So You Think You Know Hepatitis?
Many people assume hepatitis is a disease that only affects alcoholics, drug users, and those who are unvaccinated. Actually, the word hepatitis is broken down this way: hepat originates from the Greek word for liver and the suffix -itis is Greek for inflammation. Therefore, hepatitis refers to any process causing inflammation of liver cells. Hepatitis can be short-lived in which there is total recovery within six months (acute) or can last longer than six months (chronic). Although viruses most frequently cause acute hepatitis, there are several other causes, which include side-effects from medications and herbs, autoimmune and/or cholestatic diseases, genetic disorders, excessive fat intake, and alcohol abuse.
Protect Your Liver
The liver is a large, complex, triangular-shaped solid organ located in the upper right abdomen, just below the diaphragm and behind the ribs, extending across the midline to the left side. It is the largest and heaviest internal organ, weighing about 1.5 kilograms.
A strong, working liver is vital for human health. The liver is responsible for a host of essential bodily functions, comprising critical roles in digestion and nutrient absorption, complex metabolic functions, protein production, and hormonal production and regulation. It is the primary organ involved in the breakdown of every toxic substance your body encounters, whether you ingest, inject, touch, breathe, or otherwise encounter, preventing accumulation of waste products within the body.
Cirrhosis is a condition resulting from liver damage. In cirrhosis, abnormal structures replace normal liver tissue, impairing its ability to perform. These structures include excess fibrous connective tissue (fibrosis), scar tissue, and lumps that occur when damaged tissue regenerates (regenerative nodules). With mild cirrhosis, your liver can make repairs and continue its role in the body, but with more advanced cirrhosis the liver can no longer function.
Viruses
Five known viruses infect the liver, Hepatitis A, B, C, D, and E. In North America, the first three are most common.
Hepatitis A (HAV) spreads when a person ingests food or beverages, including water, contaminated with stool containing the virus. Symptoms of infection are usually mild and can be mistaken for the flu – fatigue, fever, abdominal pain, nausea, and loss of appetite. HAV does not become chronic and therefore does not cause permanent liver damage. Once you have contracted HAV, your immune system makes antibodies so that you will never get it again. Anti-HAV antibodies can be detected in 30%-40% of the population in developed countries and 90% of the population in developing countries. There is a vaccine available to prevent HAV infection.
Hepatitis B (HBV) spreads by exposure to infected blood or body fluids (saliva, semen, vaginal excretions) through sexual contact, blood transfusions, sharing of needles and syringes, and from mother to child during childbirth. HBV can be acute or chronic. An acute infection lasts only a few weeks and symptoms include fatigue, loss of appetite, vomiting, body aches, and mild fever. Chronic infection usually has no symptoms but does lead to severe liver damage (cirrhosis) in 20-30% of all patients. Patients who develop cirrhosis are at highest risk for developing liver cancer. There is no cure for HBV but there are several medications that physicians prescribe to slow the disease progression. There is a vaccine available to prevent HBV infection.
Hepatitis C (HCV) is transmitted by blood-to-blood contact, such as sharing of needles and other drug equipment (straws, spoons, water, cotton, cookers), blood transfusions, tattoos, body piercings, sexual contact and, rarely, mother-to-child during childbirth. Most people have no symptoms during the acute phase but, if they do, the symptoms are generally mild and include fatigue, decreased appetite, and weakness. HCV becomes chronic in approximately 75% of infected people. Most chronic carriers have few or no symptoms but some report fatigue, general weakness, and vague discomfort in the area around the liver. In about 25%, chronic HCV can lead to cirrhosis of the liver and cirrhosis may lead to liver cancer. There are treatments available for HCV that offer a 50-90% chance of a cure. There is no vaccine available for prevention of HCV infection at this time.
Hepatitis D (HDV) is a virus that can live only in people who also have a Hepatitis B infection. It spreads along the same routes as HBV, by blood, sexual contact, and from mother to child. People with both chronic HBV and chronic HDV are also likely to have advanced liver disease in the form of cirrhosis. There is currently no cure for HDV. It is preventable by avoiding HBV infection; therefore, a HBV vaccination is a good first step to avoid contracting HDV.
Hepatitis E (HEV), like HAV, spreads from the stool of one person to the mouth of another, usually by a contaminated food or water supply. Outbreaks have occurred only in Mexico, Peru, and parts of Asia and Africa. Symptoms include yellow skin (jaundice), loss of appetite, abdominal pain, nausea, and vomiting. Chronic infection does not develop and people do not become carriers.
Medications
Many drugs may cause hepatitis, of these, acetaminophen (Tylenol®) is the most recognized. Other drugs that can lead to liver inflammation include non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen, anabolic steroids, birth control pills, anti-fungals, statins (for decreasing cholesterol levels), methotrexate (for rheumatoid arthritis), some antibiotics, and some medications used to treat tuberculosis. Please note that this list is not inclusive and many patients can safely use these medications while under a physician’s care. During close clinical observation, if early signs of hepatitis do occur, then the patient can stop the medication, usually resulting in symptom reversal.
Herbs
The fact that herbs are natural does not mean that they are harmless. There is a long list of herbs linked to hepatitis, liver damage, and liver failure. Here are a few examples of herbs that may cause hepatitis: black cohosh, chaparral, comfrey, kava, lobelia, mistletoe, germander, ragwort, sassafras, skullcap, sweet clover, and valerian.
