitis A or B.
- For treating alcoholic hepatitis, complete abstinence from alcohol is recommended.
- Patients suffering from NASH need to lose excess weight and exercise regularly. Other than this, patients with NASH tend to have elevated blood sugars and often develop type 2 diabetes. So, it is important to keep blood sugars under control in order to decrease the accumulation of fat and inflammation in the liver.
- Endoscopy is done if patient has cirrhosis to check for esophageal varices, enlarged veins in the esophagus, which may cause life-threatening bleeding.
- Patient should be screened periodically with a blood test known as alpha fetoprotein and ultrasounds to detect early liver cancer.
- For treating autoimmune chronic hepatitis, medications, such as corticosteroids, and which suppress the immune system, such as azathioprine, are used. These medications help in decreasing symptoms, reducing inflammation of the liver and increasing the survival rate.
- Treatment for other less common types of chronic hepatitis is done by treating the underlying disease which is causing the condition. If the chronic hepatitis is caused due to medications, then they should be stopped or the medicine should be replaced.
- A liver transplant may be required if patient has cirrhosis or liver failure.
- Alcohol or use of acetaminophen should be avoided to prevent further liver damage in chronic hepatitis.
- Patients should follow a well-balanced diet and maintain good physical fitness, so that they are better able to combat fatigue and also for improving overall health. Patients should also try to restrict their salt intake if they have a tendency to accumulate fluid as a result of cirrhosis. Patients should always consult their physician before starting any additional drugs (prescription/ nonprescription/ alternative medications), as the injured liver will not be able to detoxify these meds.
Prevention of Chronic Hepatitis
- Chronic hepatitis is commonly caused by infection from the hepatitis B or C virus. These viruses are mainly passed from person to person through sexual contact or contact with other bodily fluids such as when needles are shared or during blood transfusions. The reason why some cases of viral hepatitis develop into chronic hepatitis and others do not is unknown. The best mode of prevention of chronic hepatitis is preventing against the hepatitis B and C viruses. This can be done by taking hepatitis B vaccinations.
- Using condoms during sexual contact helps in preventing infection.
- Sharing of the needles should be avoided.
- Patients should maintain adequate weight and exercise regularly, as non-alcoholic steatohepatitis (NASH) commonly occurs in those individuals who are overweight.
- As the cause for autoimmune chronic hepatitis is not known, so there is no way to prevent it.
- Patients taking medications which may affect the liver should get regular blood tests to detect any liver damage or development of chronic hepatitis.
Prognosis for Chronic Hepatitis
In severe stages, cirrhosis may lead to liver failure and death. The only way for preventing these is a liver transplant. The chances of developing cirrhosis depend on the extent of the disease and the patient's response to treatment. Other factors which influence the prognosis are: age, other medical conditions, alcohol use and sub type of virus. Patients with cirrhosis are at increased risk for developing liver cancer, so they must have regular blood tests and ultrasounds to examine the liver. The cause of the hepatitis and the degree of inflammation determines the risk of developing cirrhosis.
Investigations for Chronic Hepatitis
As chronic hepatitis usually does not cause early symptoms, the condition is often discovered during routine blood tests. If there is a suspicion of chronic hepatitis, then the doctor examines the patient for jaundice, abdominal tenderness, especially in the right upper quadrant where the liver is situated, and signs of liver failure such as filling up of water in the abdomen. Blood tests are done to measure:
- Presence of liver enzymes, which are released if there is damage or inflammation of the liver cells.
- Bile duct enzymes.
- Bilirubin levels, as elevated levels of bilirubin cause jaundice.
- Clotting factors and protein levels to evaluate the liver function.
If the above mentioned tests indicate liver inflammation or liver failure, then the doctor will conduct further tests for hepatitis B and C and for antibodies which indicate autoimmune hepatitis. The doctor will also analyze the medications which the patient is taking to determine if they are the cause of chronic hepatitis. If the cause is still not known, then additional blood tests are ordered to check for other uncommon causes. An ultrasound or computed tomography (CT) test may be done to evaluate the liver size. A liver which is small in size and appears scarred indicates cirrhosis.
A liver biopsy may also be recommended. Biopsy helps in determining the extent of scarring and also the extent and type of damage to the liver. This will help in determining the best course of treatment and also helps in determining the patient's chances of developing cirrhosis and liver failure. A liver biopsy also helps in checking other disorders, such as fatty liver or alcoholic liver disease.
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