Hepatitis in easy terms is inflammation or swelling of the liver. These results in injury/loss of liver cells or hepatocytes.
Types of Hepatitis:
Acute Hepatitis: If the period of inflammation of liver lasts for less than six months and is characterized by normalization of the liver function tests, it is called acute hepatitis. Patients who developed encephalopathy after the onset of icterus were supposed to have acute hepatic failure.
Chronic Hepatitis: This kind of hepatitis is long-standing and has been present for more than 6 months.
Causes of Hepatitis:
- Viral Hepatitis: Hepatitis A, B, C, D and E.
- Other viruses: Epstein-Barr virus (EBV), Cytomegalovirus (CMV) Herpes simplex virus (HSV), COVID 19 virus.
- Drug-Induced: Acetaminophen, paracetamol, Antitubercular drugs (Anti TB medicines), Methotrexate (commonly used for skin diseases like Psoriasis)
- Chemicals/ others: Ethylene glycol, dyes etc
- Pregnancy-related: Preeclampsia, Acute fatty liver of pregnancy, HELLP syndrome
- Metabolic or hereditary: Nonalcoholic fatty liver disease, Hemochromatosis, Wilson's disease
Infection with a virus (viral hepatitis A, B, C, D & E): Viral hepatitis has been known as a severe public health problem in India by the World Health Organization (WHO). Nearly 119,000 cases of all-cause viral hepatitis were reported in India in 2012.
Acute Viral hepatitis is most generally seen due to acute Hepatitis A or Hepatitis E virus infection. The Indian population is displaying a fresh upward shift in the average age at first Hepatitis A virus infection, among the socio-economically developed population resulting in pockets of sensitive populations.
Hepatitis E virus is the most important cause of epidemic hepatitis though Hepatitis A virus is well-known among children. Most acute liver failures diagnosed in India are attributable to Hepatitis E virus. Hepatitis E virus is the most common cause of hepatitis during pregnancy. The spread of both HAV and HEV occurs through the fecal-oral route, that means due to ingestion of contaminated water — sewage-contaminated and inadequately-treated water.
Overdose of drugs (such as acetaminophen, paracetamol): There is always a history of drug intake in such people. Most often these medicines have been self-administered in wrong doses or incidentally ingested.
Chemical exposure: such as dry-cleaning chemicals and some wild mushrooms
Acute hepatitis can present with various clinical signs and symptoms, ranging from asymptomatic elevated liver function tests to acute liver failure requiring liver transplantation.
Fever, fatigue, loss of appetite, vomiting, diarrhoea and abdominal pain
Jaundice (yellow discoloration of eye, dark-coloured urine and light-coloured stools
The signs of severe hepatitis can be easily missed or may match other forms or medical problems.
Diagnosis of Acute hepatitis involves:
- Complete medical history and clinical examination
- Blood tests: Liver function tests, coagulation profile
- Blood tests for virus detection
- Ultrasonography: to see condition of liver
Treatment of Acute Hepatitis
Treatment for acute hepatitis depends on the condition of the patient. Some patients may need admission to a hospital in the first phase for complete evaluation and stabilization. Most patients need supportive medical care which is defined by the treating liver physician based on the individual patient and disease severity parameters.
Majority of the people recover uneventfully with just supportive care. Severe acute hepatitis may require ICU care and appropriate management as per the treating team.
Hepatitis is known as chronic if signs continue longer than six months. These are a small balance of those patients who did not recover fully from acute hepatitis and extended chronic hepatitis.
Cause of Chronic Hepatitis
Common causes of chronic hepatitis are:
- Chronic viral hepatitis
- Chronic alcoholic hepatitis
- Autoimmune hepatitis (when the body attacks its tissues)
- Drug-induced chronic hepatitis (methotrexate, TB medicines)
- Metabolic disorders (such as Hemochromatosis or Wilson’s Disease)
Chronic Hepatitis Symptoms
Majority of people undergo no indications and are diagnosed during a health check-up or differently. Signs for chronic hepatitis are usually non-specific such as loss of appetite, weight loss, fatigue, low-grade temperature. Some patients present with, upper abdominal pain, jaundice, and other signs of liver failure.
Diagnosis of chronic hepatitis involves:
- A complete medical history and medical examination
- Blood tests especially Liver function tests, PT-INR, coagulation profile
- Specific laboratory tests for virus detection
- Ultrasonography as an imaging tool
- Liver biopsy
All steps should be taken to identify the cause of chronic hepatitis. Even then a few sets of patients will be fall under a category where no specific cause is identified.
Treatment may include one/more of the following:
Antiviral agents: There has been an incredible success in treating chronic Hepatitis B or C in recent times. These medicines stop the viral replication and eventually kill them from our blood. Recently launched medicine like sofosbuvir and velpatasvir, has increased the success rate of treating HCV to more than 90%. Besides, in Hepatitis B, oral anti-viral agents such as Tenofovir or Entecavir has been utilized with a high rate of success.
Steroids: Steroids have been used to treat for a variety of chronic liver disease including alcoholic hepatitis and autoimmune liver diseases. This is decided by the physician.
Discontinuation of medicines/drugs: If a medicine is identified as the inciting cause it should be withdrawn and a substitute should be used. In case of patients taking anti-tubercular treatment, it is advisable to switch to liver safe anti-tubercular drugs. Patients with Psoriasis (skin disorder) should be switched over from methotrexate.
Abstinence from alcohol: It is the most important step and treatment for recovery in alcohol-induced chronic liver disease. It is highly advisable in Hepatitis C and other chronic diseases of the liver. Patients taking anti-tubercular medication or with Psoriasis (skin disorder) who are on methotrexate should be advised not to drink alcohol.