What is Hepatitis?
The term “hepatitis” means inflammation of the liver. It does not tell us the cause of this inflammation. There are many causes of hepatitis.
The more well-known ones are:
- Hepatitis A, B, C, D, E, G virus infections (what I call the “alphabet soup of virus hepatitis”)
- Alcoholic hepatitis
- Drug induced hepatitis
- Fatty liver induced hepatitis (steatohepatitis)
- Autoimmune hepatitis
- Metabolic diseases due to Copper and Iron metabolism (Wilson’s Disease and Haemochromatosis respectively)
- Toxin induced hepatitis (such as Aflatoxin)
What is Acute Hepatitis?
Hepatitis can be divided into acute hepatitis and chronic hepatitis. In acute hepatitis there is inflammation of the liver which causes the rapid death of liver cells. If the inflammation is mild, the liver could recover from the acute hepatitis. If the inflammation is very severe, the liver may be so damaged that the patient will suffer liver failure. This is called fulminant hepatitis and would be life threatening.
What are the symptoms and signs of Acute Hepatitis?
In general, there are three phases, the “prodrome”, the “icteric” or jaundiced phase and the “convalescence phase”.
- Non-specific constitutional symptoms occur such as tiredness, fatigue, low grade fever, loss of appetite)
- There could be diarrhoea, nausea and vomiting
- Aversion to cigarette smoking
- Skin rashes
- Joint pains
- Dark urine is noted a few days before the onset of
- Jaundice, which is yellowness of the whites of the eyes, mucous membranes and skin due to accumulation of the yellow pigment bilirubin
- Fever and constitutional symptoms often recede after jaundice appears
- The liver may be enlarged on clinical examination and may be tender
- Weight loss is quickly corrected
- Fatigue however may persist for months
- Elevated bilirubin levels may persist even after jaundice subsides
What are the symptoms and signs of fulminant hepatitis?
Although acute viral hepatitis seldom leads to liver failure, when it happens, it is very dangerous and mortality is very high especially in the elderly. Danger signs that may indicate fulminate hepatitis are:
- Disturbance of sleep (insomnia, reversal of night and day sleeping)
- Mental changes such as irritability, hyperexcitability and impaired thinking capability
- Severe nausea and vomiting
- Bleeding tendency
- High fever
Doctors would suspect acute hepatitis if a patient is unwell and the liver enzymes are elevated in a blood test for liver function. The two important enzymes are commonly known as ALT and AST. These are released from dying liver cells. The degree of elevation of the enzymes is a proxy for the severity of the liver damage. The yellow pigment bilirubin could be elevated as well and this causes jaundice, which is yellowness of the whites of the eyes and the skin. The level of bilirubin and the degree of jaundice are also proxies for the severity of the acute hepatitis.
What are the causes of Acute Hepatitis?
Acute hepatitis can be caused by the viruses Hepatitis A, B, C, D and E. Alcohol can also cause acute hepatitis if taken in a large amount over a short period of time. Some drugs can cause acute or even fulminant hepatitis. Although some drugs have a higher risk than others, patients can have sensitivities to drugs that are quite unique to them (called “idiosyncratic” reactions). Hence, a history of medicine usage is very important. Wilson’s Disease and autoimmune hepatitis can both also cause acute to fulminant hepatitis.
What is Chronic Hepatitis?
Chronic hepatitis is a lower level inflammation of the liver which carries on in the background, often undetected, over many years. The liver cells are gradually damaged and killed and replaced by scar tissue. This means that the patients might not even know that their livers are being slowly damaged over years to decades. Their livers become more and more scarred called liver cirrhosis and gradually lose functional capacity.
What happens if chronic hepatitis leads to liver scarring (cirrhosis)?
After many years, patients only find out when one day they feel unwell, or become jaundiced and doctors discover the chronic hepatitis on doing blood tests and imaging the liver such as by ultrasound, CT or MRI scans. Thereafter, the patients would require treatment, if treatment is available for the cause, regular monitoring, at least six monthly.
The consequences are un-wellness, accumulation of fluid in the abdominal cavity (ascites), bleeding from bloated veins in the oesophagus (bleeding oesophageal varices), infections, brain dysfunction from mild impairment to deep coma (encephalopathy) and liver cancer. If their conditions deteriorate beyond rescue by medical means, then the only option left is liver transplantation.
What are the causes of chronic hepatitis?
The causes of chronic hepatitis include viruses Hepatitis B and C, alcohol, autoimmune hepatitis, drug-induced hepatitis and Wilson’s Disease. It is important to detect the cause of the chronic hepatitis as specific treatment varies considerably.