Information on hepatitis virus symptoms such as chronic liver inflammation.

What is Hepatitis?

Hepatitis is a general term that refers to inflammation and swelling of the liver and can be caused by a number of different things including viral, bacterial or fungal infections toxins such as alcohol or drugs or any other disease process that may affect the liver. The most common cause of hepatitis is an infection with one of the hepatitis viruses. Hepatitis can be acute (short lived) or it can be chronic, sometimes never going away.

Some types of hepatitis will resolve on their own without treatment and others may need intensive or prolonged treatment. Similarly some types of hepatitis will leave no lasting effect on the liver while others can cause permanent damage or scarring to the liver and sometimes even cancer.

The liver is found in the upper right hand side of the abdomen and is an extremely important organ responsible for many functions including processing nutrients, breaking down toxins, manufacturing bile to break down fats, regulating blood clotting and manufacturing important body proteins. If the inflammation of the liver is severe enough to interfere with any of these functions it can be potentially dangerous.

What are the Symptoms of Hepatitis?

The initial symptoms of hepatitis can be quite vague and often resemble the flu which is why diagnosis can sometimes be delayed or even missed. These mild symptoms include:

• Tiredness and lethargy
• Enlarged glands
• Loss of appetite of Appetite
• Headaches
• Fever

The more specific symptoms of hepatitis are the same irrespective of the cause however they can vary from person to person and can also vary over time. As the inflammation of the liver progresses you may note:

• Jaundice – a yellowing of the skin, mucous membranes and sclera (whites of the eyes)
• Dark urine
• Pale stools
• Stomach pain or swelling
• Nausea and vomiting
• Pruritis (itching of the skin)

What Causes Hepatitis?

The most common cause of hepatitis is infection with one of the specific hepatitis viruses:

• Hepatitis A – spread through water or food that has been contaminated with fecal matter. Tends to more short lived and is often mis-diagnosed as ‘flu.
• Hepatitis B – spread through infected needles, blood, unprotected sex or from mother to baby. The vast majority of cases resolve but up to 3% of patients can become carriers who can continue to spread the virus.
• Hepatitis C – is the most common cause of chronic hepatitis and is spread in the same way as Hepatitis B.
• Hepatitis D and E – are much rarer especially in the western world. Hepatitis D only occurs in the presence of hepatitis B and is spread in the same manner. Hepatitis E is transmitted in the same way as Hepatitis A and is more common in the less westernized parts of the world

There are many other causes of hepatitis including:

• Hepatitis caused by viruses other than the specific hepatitis viruses e.g. CMV
• Chemically induced hepatitis – due to alcohol, recreational or prescription drugs, environmental toxins
• Inherited hepatitis – diseases such as Wilson’s Disease, Haemochromatosis or alpha-1-antitrypsin deficiency
• Non-alcoholic Fatty Liver Disease – is one of the most common causes of chronic hepatitis. There is a build up of fatty deposits in the liver and it tends to occur in people who have a combination of high blood pressure, raised cholesterol and Type 2 Diabetes.
• Autoimmune Hepatitis – tends to be chronic and occurs more frequently in women. It usually occurs in conjunction with other auto-immune diseases.

Diagnosing Hepatitis

In most cases the diagnosis of acute hepatitis can be made by your doctor based on the signs and symptoms listed above with confirmation on physical examination. Patients with chronic hepatitis however often have no symptoms and it may only be picked up on a routine examination or during investigations for another condition.

There are a number of special tests that can be performed to confirm the diagnosis of hepatitis:

• Bilirubin – a breakdown product of old red blood cells. The liver usually converts it to a water soluble form that can be passed out in the urine. Levels of the non-water soluble bilirubin in the blood are raised in liver disease and this is what causes the jaundice.
• ALT – a raised level of this enzyme is the best indicator of hepatitis as this enzyme is mainly found in the liver.
• ALP – the levels of this enzyme are usually raised when the bile ducts are blocked.
• AST – levels can also be raised when the liver is inflamed.
• Albumin – this protein is made by the liver and if the liver is not functioning optimally its levels will be decreased.
• Total protein – this is a measure of the albumin and all other proteins in the blood and is also indicative of how well the liver is functioning.
• An ultrasound scan can show an enlarged liver and whether there is any change in the structure of the liver, gall bladder or bile ducts.
• Clotting time – because so many of the factors involved in blood clotting are made in the liver a prolonged clotting time can be a good indication of liver function.

Once the diagnosis of hepatitis is confirmed there are a number of tests that can be performed to determine the cause of the hepatitis:

• Viral testing – there are many different blood tests (testing for antibodies and antigens) that can be performed to determine which virus is responsible
• If an inherited form of hepatitis is suspected- specific tests can be performed to check for specific diseases e.g. iron levels if haemochromatosis is suspected or copper levels if Wilson’s disease is suspected.
• Blood tests- are available to check for drugs, alcohol or toxins in the blood a good history from the patient often provides the answer.
• Auto-antibodies- can be measured in the blood if an autoimmune cause of the hepatitis is suspected.
• Liver biopsy – a small amount of liver cells are withdrawn using a hollow needle for microscopic examination.

Help for Hepatitis

Conventional medicine employs a combination of prevention, supportive therapy and medication to treat hepatitis, depending on the cause. Routine screening of pregnant women for hepatitis B with vaccination of the newborn at birth has reduced the incidence of Hepatitis B. Ensuring a safe supply of clean water and good sanitation services will help to decrease the incidence of Hepatitis A and E.

If there is an underlying disorder this is treated to prevent further damage to the liver. If toxins, alcohol or drugs are the cause they must be avoided. Unfortunately liver disease can often be difficult to treat with a single pronged approach and for a small percentage of people a liver transplant may be necessary if the liver is irreparably damaged.

More Information on Hepatitis

Here are some tips on how to look after your liver: