Introduction
Hepatitis refers to inflammation of the liver. Inflammation is a response mounted by a living body tissue against an injurious stimulus. There are various types of hepatitis. Examples are alcoholic hepatitis, viral hepatitis and auto-immune hepatitis.
The liver is the second-largest organ in the body after the skin. It performs various crucial functions in the body.
Human liver anatomy on scientific background.
The main functions of the liver are:
- Metabolism of carbohydrates, proteins, and lipids
- Bile production and secretion
- Detoxification and excretion of wastes and toxins
- Blood filtration and clearance
- Storage of vitamins and minerals
- Blood clotting factor production
- Hormone regulation
- Immune system support
- Glucose regulation and storage
- Cholesterol and lipid regulation
- Albumin production
- Urea synthesis
- Drug metabolism and clearance
- Red blood cell breakdown (hemolysis)
- Bilirubin conjugation and excretion
Key Facts & Statistics
What are the key facts and statistics about hepatitis?
The following are about viral hepatitis:
- In the United States, there were almost 2,000 cases of acute hepatitis A in the year 2016.
- Globally, over 350 million individuals live with chronic hepatitis B and C. Out of this figure, 826,000 are in the United States with hepatitis B.
- In 2022, more than 1 million deaths occurred as a result of hepatitis B infection, most of them due to liver cirrhosis and hepatocellular carcinoma.
Causes & Types
What are the causes and types of hepatitis?
There are various forms of hepatitis, each with specific causes. These types are:
- Viral hepatitis.
- Alcoholic hepatitis.
- Toxic hepatitis.
- Auto-immune hepatitis.
Image showing an inflammed human liver.
What are the specific causes of these types of hepatitis?
Viral hepatitis
- As the name suggests, it is caused by a virus. It is classified into 5 sub-types which are:
- Hepatitis A. It is caused by hepatitis A virus (HAV).
- Hepatitis B. It is caused by hepatitis B virus (HBV).
- Hepatitis C. It is caused by hepatitis C virus (HCV).
- Hepatitis D. It is caused by hepatitis D virus (HDV).
- Hepatitis E. It is caused by hepatitis E virus (HEV).
- Viral hepatitis is the most common form of hepatitis.
Alcoholic hepatitis.
It is caused by uncontrolled chronic abuse of alcoholic drinks, usually through drinking excessive quantities of alcohol over a period of many years.
Toxic hepatitis.
It can be due to toxins which can in form of chemicals, medications and poisons.
Auto-immune hepatitis.
- It is a chronic form of hepatitis where the body’s own immune system attacks the liver.
- The exact causes of auto-immune hepatitis are not known.
- It is a rare form of long-term hepatitis.
Risk Factors
What are the risk factors for hepatitis?
- Having many sexual partners.
- Poor nutrition.
- Receiving long-term kidney dialysis.
- Excessive consumption of alcoholic beverages.
- Sharing needles and other body-piercing and body-cutting instruments.
- Working in a health centre.
Signs & Symptoms
What are the signs and symptoms of hepatitis?
Sometimes, individuals infected with hepatitis may not show symptoms and they will not know they have the disease.
If symptoms occur, they might include:
- Jaundice.
- Muscle and joint pain.
- Itchy skin.
- Abdominal pain.
- Fatigue.
- Fever.
- Nausea and vomiting.
- Dark urine.
- Loss of appetite.
Diagnostic Procedures & Tests
How is hepatitis diagnosed?
- Patient-history taking. This procedure will include any presenting symptoms, apart from medical history of the patient.
- Physical examination.
- Blood tests for viral hepatitis.
- Imaging tests such as ultrasound and computed tomography scan.
- Liver biopsy.
Treatment and Management
Does hepatitis have a cure?
Some forms of hepatitis can be treated and cured successfully. For example, hepatitis B.
How is hepatitis treated?
Viral hepatitis.
- Hepatitis A does not have a definitive cure. With early diagnosis and administration of either hepatitis A vaccine or hepatitis A immune globulin, the infection might be stopped from progressing further.
- Hepatitis B can be treated using entecavir, telbivudine or interferon alpha-2b.
- Hepatitis C can be treated using daclatasvir, simeprevir, sofosbuvir or glecaprevir/pibrentasvir.
- Hepatitis D is treated using interferons in addition to hepatitis B medications.
- Hepatitris E is treated using ribavirin.
Medications for viral hepatitis
Alcoholic hepatitis.
- Stop alcohol consumption: Complete abstinence from alcohol.
- Nutritional support: High-protein diet, vitamin supplementation (especially thiamine).
- Corticosteroids: To reduce inflammation in severe cases.
- Pentoxifylline: May help improve outcomes in severe cases.
- Liver transplant: Considered in cases of acute liver failure or severe chronic disease.
Toxic hepatitis.
- Remove the source of toxicity: Discontinue the offending drug or exposure.
- Supportive care: Manage symptoms and complications.
- N-acetylcysteine (NAC): For acetaminophen overdose.
- Corticosteroids: In cases of severe inflammation.
- Liver transplant: In cases of acute liver failure
Auto-immune hepatitis.
- Corticosteroids: Prednisone to reduce inflammation.
- Immunosuppressants: Azathioprine or mercaptopurine for long-term management.
- Liver transplant: For patients with severe liver damage or failure.
Liver transplant. This surgical procedure is performed when chronic hepatitis has led to liver failure or liver cancer.
Complications
What are the complications of hepatitis?
Death can result as a complication of hepatitis B.
Prevention
How do we prevent hepatitis?
- Depending on the kind of hepatitis, we can prevent hepatitis by lowering the associated risks.
- For example, limiting excessive alcohol intake can prevent alcoholic hepatitis. In addition to this, practising safe sex by using a condom when having sex and avoiding sharing of body-piercing instruments can help in reducing risk of contracting hepatitis B.
- Also, vaccination against hepatitis A and B can prevent them.
- Avoid sharing of body-piercing tools.
- Embrace proper personal hygiene such as washing hands with soap and clean water.
- Transfuse only screened blood which has no infections.