Hepatitis

• Symptoms: Light or clay-colored stool, jaundice, nausea, vomiting, fever, loss of appetite, fatigue, joint pain, abdominal pain, bloated belly, dark urine, yellowing of the eyes and skin, itching, weight loss, malaise, diarrhoea
• Causes: Exposure to hepatitis viruses, contact with body fluids, contaminated food and water, heavy alcohol drinking, autoimmune disorder, environmental factors
• Risk Factors: Injecting drugs from shared needles, living with a hepatitis patient, sexual intimacy with hepatitis infected person, exposure to contaminated food and water
• Severity: Mild to Severe
• Which doctor to consult: Gastroenterologist, Hepatologist, Infectious disease specialist

Overview

Hepatitis is a liver inflammation or swelling that can cause damage to the organ. It has a direct impact on the functionality of the liver. The liver is responsible for vital functions like processing nutrients, filtering blood, and preventing infection. So, all of these can be jeopardised due to hepatitis infection. In extreme cases, it can even cause fatal complications like cirrhosis, liver failure and liver carcinoma.

Hepatitis is primarily caused by infection, although other factors like heavy alcohol consumption, toxicity, and the body's autoimmune response can also cause it.

The infection can be of various types, according to research. For instance, some known types are viral hepatitis, alcoholic hepatitis, toxic hepatitis, autoimmune hepatitis, etc.

Depending on the viruses that can cause the liver infection, viral hepatitis is categorised into the following few types:

• Hepatitis A, caused by the hepatitis A virus (HAV)
• Hepatitis B, caused by the hepatitis B virus (HBV)
• Hepatitis C, caused by the hepatitis C virus (HCV)
• Hepatitis D, caused by the hepatitis D virus (HDV)
• Hepatitis E, caused by the hepatitis E virus (HEV)

Hepatitis A and E types are caused due to consuming contaminated food or water. The contamination can occur from the stool of a hepatitis-infected person. Hepatitis E can also occur from eating uncooked or under-prepared pork and shellfish.

On the other hand, hepatitis B, C, and D can spread from the contaminated blood of a patient. Even body fluid contact with an infected person can cause hepatitis B and D.

However, among all of these, hepatitis A, B, and C are the most prevalent types. The disease can permanently scar the liver if left untreated, resulting in cirrhosis. This significantly lowers the survival chance of the patient, as patients with compensated cirrhosis have a lifespan of 12 years. A worse prognosis of the condition can reduce the lifespan to two years if a liver transplant is not performed.

When to Consult a Doctor?

An individual must seek medical attention if he/she faces any of the following situations:

On Symptoms: Despite its severe circumstances, there is no need to panic when diagnosed with hepatitis. Often, the symptoms do not aggravate beyond a headache or fatigue. However, if the symptoms refuse to go away, it is best to get checked by a doctor. In the case of hepatitis, the quicker an individul seeks medical attention, the better. Doctors may examine the individual for external symptoms such as an alteration in vision, discomfort in the chest and dizziness. However, a prominent sign of hepatitis is diarrhoea that lasts over 48 hours with traces of blood in the stool.

Routine Check-up: Regular screening like hepatitis panel tests and vaccination (especially for the HAV and HBV virus) can keep an individual protected.

During Pregnancy: Pregnant women need to undergo hepatitis testing as an HBV infection during this can progress the chances of cirrhosis. Pregnancy can also aggravate a hepatitis D infection, resulting in chronic liver diseases.

Hepatitis E is associated with preterm and low birth weights. So, to avoid all these complications, it is better to consult a doctor beforehand.

Diagnosis

A doctor must diagnose the type of hepatitis first to provide proper treatment. For instance, hepatitis A may have similar symptoms to other acute viral hepatitis types. Due to this, an individual must consult a gastroenterologist, hepatologist, and infectious disease specialist. They may conduct various examinations to confirm the disease. These tests are primarily helpful for diagnosing hepatitis A, B, and C.

Physical Examination: Usually, doctors will perform a routine physical exam based on the signs and symptoms a patient experiences. This includes pressing against the abdomen gently to diagnose if the liver is swollen. The doctor also examines the skin and eyes for signs of jaundice, as these areas can exhibit a yellowish tint. Doctors may also question your medical history and current conditions, which you must explain in detail.

Diagnostic Tests

Blood Tests: Blood tests are the primary diagnosing test conducted to verify the occurrence of any form of hepatitis. The test result can also confirm the hepatitis type, whether the infection status is dormant or active. Blood tests also verify if a person is immune to the disease. The test includes examining various immunoglobulin antibodies against the viruses. For instance, a hepatitis A blood test confirms specific HAV-IgM antibodies in the blood. Similarly, hepatitis D is confirmed through IgG and IgM level testing.

