Hepatitis may be the Greek term for liver inflammation. It is characterised by the damage of a number of liver cells and also the presence of inflammatory cells in the liver tissue.

Hepatitis can be caused by viruses that mainly attack the liver cells, for example hepatitis A and B. Patients with glandular fever, brought on by the Epstein-Barr virus, may also suffer from a panic attack of hepatitis.

Hepatitis can be divided into 2 subgroups according to its duration:

• acute hepatitis – lasting under 6 months
• chronic hepatitis – staying longer than 6 months.

What can cause acute hepatitis?

Acute hepatitis has a number of possible causes.

• Infectious viral hepatitis, for example hepatitis A, hepatitis B, hepatitis C, hepatitis D and hepatitis E.
• Other viral diseases, for example glandular fever and cytomegalovirus.
• Severe bacterial infections.
• Amoebic infections.
• Medicines, eg paracetamol poisoning and halothane (an anaesthetic).
• Harmful toxins: alcohol and fungal toxins, eg toadstool poisoning.

What can cause chronic hepatitis?

Persistent hepatitis also offers a number of different causes.

• Infectious hepatitis, such as hepatitis B, hepatitis C and hepatitis D.
• Drug reactions.
• Toxins, for example alcohol.
• Autoimmune hepatitis. This is a disease in which a number of liver cells are destroyed through the patient’s own defense mechanisms. Autoimmune hepatitis can also sometimes occur as acute hepatitis. The reason is unknown.
• Inborn metabolic disorders, such as Wilson’s disease (disorder of the body’s copper metabolism) and haemochromatosis (disorder from the body’s iron metabolism).

How can you get hepatitis ?

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A person can develop hepatitis if they contract among the viruses that can cause liver inflammation, or as a result of exposure to substances that induce hepatitis – alcohol, fungal toxins and certain medicines.

There are two ways medicines can cause hepatitis: it can either occur as a result of medicine poisoning through overdoses of a medicine (eg paracetamol), 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.

Do you know the the signs of hepatitis?

Acute hepatitis

The symptoms of acute hepatitis vary considerably for every person. Some patients have no symptoms at all, and in most cases, children only show mild symptoms.
In the first stages:

• tiredness, general malaise, slight fever
• nausea, poor appetite, changes in taste perception
• pressure or pain below the best ribs caused by an enlarged liver
• aching muscles and joints, headache, skin rash.

The jaundiced phase:

• yellowing of sclerae (the whites from the eyes), pores and skin and mucous membranes
• dark urine
• light-coloured stools
• around this time, the other signs and symptoms subside.

The recovery phase:

• tiredness that may are weeks.

Persistent hepatitis

• Many patients have no symptoms.
• Tiredness, a heightened need for sleep, aching muscles and joints.
• Periodic light pressure or pain below the right ribs – enlarged liver.
• Jaundice is a very late characteristic of chronic hepatitis. It is a sign that the disease has become serious.

Who’s vulnerable to hepatitis ?

• Patients with jaundice or other symptoms of hepatitis.
• People in high risk groups.
• People who are at increased risk as a result of hereditary kind of hepatitis within their families.

How can hepatitis be avoided ?

• By avoiding contact with the infectious hepatitis viruses.
• By being vaccinated against hepatitis A and hepatitis B, for those who have a bad risk of being infected.
• By refraining from drinking large amounts of alcohol.

What you can do in your own home ?

• Avoid alcohol consumption if you’ve the signs of hepatitis or if a blood sample has shown that the disease is active.
• If alcoholism is the cause, you have to stop drinking completely and see your doctor. Eat a well-balanced diet.
• If you have symptoms of acute hepatitis, you may need to decelerate. However, if you feel fine, there is no reason why you should not start working and keep up your alternative activities.
• If you have hepatitis A and your job involves food handling, your doctor will advise you on when it’s safe to return to work
• If you have chronic hepatitis, try to lead an ordinary life as far as possible.
• People who have hepatitis B must inform their family and their sexual partners about it. Sexual along with other close contacts will have 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, to enable them to protect themselves against it by practising good hygiene and seek advice on vaccination and other preventive measures.
• If you’ve chronic hepatitis, you ought to have regular clinic review because of your specialist.

