Hepatitis (liver inflammation)
Reviewed by Dr Janice Main, reader and honorary consultant physician in infectious diseases and general medicine
What is hepatitis?
Hepatitis is the Greek term for liver inflammation. It is characterised by the destruction of a number of liver cells and the presence of inflammatory cells in the liver tissue.
Hepatitis can be caused by viruses that primarily attack the liver cells, such ashepatitis A and B. Patients with glandular fever, caused by the Epstein-Barr virus, can also suffer from an attack of hepatitis.
Hepatitis can be divided into two subgroups according to its duration:
- acute hepatitis – lasting less than six months
- chronic hepatitis – lasting longer than six months.
What can cause acute hepatitis?
Acute hepatitis has a number of possible causes.
- Infectious viral hepatitis, such as hepatitis A, hepatitis B, hepatitis C, hepatitis D and hepatitis E.
- Other viral diseases, such as glandular fever and cytomegalovirus.
- Severe bacterial infections.
- Amoebic infections.
- Medicines, eg paracetamol poisoning and halothane (an anaesthetic).
- Toxins: alcohol and fungal toxins, eg toadstool poisoning.
What can cause chronic hepatitis?
Chronic hepatitis also has a number of different causes.
- Infectious hepatitis, such as hepatitis B, hepatitis C and hepatitis D.
- Drug reactions.
- Toxins, such as alcohol.
- Autoimmune hepatitis. This is a disease in which a number of liver cells are destroyed by the patient's own immune system. Autoimmune hepatitis can also sometimes occur as acute hepatitis. The cause is unknown.
- Inborn metabolic disorders, such as Wilson's disease (disorder of the body's copper metabolism) and haemochromatosis (disorder of the body's iron metabolism).
How do you get hepatitis?
A person can develop hepatitis if they contract one of the viruses that can cause liver inflammation, or as a result of exposure to substances that can cause hepatitis – alcohol, fungal toxins and certain medicines.
There are two ways in which medicines can lead to hepatitis: it can either occur as a result of medicine poisoning through overdoses of a medicine (egparacetamol), or it can occur as a result of an abnormal reaction of the liver to a normal dose (eg halothane, the anaesthetic). Fortunately, the latter type of hepatitis is rare.
What are the symptoms of hepatitis?
The symptoms of acute hepatitis vary considerably from person to person. Some patients have no symptoms at all, and in most cases, children only show mild symptoms.
In the early stages:
- tiredness, general malaise, slight fever
- nausea, poor appetite, changes in taste perception
- pressure or pain below the right ribs caused by an enlarged liver
- aching muscles and joints, headache, skin rash.
The jaundiced phase:
- yellowing of sclerae (the whites of the eyes), skin and mucous membranes
- dark urine
- light-coloured stools
- around this time, the other symptoms subside.
The recovery phase:
- tiredness that can last for weeks.
- Many patients have no symptoms.
- Tiredness, an increased need for sleep, aching muscles and joints.
- Periodic light pressure or pain below the right ribs – enlarged liver.
- Jaundice is a very late symptom of chronic hepatitis. It is a sign that the disease has become serious.
Who is at risk of hepatitis?
- Patients with jaundice or other symptoms of hepatitis.
- People in high risk groups.
- People who are at increased risk due to a hereditary type of hepatitis in their families.
How can hepatitis be prevented?
- By avoiding exposure to the infectious hepatitis viruses.
- By being vaccinated against hepatitis A and hepatitis B, if you have a high risk of being infected.
- By refraining from drinking large amounts of alcohol.
What can be done at home?
- Avoid drinking alcohol if you have symptoms of hepatitis or if a blood sample has shown that the disease is active.
- If alcoholism is the cause, you must stop drinking completely and see your doctor. Eat a well-balanced diet.
- If you have symptoms of acute hepatitis, you may need to slow down. However, if you feel fine, there is no reason why you should not go to work and keep up your other activities.
- If you have hepatitis A and your job involves food handling, your doctor will advise you on when it is safe to return to work
- If you have chronic hepatitis, try to lead a normal life as far as possible.
- People with hepatitis B must inform their family and their sexual partners about it. Sexual and other close contacts will need to protect themselves by being vaccinated. Condoms should be used until the vaccine has begun to work.
- If you have hepatitis A, you must inform your family, so that they can protect themselves against it by practising good hygiene and seek advice on vaccination and other preventive measures.
- If you have chronic hepatitis, you should have regular clinic review by your specialist.
How is hepatitis diagnosed?
Blood tests will help determine the cause and severity of the hepatitis.
Further information may be obtained from ultrasound and other types of liver scans.
In certain situations a liver biopsy may be recommended. This involves taking a tiny piece of the liver to look at under the microscope. The procedure is generally done under local anaesthetic as a day case in a specialist unit.
Acute infectious viral hepatitis usually improves with no specific treatment.
Acute infection is rarely life threatening.
Hepatitis B and hepatitis C can become chronic. Hepatitis A never does.
Acute hepatitis caused by medicines or alcohol usually improves once the liver is no longer exposed to these substances.
About one fifth of the patients with chronic hepatitis B and C are at risk of developing cirrhosis or cancer of the liver can.
Cirrhosis can also be caused by other types of chronic hepatitis.
How is hepatitis treated?
- No medical treatment is generally required for acute viral hepatitis.
- Chronic hepatitis B can be treated with interferon alfa or other antiviral agents.
- Chronic hepatitis C can be treated with interferon alfa and ribavirin (tribavirin).
- Autoimmune hepatitis can by treated with corticosteroids.
Based on a text by Professor Court Pedersen, consultant and Professor Ove Schaffalitzky de Muckadell, consultant
Last updated 10.11.2010