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Learn More About Hepatitis

Hepatitis is general medical term that describes a process that leads to Inflammation and damage to the tissues of the Liver.

The most common cause is Viral hepatitis, however there are other causes such as Alcohol, Parasites, Drugs and others.

The level of severity of the is condition, or damage of the liver, largely differs from one patient to another.

Some may see virtually minimal or no symptoms while others may have significantly more serious problems.

 

Other Causes besides viral that can be seen:

–  Alcohol
–  Toxic Chemicals
–  Bacterial
–  Parasites
–  Certain Drugs
–  Wilson’s disease
–  Alpha 1-antitrypsin deficiency

 

Symptoms:

–  Prodromal phase
–  Icteric phase
–  Covbalescent phase, and complications
–  Hepatomegaly is seen in over 40% of cases.
–  Liver tenderness can be seen as can lymph tenderness.
–  Enlarged Spleen can be seen in 10 – 15 %.
–  Neural imparement can be seen in chronic C
–  Jaundice
–  Fever
–  Abdominal pain
–  Nausea
–  Weakness
–  Cirrhosis

 

Depending on the cause and severity – can be classified as acute  (less than 6 months), chronic (greater than 6 months) or fulimant.

Acute Hepatitis

Typically follows a pattern with three distinctive phases.

1.)  Initial prodromal phase

–  Flu-like symptoms occur in most cases
–  Includes Nausea, Vomiting, Fatigue, Poor Appetite, Headaches, Joint Pain and possibly Fever
–  Small percentage of patients have urine color changes, clay – colored stools, abdominal pain, and more.

2.)  Clinical Jaundice

–  Jaundice = Yellowing of Skin
–  Icterus = Yellowing of Eyes
–  This follows prodrome after a week or two.
–  Can last 1-6 weeks
–  Enlarged liver and abdominal pain can be associated.
–  Possible spleen enlargement and weight loss can be seen.

3.)  Recovery Phase

–  Resolution of symptoms
–  Elevated liver enzymes are often seen
–  Continued enlarged liver.
–  Hepatitis A and E will resolve after 1-2 months
–  Many of the Hepatitis B will resolve after 3-4 months.
–  Very few Hepatitis C cases will resolve completely.

 

Chronic Hepatitis

–  Often without symptoms most of the time
–  Inflammation will progress during this stage.
–  Patients can develop worsening symptoms at different times
–  Symptoms would be similar (at times) to acute stage.
–  Additional symptoms include: hair growth, lack of menstrual period, ascites, encephalopathy, esphageal varices, hepatorenal syndrome.
–  During this stage – Cirrhosis develops in some cases.

 

Fulminant Hepatitis

–  This is a rare and life-threatening complication
–  Can occur with Drug-induced, Autoimmune Hepatitis, as well as Hepatitis B, D, and E

–  Severe symptoms are seen very soon after/during Acute Hepatitis phase.
–  Death occurs without treatment in 75% of cases.
–  Death often occurs as a result of GI problems, Sepsis, Respiratory Failure and/or Kidney Failure.
–  Treatment is a Liver transplant

 

Viral Hepatitis

Hepatitis A

–  HAV or Hepatitis A is a 27-nm RNA hepatovirus.
–  HAV vaccine introduce in 1995
–  Also called infectious hepatitis
–  Transmitted by fecal-oral routes.
–  Typically seen in over crowded areas and poor sanitation.
–  Passed in contaminated waters or foods
–  Mortality rate is low
–  Fulminate hepatitis A is uncommon alone.
–  More prevalent with patients already having Hepatitis C.
–  Can persist for years and 30% of the population in the US have serologic evidence of previous infection.

