Apollo Hospitals International, Ahmedabad

Hepatitis is inflammation of liver, resulting in liver cell damage & destruction. It can be categorized in two groups:

• Acute hepatitis
• Chronic hepatitis

There are 5 main types of hepatitis virus that have been identified. These include:
 
Hepatitis A - This type of hepatitis is usually spread by fecal-oral contact, including:

• Touching an infected person's stool
• Consuming food made by someone who touched infected stool
• Drinking water made dirty by infected stool (problem in developing countries)
• Having anal sexual intercourse with infected person

Hepatitis B - This type of hepatitis spreads mainly through contaminated blood & blood products, sexual contact & contaminated intravenous needles. Hepatitis B can lead to chronic hepatitis, cirrhosis, liver cancer, liver failure & even death.

Hepatitis C - The symptoms of this type of hepatitis are less severe than hepatitis B. Hepatitis C. It spreads through contaminated blood/ blood products, sexual contact & contaminated intravenous needles. With some cases of Hepatitis C, no mode of transmission can be identified.

Hepatitis D - This form occurs together with hepatitis B, making hepatitis B infection worse.

Hepatitis E - This form is similar to hepatitis A & occurs most frequently in underdeveloped countries.

Acute Hepatitis

Acute hepatitis is quite common disease.

Causes:

Common causes of acute hepatitis may include:

• Infection with virus (viral hepatitis A, B, C, D, or E)
• Overdose of drugs (such as acetaminophen)
• Chemical exposure (such as dry cleaning chemicals)

Symptoms:

Acute hepatitis usually starts with flu-like symptoms. The following are most common symptoms of acute hepatitis. However, each individual may experience symptoms differently:

• Jaundice
• Nausea
• Vomiting
• Loss of appetite
• Fever
• Tender in the right, upper abdomen
• Sore muscles
• Joint pain
• Itchy red hives on skin

The symptoms of acute hepatitis may also resemble other conditions/ medical problems. Consult a physician for proper diagnosis.

Diagnosis:

In addition to complete medical history & medical examination, diagnostic procedures for acute hepatitis may include:

• Specific laboratory tests
• Liver function tests

Treatment:

Treatment varies, depending on type of acute hepatitis (viral versus non-viral). Most people recover without treatment. Severe acute hepatitis may also require hospitalization. Specific treatment for acute hepatitis is determined based on:

• Patient’s overall health & medical history
• Extent of the disease
• Patient’s tolerance for specific medications, procedures or therapies
• Expectations for course of the disease

Chronic Hepatitis

Some people do not recover fully from acute hepatitis & develop chronic hepatitis. Hepatitis is considered chronic if symptoms persist for more than six months.

Different Forms:

Alcohol-induced chronic hepatitis - Continued damage throughout liver from heavy alcohol consumption.

Chronic active hepatitis - An aggressive inflammation & destroyer of liver cells, which usually leads to cirrhosis.

Chronic persistent hepatitis - A milder inflammation of liver, which usually does not lead to cirrhosis.

Jaundice is yellowish discoloration of skin and of whites of the eyes caused by abnormally high levels of pigment bilirubin in bloodstream. Often, jaundice disappears as the case resolves, but surgery/ endoscopy is sometimes needed.

Old/ damaged red blood cells are constantly being removed from circulation, mainly by spleen. During this process, hemoglobin, the part of red blood cells that carries oxygen is broken down into dark greenish yellow pigment called bilirubin. Bilirubin is then carried in bloodstream to liver and is excreted into intestine as a component of bile (the digestive fluid produced by liver).

If bilirubin cannot be excreted into bile quickly enough, it builds up in blood. The excess bilirubin is deposited in skin, resulting in yellowish discoloration called jaundice.

Causes:

• Liver damage/ blockage in bile duct can cause jaundice
• Laboratory & often imaging tests help identify the cause
• High levels of bilirubin in blood
• Liver problems originating either within or outside the liver
• Damage to liver due to inflammation/ scarring (impairing its ability to excrete bilirubin into bile)
• Blockage of bile ducts which carry bile from liver to small intestine
• Overproduction of bilirubin (due to excessive breakdown of red blood cells)

Symptoms:

• Skin & whites of eyes look yellow
• Skin may itch
• Urine is often dark
• Light-colored stools
• Acute inflammation of the liver (acute hepatitis)
• Loss of appetite, nausea, vomiting & fever

Diagnosis and Treatment

• Laboratory tests & imaging studies to determine cause of jaundice
• If problem related to liver such as acute viral hepatitis, jaundice usually disappears gradually as condition of the liver improves
• If problem is blockage of bile duct, surgery/ surgical endoscopy (using a flexible viewing tube with surgical instruments attached is performed as soon as possible to reopen affected bile duct
• Itching caused by jaundice can be treated with cholestyramine

Alcohol-Related Cirrhosis

It develops silently but is usually present with an episode of internal bleeding/ jaundice, which is often fatal.