Autoimmune
Autoimmune hepatitis is a disease in which liver inflammation results from an attack on the liver by a person’s own immune system. The exact cause is unknown but there is likely a genetic factor, which may make some people more susceptible. Seventy percent of those with autoimmune hepatitis are female. Fatigue is the most commonly reported symptom. There is no cure for autoimmune hepatitis but medications such as prednisone and azathioprine (Imuran®) help reduce symptoms.
Cholestatic
Cholestatic refers to the flow of bile within the liver. Bile, produced in the liver, travels through the bile ducts to the gallbladder where it is stored and eventually pumped into the small intestine to help digest fats.
Primary Biliary Cirrhosis (PBC) is an autoimmune disease that attacks the cells lining the bile ducts. Once damaged, bile leaks out from the ducts and causes damage such as inflammation and scarring of liver tissue. Like autoimmune hepatitis, PBC primarily affects women. Symptoms include fatigue and itchy skin. PBC is a lifelong condition that is treated with ursodiol, a medication that assists the liver in moving bile through the ducts.
Primary Sclerosing Cholangitis (PSC) is a disease that damages and blocks bile ducts inside as well as outside of the liver. There is a link between PSC and inflammatory bowel disease (Crohn’s disease and ulcerative colitis), although this association is unclear. There is no treatment for PSC except for management of the symptoms, which include fatigue, itchy skin, and yellowing of the skin (jaundice).
Genetic (Inherited)
Hemochromatosis is a term that describes when the body absorbs and stores too much iron in the liver, heart, pancreas, joints, or other organs. For this disease to be present, a person must inherit a defective gene from each parent, however, when only one defective gene passes, then the person is a carrier but will not exhibit any disease signs. Many people have no symptoms but, of those who do, joint pain is the most common. Treatment is ridding the body of excess iron by removing blood (phlebotomy) the same way it is drawn from donors at a blood bank. Iron levels in the blood determine the frequency of the phlebotomies. This disease is not curable but is easily managed.
Wilson’s Disease is a genetic disorder that causes a build-up of copper in the liver, central nervous system, and other organs. Like hemochromatosis, you need to inherit one abnormal gene from each parent and carriers who only have one copy of the defective gene do not have any symptoms. Depending on where the copper build-up occurs, symptoms may vary. If it is in the liver, the symptoms include fatigue, jaundice, enlarged liver, and easy bruising. If the build-up is in the central nervous system, problems with speech, tremors, and muscle stiffness, as well as behavioural changes may result. As copper also accumulates in the eye, a gold or greenish gold ring may appear around the outer edge of the cornea (Kayser-Fleischer rings). Lifelong treatment involves a diet low in copper and a medication called penicillamine, which binds to copper and helps to remove it from the body.
Fatty Liver
Non-Alcoholic Fatty Liver Disease (NAFLD) is the most common cause of chronic liver disease, affecting approximately 30% of Western populations. A fatty liver is a harmless condition in which a specific type of fat deposits in the liver cells. This condition is reversible and does not lead to cirrhosis, liver failure, or liver cancer. However, when the fat accumulation causes inflammation of the liver cells, in 2-5% of North Americans, the condition becomes non-alcoholic steatohepatitis (NASH), and this can lead to cirrhosis. Obesity, sedentary lifestyle, diabetes, high cholesterol, and high blood pressure all increase a person’s chance of developing NAFLD and NASH. There are few or no symptoms. Treatment includes a plan for weight loss, by following a healthy diet and exercising, as well as management of the other medical conditions.
Alcohol Abuse
Excessive and prolonged use of alcohol can lead to fatty liver disease. Alcoholic hepatitis is when the toxic effects of alcohol cause inflammation of the liver cells, which can lead to severe scarring (cirrhosis), occurring in 10-20% of alcoholics. Alcoholic fatty liver and hepatitis are potentially reversible if the alcohol use ceases prior to the development of cirrhosis.
Alcohol and Your Liver
- The alcohol content of a drink, rather than the type of beverage consumed, is significant to the development of cirrhosis.
- Males whose daily consumption of alcohol exceeds 80g (6 bottles of beer or 4 glasses of wine) are at a high risk of developing cirrhosis; for females this limit is 40g (3 bottles of beer or 2 glasses of wine) per day.1,2
- Binge drinking is less injurious to the liver than continued daily drinking.1
- Women are more susceptible than men are to liver damage and they subsequently develop cirrhosis at an earlier age. The influence of female sex hormones might be a possible explanation for this difference between genders.3
Conclusion
A high percentage of alcoholics and drug users do develop hepatitis, but many others acquire hepatitis due to a variety of other causes, particularly viruses. Some types of hepatitis resolve quickly but others last for years, often for a lifetime. Even if you have hepatitis, there are medications and lifestyle changes, such as restricting alcohol intake and maintaining a healthy body weight, which may help to keep the disease from getting worse. Collectively applying knowledge about viral hepatitis to modify social behaviours will help decrease the spread of infectious forms of the disease.
Therefore, it is important that each person with any type of hepatitis be under the care of a physician who specializes in liver disease. This way, the physician can offer current disease information and, if necessary, prescribe the medication(s) needed for the person to live life to its fullest.