 

Hepatitis B

–  HBC or Hepatitis B is a 42 nm hepadnavirus
–  8 different genotypes (A-H) may determine infection and ability for response of antiviral medication.
–  Transmitted through blood or blood products or through sexual contact
–  It is present in saliva, semen, and vaginal secretions.
–  Mothers with Hep B can pass it to their child during delivery.Incubation time is 6 weeks to 6 months.
–  Risk of fulminate Hepatitis B is 1% of which have a mortality rate of 60%

 

Hepatitis C

–  HCV or Hepatitis C is a single stranded RNA virus – 6 major genotypes
–  50% of individuals infected from IV drug use.
–  Other risk factors are intranasal cocaine use, body piercings, tattoos, multiple sexual partners, and hemodialysis.
–  Transmission via breast-feeding has not been documented.
–  Incubation is 6 weeks on average.
–  Second most common cause agent of cirrhosis (after alcohol induced liver disease)

 

Hepatitis D

–  HDV or Hepatitis D is a defective RNA virus that is only seen with hepatitis B.
–  Occurrence is seen simultaneously with B.
–  If infections occurs at the same time as B outcome is usually similar to B.
–  If infections occurs in individual with chronic B than short term outcome may be worse.
–  Including fulminant or progression to cirrhosis.
–  Seen in IV drug users.
–  Overall uncommon infection.
–  Individuals having HDV has a 3x risk of hepatocullular carcinoma.

 

Hepatitis E

–  HEV or Hepatitis is a 29-32 nm RNA virus.
–  Rare in US – typically seen in an endemic area.
–  Waterborne transmission.
–  Mortality rate of 10% – 20% in pregnant women

 

Hepatitis G

–  HGV or Hepatitis G is a flavivirus and is percutaneously transmitted.
–  Does not typically cause liver disease.
–  Typically does not affect those individuals with chronic B or C

 

Parasite Hepatitis

–  Parasites can infect the liver and this activates an immune response
–  Such parasites include: Protozoans, Trypanosoma Cruzi, Entamoeba histolytica, Some plasmodium types including Malaria causing, Leishmania species.
–  Others such as worms such as Echinococcus granulosus, Liver Flukes, and Clonorchis sinensis and others

 

Bacterial Related Hepatitis

–  Some bacteria can cause liver infections, abscess, hepatitis, or other liver diseases
–  Some of the most common bacteria include: Escherichia coli and Klebsiella pneumoniae.
–  Other bacteria less commonly seen include: Bartonella henselae, Borrelia burgdorferi, Campylobacter species, Neisseria meningitidis, Neisseria gonorrhoeae, Salmonella.
–  Other infections include: Coxiella burnetii, Mycobacteira, Rickettsia, Troponema pallidum, Tropheryma whipplei.

 

Alcoholic Hepatitis

–  Inflammation of the liver caused by excessive alcohol consumption.
–  This is the most common cause of Cirrhosis in the U.S.
–  Can range from least severe – Hepatomegaly (Enlarged liver), to Alcoholic Steatosis, to Alcoholic Hepatitis, to Cirrhosis, and Liver Cancer.
–  Develops from over years-long exposure
–  Can occur in 10-20% of alcoholics
–  Highest risk factors include: quantity and duration of alcohol.
–  Typically more than 80 grams in men and 40 grams in women is a high risk factor and chronic (1 beer or 4 ounces of wine is equivalent to 12 gm of alcohol)

 

Drug/Toxin Related Hepatitis

–  This includes a long list of medications, toxins, dietary supplements, Herbal, and more agents that cause inflammation of the liver.
–  The severity of liver damage can be minimal to toxic
–  Many different types of damage can occur depending on type of medication or toxin.
–  The time frame of injury often depends on type, dosage, frequency, and other related medical conditions.

 

Autoimmune Hepatitis

–  Autoimmune Hepatitis is when the patient’s Immune System is attacking its own Liver causing potentially serious affects.
–  It is seen in about 2 per every 100,000 individuals
–  Often, it take years to develop but in many cases it can be more of an acute injury to the liver.
–  It can affect men and women, but more young women are affected.