Hepatitis

Introduction to Hepatitis

Hepatitis is an inflammation of the liver which can be caused by either infective agents, drugs and other toxins.
It is the most predominant and important presentation of liver disease worldwide.
One can easily know the cause, and duration of a particular hepatitis from the suffixes acute, chronic, viral,
autoimmune, alcoholic etc.

Causes of hepatitis

Hepatitis is caused by viruses, heavy alcohol consumption, toxins, some disease conditions and some drugs.
Viral hepatitis are the most common type of hepatitis. Viruses causing them include hepatitis A, B, C, D and E Viruses.
Hepatitis A and E viruses basically cause acute infections. Other hepatitis viruses can cause both acute and chronic infections.

 Risk factors for hepatitis

  • Family history.
  • Alcohol ingestion
  • Previous blood transfusion
  • Contamination of food and water by sewage
  • Drug ingestion
  • Sexual contact
  • Exposure to contaminated sharp objects/instruments

Symptoms and clinical features of hepatitis

1. Symptoms of acute hepatitis:

  1. With or without mild fever
  2. Mild-to-moderate jaundice
  3. Vague right upper quadrant discomfort
  4. There may be enlargement of the liver below the costal margin with varying consistency (depending on the stage of the liver disease)

2. Symptoms of chronic hepatitis:

  • Re-occurence of jaundice may suggest a chronic illness

Differential diagnoses

  1. Liver abscess
  2. Metabolic liver disease/disorder
  3. Primary or secondary liver cancer
  4. Cholecystitis

Complications of hepatitis

Untreated, poorly treated or chronic hepatitis can lead to the following complications:

  1. Fulminant hepatic failure
  2. Bleeding tendencies
  3. Acute or subacute hepatic necrosis.
  4. Chronic active hepatitis.
  5. Chronic hepatitis.
  6. Cirrhosis..
  7. Hepatocellular carcinoma in patients with hepatitis B and C viruses infection

Investigations

  • Liver Function Tests
  • Serologic markers of Hepatitis A, B, C, D and E
  • Abdominal ultrasonography

Treatment for hepatitis

Treatment objectives

  1. Provide supportive measures
  2. Prevent progression to chronic phase (applicable to Hepatitis C virus only)
  3. Improve patients quality of life

Non-drug treatment

  • High carbohydrate and low protein diet
  • Discontinuation of hepatotoxic medication
  • Discontinuation of alcoholic drinks consumption
  • Bed rest

Drug treatment

1. Hepatitis A

This type of hepatitis is self-limiting. Therefore, there is no specific drug treatment for it.

2. Hepatitis B

a. Acute:
  • Acute hepatitis B is self-limiting to fulminant
  • Its treatment is supportive
b. Chronic:

Follow your national treatment guidelines for chronic hepatitis B treatment initiation.
Treat only those with viral load exceeding 2000 International Units/ml for e antigen negative patients or 20000 International Units/ml for e antigen positive patients.
Monitor those not meeting treatment criteria with bi annual viral load.

  1. Pegylated interferon alfa -2b:180 microgram subcutaneously weekly for 48 weeks.
  2. Tenofovir 300 mg daily for 2-5 years (used when patient has liver failure).
  3. Liver transplant

3. Chronic Hepatitis C:

Pegylated interferon alfa
2b:180 microgram subcutaneously
weekly for 48 weeks.

Plus

Ribavirin 400 mg orally twice daily for adults with body weight less than 65 kg; 400 mg in the morning and 600 mg in the evening for adults weighing 65-85 kg: 600 mg twice daily for adults weighing over 85 kg

4. Hepatitis D

Interferon alfa -2b: 3 million units  subcutaneously 3 times weekly for 4 months

Plus

Lamivudine: 100 mg orally once daily for 4 months

5. Hepatitis E

  1. Treatment for hepatitis E is majorly supportive.

Notable adverse drug reactions

  1. Interferon alpha 2b and Ribavirin reduce haematopoiesis
  2. Flu-like illness
  3. Leucopenia
  4. Psychiatric-like symptoms
  5. Development of early resistance if therapy exceeds one year

Prevention of hepatitis

To prevent oneself from having hepatitis, observe the following recommendations:

  1. Screen blood and blood products for hepatotrophic viruses
  2. Immunize against hepatitis A, and  B viruses
  3. Prevent faecal contamination of food and water
  4. Reduce drug misuse/abuse
  5. Take pre-exposure prophylaxis
  6. Take post-exposure prophylaxis
  7. Avoid exposure to unsterilized sharp objects.