How is hepatitis identified ?

Blood tests will help determine the cause and harshness of the hepatitis.

Further information may be from ultrasound along with other kinds of liver scans.

In certain situations a liver biopsy may be recommended. This involves taking a tiny bit of the liver to check out underneath the microscope. The procedure is generally done under local anaesthetic as a day case in a specialist unit.

Potential customers

Acute infectious viral hepatitis usually improves with no specific treatment.

Acute infection isn’t life-threatening.

Hepatitis B and hepatitis C may become chronic. Hepatitis A never does.

Acute hepatitis brought on 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 chance of developing cirrhosis or cancer of the liver can.

Cirrhosis may also be caused by other kinds of chronic hepatitis.

How is hepatitis treated ?

• No medical treatment method is usually necessary for acute viral hepatitis.
• Chronic hepatitis B can be treated with interferon alfa or other antiviral agents.
• Chronic hepatitis C may be treatable with interferon alfa and ribavirin (tribavirin).
• Autoimmune hepatitis can by treated with corticosteroids.

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The HCV an infection takes years to produce symptoms in those infected with this virus. About 35% of the infected people may produce symptoms while the rest may not produce symptoms at all. Hepatitis C does not have prominent symptoms in the early stage. The infected individual may experience vague symptoms for example abdominal pain, impaired digestion, loss of appetite, lassitude, weakness, itching, etc. However, these symptoms are extremely common that it is hard to point towards the diagnosis of Hepatitis C. The seriousness of the symptoms is not directly proportional to the concentration of liver dysfunction, however.

Patients in the advanced stage can experience more severe symptoms such as yellow sclera, sometimes paleness (whiteness) of eyes, loss of appetite, depression, bleeding from rectum, bloody vomiting, exhaustion and weight loss. Advanced stage symptoms of Hepatitis C are the ones due to chronic inflammation of liver (hepatitis), cirrhosis (scarring of tissues) of liver and/or liver failure.

The patients with acute Hepatitis C existing with lethargic feeling, loss of appetite, nausea, vomiting, body pain, and exhaustion. Objectively, one may observe yellowness of sclera (icterus or jaundice because it is called).

Hepatitis C has 4 phases:

• the acute stage
• the chronic stage
• compensated cirrhosis, and
• decompensated cirrhosis

However, you may not progress through each one of these stages because the span of the condition is unpredictable.

The acute (initial) stage

The acute stage is the first 6 months of infection. Most people don’t experience any symptoms in this phase.

Others will have vague flu-like signs and symptoms, including:

• fever
• tiredness
• loss of appetite
• belly pains
• nausea
• vomiting

These occur a couple weeks after being infected. A few people also develop jaundice (see box, right).

Approximately one in five people will fight off the hepatitis C virus and clear it from their body during this period.

The chronic stage

Hepatitis C has been said to be chronic when you have been infected for over 6 months.

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In people with a chronic infection, the virus remains active but may not cause any Hepatitis C symptoms throughout their life or for many years. They may remain well and develop no liver problems. However, they are carriers, which means that they are able to pass the virus on to others, for instance, by sharing needles.

Others with chronic hepatitis C will develop signs and symptoms, including:

• extreme tiredness
• depression
• short-term memory problems or difficulty concentrating
• mood swings
• digestive problems
• joint and muscle aches and pains
• headaches
• flu-like signs and symptoms
• pain or discomfort within the liver area
• stomach pains
• itching

Compensated cirrhosis

About 1 in 5 individuals with chronic hepatitis C will build up cirrhosis during a period of about 20 to 30 years (it can be sooner in people who consume alcohol).

Cirrhosis is scarring of the liver due to long-term, continuous damage to the liver. It is a serious condition where healthy tissue in the liver is ruined and replaced by scar tissue, which starts to block the flow of blood through your liver.

Compensated cirrhosis implies that the liver can continue to execute its normal functions (the liver can compensate for the damage).

Decompensated cirrhosis

Some people with compensated cirrhosis will deteriorate further and develop decompensated cirrhosis. This means the liver stops functioning (liver failure).

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