Imaging Tests

Imaging tests are further done to reconfirm the doctor's diagnosis after the type of hepatitis is diagnosed through the blood test. Doctors can recommend one or all imaging tests to assess the liver condition properly.

• Ultrasound: An ultrasound test utilises high-frequency sound waves to get a proper image of the body's internal structure. A handheld transducer is placed against the abdomen while it captures and sends the image of the liver to a computer screen. The test confirms the occurrence of inflammation in the liver, as the image shows large scarred areas on the organ. This can even indicate a progression of the disease towards cirrhosis.
• CT Scans and MRI: If the blood tests and ultrasound indicate liver cancer, a CT scan or MRI is recommended. A doctor can also prescribe these tests if the patient has a medical history of liver carcinoma. These tests provide much greater details about the liver as two, or three-dimensional images of the internal body structures are produced.

Advanced Test

Transient Elastography: One of the more advanced liver imaging tests is the transient elastography of the liver. It allows the measurement of the liver tissue and helps doctor determine how soft or hard it is. If liver stiffness is detected, it could indicate fibrosis, usually caused due to a liver injury. The stiffness level also evaluates the damage that occurred due to viral hepatitis.

Advanced Tests

Liver Biopsy: If the results from the various imaging studies are unsatisfactory, a liver biopsy is recommended. This is a rare situation, but it helps doctors better understand the impact on the liver due to viral hepatitis. This information later helps in providing proper treatment to the patient. During the procedure, doctor will perform local anaesthesia on the skin and insert a needle into the liver. A small sample is collected and later sent for further lab testing for confirmation.

Treatment

Home Care: There are specific remedies one can perform to ease the suffering during hepatitis and accelerate the healing process. Although hepatitis A is rarely fatal, patients can take up to months to fully recover. Taking care of oneself at home during this time is essential. Eating meals in tiny portions is also recommended, as taking good care of the skin and getting as much rest as possible. For hepatitis C infection, consuming natural herbs like Schisandra, milk thistle, turmeric and dandelion root promises good results. Also, homoeopathy and naturopathy can offer relief. But one should inform the doctor before opting for these alternative methods.

Medication: The best way to prevent hepatitis is to get vaccinated. Once infected, there is not much treatment available except for letting the body heal independently. However, certain medications like acetaminophen and paracetamol are prescribed to patients with hepatitis A. For hepatitis B, several antiviral medicines like entecavir, lamivudine, telbivudine, tenofovir, and adefovir are helpful. A doctor may even apply interferon injections to prevent the infection.

Surgical Treatment: A transplant is the only option in extreme cases where the liver is damaged beyond repair. During this procedure, general anaesthesia is applied. A surgeon then removes the damaged liver tissue and replaces it with a healthy one from a donor. Usually, most livers come from deceased donors. This treatment method is only prescribed as a last resort at the end-stage of liver disease.

Risk and Complications if Left Untreated

• Liver Cirrhosis: If left untreated, all hepatitis infections harm the liver. Continuing over a prolonged period can cause scarring of the liver tissues, resulting in liver cirrhosis. This can disrupt the normal functioning of the liver, making leading a regular life impossible. Patients with liver cirrhosis also have a reduced lifespan.
• Liver Cancer: One of the worst scenarios if hepatitis is not treated on time is the formation of liver carcinoma. Usually, patients with hepatitis B and C infections are at the most risk of developing this complication. The condition can aggravate in the presence of other symptoms like abnormal liver enzyme secretion.
• Fulminant Hepatitis: Fulminant hepatitis, also called fulminant hepatic failure, is a severe condition. It can cause multiple liver impairments, pushing the organ to stop functioning entirely. In worst cases, a patient can go into a hepatic coma, where the liver synthesising function halts after eight weeks of being infected with hepatitis.

Additional Information

Hepatitis complications due to smoking: Although smoking may not impact the liver directly, it can surely increase the carcinogens in the body. In the case of hepatitis B infection, cigarette smoking has been seen to increase the damage to the liver cells also. If an individual is already prone to certain types of cancer, a hepatitis infection can worsen it.

It has also been seen that smoking and hepatitis B and C infections are closely associated in patients with liver cancer. This is due to the cytotoxic chemicals released from smoking that can cause fibrosis and increase inflammation. Moreover, smoking can make the body produce more proinflammatory cytokines that cause further injury to the liver.

Hepatitis complications due to age: Hepatitis infections tend to be more severe among the elderly. For example, a hepatitis C infection may accelerate quicker in an older person than a younger one. This is due to the decline in overall immune health.

Even treatments can become complicated in the case of older patients. Performing specific transplants has an age limit, which may not always be a viable solution. Common symptoms of liver disease in elderly patients can include fatigue, nausea, vomiting, and muscle pain.

It has been seen that those above the age of 65 are more prone to contracting a severe infection. Also, not all hepatitis types can be treated the same way. So, in older patients' cases, stricter precautions must be taken.