HepatitisIntroduction:
Hepatitis means that the liver is inflamed. This inflammation
can be caused by alcohol (alcoholic hepatitis), by drugs( drug induced hepatitis)
or by a viruses( hepatitis A ,B, C etc.). Viral hepatitis is dealt with in another
chapter. Symptoms: Depending on what the immune system of the patient
is like, hepatitis presents in very different ways. A person with good
immunity might only experience a flu like illness that lasts for a few days with
a lack of appetite, but only very little bloating or abdominal discomfort. Another
patient might suddenly be very ill with a violent distaste for cigarettes, even
though the patient might have been a heavy smoker before. Nausea, vomiting
and a fever will follow. After several days to a week the urine turns dark and
the patient looks jaundiced. In the second week the patient may feel better, although
the jaundice is still worsening. The physician feels an enlarged tender liver
with a smooth edge. Within 3 to 4 weeks from the beginning most patients recover.
Blood tests help in determining the severity and the type of virus. The higher
the liver enzymes, the worse the liver damage. Hepatitis A and E do not tend to
get chronic. Hepatitis B, C, D and G lead to a chronic hepatitis and cirrhosis.
Hepatitis B, C and D have been linked with liver cancer. Treatment: Treatment
for acute hepatitis is supportive. During the icteric (jaundice) phase the patient
should stay home, but no special treatment other than rest is necessary. Vitamin
supplements or corticosteroids have not been shown to be of value. There is no
special dietary requirement. When the jaundice disappears and the appetite has
returned the patient can return to work, even if the liver enzymes are not quite
back to normal. Chronic hepatitis exists when hepatitis persists on laboratory
tests beyond 6 months. The gastroenterologist will want to do some more involved
tests including a liver biopsy to see what the liver tissue looks like histologically.
Depending on what the pathologist finds out the treatment may differ somewhat.
For instance, if it looks like a drug induced hepatitis (for instance from oral
contraceptive use) the physician will advise to stop the medication that causes
the hepatitis. On the other hand, the autoimmune type hepatitis can affect not
only the liver, but other organ systems as well such as the skin (acne), the colon
(ulcerative colitis), joints (arthralgia), the thyroid (thyroiditis), the bone
marrow (hemolytic anemia) and the kidney (nephritis). These cases are usually
treated with corticosteroids and possibly also with azathioprine. A gastroenterologist
should be consulted for the long-term supervision of this chronic maintenance
therapy. In the case of chronic hepatitis B and C corticosteroids are contraindicated
(=forbidden), because it would allow the virus to replicate much faster. Instead
interferon-alpha is used for maintenance by the gastroenterologist. This is now
often combined with long-term ribavirin, an antiviral antibiotic. Unfortunately
these substances are all very expensive, but do lead to cures in 30 to 40 %. Prevention: It
is important to note that hepatitis A and B vaccines are available (85% to 95%
effective). I can only recommend them to people. Research is being done to develop
a vaccine for hepatitis C. For more detailed information on viral
hepatitis click on this link. |
