Condition Summary
The liver is the largest organ in the body, and that sits in the right-upper abdomen just under the right lung, and behind the ribs. It is one of the body’s most versatile organs because it performs so many functions all at the same time. The liver makes proteins, eliminates waste material from the body, produces and metabolizes cholesterol, stores and releases glucose energy, and metabolizes many drugs used in medicine. It also produces bile that flows through bile ducts into the intestine to help digest food. This remarkable organ also has the ability to regenerate itself if it is injured or partially removed. The liver receives blood from two different sources – the heart and the intestines. All of this blood flows through the liver and returns to the heart. It is no wonder that the ancient Chinese viewed the liver, not the heart, as the center of the body.
What Is Hepatitis?
When cells in the body are injured by such things as chemicals or infection, the area that is hurt becomes inflamed. Any type of inflammation in the liver is called hepatitis. This inflammation can be caused by many types of injuries, such as drugs, viruses, bacteria, and other agents. The inflammation of the liver, in turn causes damage to individual liver cells.
- Hepatitis Type A
Previously known as infectious hepatitis, this infection can be contracted through contaminated water or food. During the acute infection, the patient’s blood and body fluids are also infectious. Although some patients become acutely and desperately sick from this infection, most people tolerate it well and fully recover. No chronic infection occurs with this virus. - Hepatitis Type B
Previously known as serum hepatitis, patients are sicker initially with this very unpleasant virus and take longer to recover, sometimes several months. Furthermore, about 10 percent of patients progress into a state of chronic smoldering infection in the liver. A person can be infected through sexual intercourse or by a contaminated needle. Homosexual men and intravenous drug users or persons who have sexual contacts with these people are at an especially high risk for contracting this disease. - Hepatitis Type C
This virus infection was previously known as non-A, non-B hepatitis In the past it was transmitted mostly by blood transfusion. There is now a good blood test to check for this virus before blood is given. Cases now occur in people who use contaminated needles for drug use. Many cases are “community acquired” meaning the physicians really don’t know how they occur. It is difficult but not impossible to transmit this virus by unprotected sexual intercourse. Many people who acquire this infection go on to a chronic phase. - Other Viruses
There is now a type E virus, which can cause hepatitis. - Infectious Mono Virus
CMV virus, and several other viruses are also capable of infecting the liver.
What Causes Hepatitis?
Additional causes of liver inflammation include:
- Alcohol
Binge drinking of alcohol can inflict an acute hepatitis injury on the liver. - Drugs
Certain drugs can also acutely injure the liver in the relatively few people who are hypersensitive or allergic to a particular medicine. - Autoimmune
There are certain conditions, such as Lupus, which can produce an acute injury to the liver. In this setting, the body’s own antibody defenses seem to actively damage the liver. - Hereditary Conditions
There are certain hereditary disorders, such as Wilson’s disease, in which acute damage to the liver can occur.
Symptoms
As with other illnesses, symptoms of hepatitis can be mild or severe, depending on the extent of the injury to the liver. With mild viral hepatitis, slight fatigue may be the only symptom. When hepatitis is severe, the patient loses the taste for food and cigarettes, develops a heaviness in the right-upper abdomen and, especially with acute B hepatitis, may have diarrhea and arthritis. The liver and even the spleen can enlarge. Jaundice then develops in which the eyes and skin turn yellow, the urine dark, and the stool putty-like and white. Jaundice results when the yellow bile pigment, which normally flows through the bile ducts to the intestine, backs up and spills into the blood. Acute hepatitis can last from two weeks to several months. The patient often needs to be hospitalized in the early, acute phase of the illness.
Diagnosis
The physician can often suspect hepatitis based on the patient’s medical history and physical exam. Certain blood tests are the best indicators of hepatitis, its causes, and its severity. Blood tests are used to follow the course of the infection through to recovery. Additional tests, such as ultrasound (zoography) are performed to study the bile ducts, gallbladder, and liver. Occasionally a liver biopsy may be needed to provide information to the physician.
Treatment
No specific treatments are available for acute viral hepatitis. Fortunately, the body develops antibodies that fight and eventually kill the virus, allowing the liver to recover. For alcohol and drug-induced hepatitis, abstinence is required. The physician must make an accurate diagnosis, support the patient during the acute phase, and provide advice during recovery. Recovery from viral hepatitis A and B results in protective antibodies so that the patient will not get the infection again and cannot transmit it to anyone else.
Cronic Phase
Some people progress to the chronic phase of hepatitis in which the liver smolders with persistent inflammation. These patients need to be followed closely by a specialist to address the various problems that can arise from this condition. Because some of these patients are infectious and can transmit the disease, they and their families must be educated about required protective measures.
Contagion and Spread
In the past, viral hepatitis had a well-deserved reputation for contagion. Contaminated water and poor sanitation provided easy transmission for these viruses. Today, much is known about how the viruses are transmitted so that prevention is usually possible.
However, infection still can occur through contaminated water or poor sanitation. In addition, during the acute phase, all body secretions – saliva, tears, semen, urine, and especially blood – are infectious. Intimate contact with someone who is infected, particularly sexual contact, is known to spread the virus. If a patient is a carrier in the chronic phase, he or she may transmit the infection through sexual contact. Intravenous drug users who share needles are at an extremely high risk of contracting hepatitis as are homosexual males who have multiple sex partners. Hepatitis viruses cannot be transmitted by touching, kissing, or sharing toilet seats with infected individuals.
Vaccination
People who travel to underdeveloped countries are advised to receive gamma globulin injections. These antibodies provide about three months of protection against hepatitis A. A permanent vaccine against this virus is being developed. Passive (short-acting) and active (permanent and long-lasting) vaccines now are available against hepatitis B. Because the consequences of this infection are serious in both the acute and chronic phases, these vaccines should be used by anyone who knows he or she has been exposed to the B virus. The following high-risk groups should receive active immunization: health care workers, especially those who handle body fluids such as blood, persons traveling to underdeveloped countries, homosexuals who have multiple sex partners; intravenous drug users; and prostitutes. The American Pediatric Association recommends that all children be vaccinated, especially sexually active teenagers.
Summary
Hepatitis, especially viral, is a potentially serious disease with long-term consequences. Most people infected with the virus, however, have a full recovery without any specific therapy. Current knowledge about the disease and advances in vaccination make prevention a realistic goal for everyone.