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Hepatitis

Introduction

Hepatitis means that the liver is inflamed. This inflammation can be caused by alcohol (alcoholic hepatitis), by drugs (drug induced hepatitis) or by 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.

Hepatitis

Hepatitis

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 %.

In the case of alcoholic hepatitis there was no cure in the past. Now there is a new treatment approach utilizing granulocyte colony-stimulating factor (GCSF).

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.

 

References

1. DM Thompson: The 46th Annual St. Paul’s Hospital CME Conference for Primary Physicians, Nov. 14-17, 2000, Vancouver/B.C./Canada

2. C Ritenbaugh Curr Oncol Rep 2000 May 2(3): 225-233.

3. PA Totten et al. J Infect Dis 2001 Jan 183(2): 269-276.

4. M Ohkawa et al. Br J Urol 1993 Dec 72(6):918-921.

5. Textbook of Primary Care Medicine, 3rd ed., Copyright © 2001 Mosby, Inc., pages 976-983: “Chapter 107 – Acute Abdomen and Common Surgical Abdominal Problems”.

6. Marx: Rosen’s Emergency Medicine: Concepts and Clinical Practice, 5th ed., Copyright © 2002 Mosby, Inc. , p. 185:”Abdominal pain”.

7. Feldman: Sleisenger & Fordtran’s Gastrointestinal and Liver Disease, 7th ed., Copyright © 2002 Elsevier, p. 71: “Chapter 4 – Abdominal Pain, Including the Acute Abdomen”.

8. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

Last modified: February 18, 2015

Disclaimer
This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.