Hepatitis

Hepatitis is a term used to describe inflammation (swelling) of the liver. It can occur as the result of a viral infection or because the liver is exposed to harmful substances such as alcohol. The condition can be self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer. Hepatitis viruses are the most common cause of hepatitis in the world but other infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune diseases can also cause hepatitis.

Liver is the largest organ inside the body. It helps the body digest food, store energy, and remove poisons. It performs following jobs –

• Bile production that’s essential to digestion
• Filtering of toxins from the body
• excretion of bilirubin, cholesterol, hormones, and drugs
• Metabolism of carbohydrates, fats, and proteins
• Activation of enzymes, which are specialized proteins essential to metabolic functions
• Storage of glycogen, minerals, and vitamins (A, D, E, and K)
• Synthesis of plasma proteins, such as albumin
• Synthesis of clotting factor

There are 5 main hepatitis viruses, mainly, types A, B, C, D and E. These 5 types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread. In particular, types B and C lead to chronic disease in hundreds of millions of people and, together, are the most common cause of liver cirrhosis and cancer. In the United States, the most common types of viral hepatitis are Hepatitis A, Hepatitis B, and Hepatitis C.

Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids. Common modes of transmission for these viruses include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepatitis B transmission from mother to baby at birth, from family member to child, and also by sexual contact.

Infection may occur with limited or no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.

Types of Hepatitis

• Hepatitis A virus (HAV) is present in the faeces of infected persons and is most often transmitted through consumption of contaminated water or food. Certain sex practices can also spread HAV. Infections are in many cases mild, with most people making a full recovery and remaining immune from further HAV infections. However, HAV infections can also be severe and life threatening. Most people in areas of the world with poor sanitation have been infected with this virus. Safe and effective vaccines are available to prevent HAV.
• Hepatitis B virus (HBV) is transmitted through exposure to infective blood, semen, and other body fluids. HBV can be transmitted from infected mothers to infants at the time of birth or from family member to infant in early childhood. Transmission may also occur through transfusions of HBV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. HBV also poses a risk to healthcare workers who sustain accidental needle stick injuries while caring for infected-HBV patients. Safe and effective vaccines are available to prevent HBV.
• Hepatitis C virus (HCV) is mostly transmitted through exposure to infective blood. This may happen through transfusions of HCV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. Sexual transmission is also possible, but is much less common. There is no vaccine for HCV.
• Hepatitis D virus (HDV) infections occur only in those who are infected with HBV. The dual infection of HDV and HBV can result in a more serious disease and worse outcome. Hepatitis B vaccines provide protection from HDV infection.
• Hepatitis E virus (HEV) is mostly transmitted through consumption of contaminated water or food. HEV is a common cause of hepatitis outbreaks in developing parts of the world and is increasingly recognized as an important cause of disease in developed countries. Safe and effective vaccines to prevent HEV infection have been developed but are not widely available.

Causes

Hepatitis can be caused by:

• Immune cells in the body attacking the liver
• Infections from viruses (such as hepatitis A, hepatitis B, or hepatitis C), bacteria, or parasites
• Liver damage from alcohol or poison
• Medicines, such as an overdose of acetaminophen
• Liver disease can also be caused by inherited disorders such as cystic fibrosis or hemochromatosis, a condition that involves having too much iron in your body.

Other causes include Wilson’s disease, a disorder in which the body retains too much copper.

Symptoms

Common symptoms:

• Fatigue
• General feeling of ill-health
• Lack of energy
• Tendency to tire easily
• Inability to finish a full days work
• The need to have more sleep
• Joint pains (arthralgia) which are an indirect effect of chronic hepatitis and are usually mild and intermittent, noted mostly in the mornings.

Less common symptoms may be:

• Nausea
• Decreased appetite
• Weight loss
• Abdominal pain or bloating
• Indigestion
• Jaundice
• Abnormal blood vessels on the skin on the face, arms and chest
• Bruising

If the disease is very active or advanced, jaundice (yellowing of the skin and whites of the eyes and darkening of the urine) may occur.

If cirrhosis develops as a result of chronic AIH there may be muscle wasting, weight loss, ascites (swelling of the abdomen with fluid) and vomiting blood. In many cases the condition develops almost secretly, with no factor pointing to the liver as a cause of ill-health.

Treatment

Medications – Hepatitis hepatitis is usually treated first with a glucocorticoid (such as prednisone).

• Glucocorticoids – Glucocorticoids such as prednisone control the inflammation in the liver, thereby preventing further scarring. The main drawback of prednisone is side effects, which can include weight gain, acne, bone loss, elevated blood glucose levels (potentially leading to diabetes), an increased risk of infections, cataracts, high blood pressure, and mood and sleep disturbance, among others. People who require long-term prednisone are monitored carefully for these side effects. To minimize the risks of side effects, the lowest possible dose of prednisone is used.
• Azathioprine or 6-mercaptopurine – A second medication, such as azathioprine {Azasan; Imuran} or 6-mercaptopurine (Purinethol) and, less commonly, methotrexate or mycophenolate mofetil, may be recommended in addition to prednisone. The benefit of adding a second medication is that it may be possible to reduce or eliminate prednisone, helping to minimize the potential side effects of prednisone.
• Budesonide – Budesonide, another medication that may be substituted for prednisone, continues to be studied, but is not yet widely used.
• Castor Oil – Castor oil that is absorbed through the skin over the liver and spleen is of benefit during times of severe inflammation. A person will need to first determine where these organs are to accomplish this. A rag should be soaked in pure, cold-pressed castor oil beforehand. The excess oil should be squeezed out just prior to use.

Liver Transplantation – Transplantation is indicated in patients with fulminant liver failure due to acute Hepatitis, or more commonly, decompensated cirrhosis secondary to it.

Alternative Treatment

• Milk Thistle – It is an herb that has properties that promote liver health. It may be sold as Silybum marianum, or as silymarin. Side effects may include nausea, diarrhea, and abdominal bloating. Still, it is well tolerated by most people. Silymarin is the most widespread supplement taken for liver disease.
• Zinc – Zinc supplements are sometimes touted as a good therapy for hepatitis . There is no evidence to suggest that zinc can halt its progression.
• Colloidal silver – It is used to treat hepatitis. Serious side effects include argyria. Argyria can cause permanent, grayish discoloration of the skin.
• Probiotics – Probiotics are live microscopic organisms (bacteria) much like the ones that are already in the your body. These good bacteria may benefit the overall health. Most people can tolerate supplementing with probiotics without harmful side effects.
• Others – Other supplements that have been studied include glycyrrhizin (from licorice root), lactoferrin (a protein found in milk), SAMe (a chemical naturally found in your body), TJ-108 (herbs used in Japanese Kampo medicine), schisandra (the berries of the plant), oxymatrine (extract of sophora root), and thymus extract (from the glands of cows).
• Curcumin – This is a chemical in turmeric, the spice that gives many curries their flavor and yellow hue. It can help the body fight inflammation, viruses, and bacteria, which can be helpful to people with hepatitis.
• Vitamins – It’s best to get the vitamins and minerals from the diet, one that includes plenty of fruits, vegetables, whole grains, and healthy fats. some Studies show that certain vitamins may help people with hepatitis. Vitamins B12 and D, for example, may make some standard hepatitis drugs work better.

Accupuncture – Acupuncture is a form of traditional Chinese medicine. Very thin needles are inserted through the skin at specific points to stimulate ther blood flow. It is generally used to treat pain and nausea. There are no published studies regarding the use of acupuncture to treat hepatitis.