Hepatitis (liver inflammation)

Hepatitis refers to all types of liver inflammation, regardless of the underlying cause. Triggers for this inflammation can be viruses, autoimmune diseases or toxins such as alcohol or drugs. The most common is hepatitis triggered by viruses.

The course of hepatitis can be divided into acute and chronic. They differ in that the acute liver inflammation heals within a year, while the chronic inflammation persists over this period.

Acute hepatitis:

The causes of acute hepatitis can be of various natures.

Infections caused by hepatitis viruses lead to the following different forms:

• Hepatitis A
• Hepatitis B
• Hepatitis C (formerly non-A or non-B hepatitis)
• Hepatitis D
• Hepatitis E
• Hepatitis G

Other pathogens can also cause liver inflammation. Doctors refer to this type of hepatitis as concomitant hepatitis. The most common pathogens include:

• Viruses: mononucleosis (Epstein-Barr virus), cytomegalovirus (CMV virus), Coxsackie virus.
• Bacteria: Leptospirosis, Brucellosis, Salmonella.
• Parasites: Amoebic dysentery (intestinal parasites), malaria (blood parasites).

Poisoning can also lead to hepatitis:

• Poisons, such as alcohol, or the plant poison of mushrooms (tuberous leaf fungus).
• Drugs, such as an overdose of acetaminophen or some anesthetic gases (halothane)

Chronic hepatitis:

Chronic hepatitis can occur as a result of these diseases:

• Hepatitis viruses: hepatitis B, hepatitis C, hepatitis D.
• Drugs, for example, some drugs go tuberculosis
• Toxins, for example: Alcohol

A distinction is also made between autoimmune hepatitis, in which the body's own immune system acts against the liver cells. Women are more often affected by this form of hepatitis than men, whereby it is assumed that a hereditary predisposition is a decisive factor. In some cases, this autoimmune disease can also present as acute hepatitis.

Inborn errors of metabolism:

• Wilson's disease: In this disease, copper metabolism is impaired.
• Hemochromatosis: This affects the body's iron metabolism.

In some patients, the cause of chronic liver inflammation can no longer be determined.

Acute hepatitis:

The symptoms of acute hepatitis vary. Sometimes it can also happen that despite proven infection no symptoms of the disease occur. In children, the course of hepatitis is usually milder.

Early phase:

Characteristic of the early phase are fatigue, general feeling of illness, fever, nausea, changes in taste, aversion to certain foods, and pain below the right ribcage. This is due to the liver becoming slightly enlarged. Muscle pain, joint pain, headache, and skin rash may also occur.

Jaundice stage:

At the beginning of this stage of the disease, there is initially a yellowing of the sclerae (whites of the eye), and later the skin and mucous membranes also turn yellow. The urine takes on a conspicuously dark colour, while the stool becomes increasingly discoloured. In addition, there is increased itching during jaundice. The other symptoms decrease at the same time.

Recovery phase (convalescence phase):

During the recovery phase of hepatitis, the patient suffers from fatigue and exhaustion. This may last for several weeks to months.

Chronic hepatitis:

The symptoms of chronic hepatitis have similarities to those of acute hepatitis. At times, patients may not show any symptoms in this case either. Symptoms may include:

• Fatigue, increased need for sleep, joint and muscle pain.
• Slight tenderness below the right costal arch, due to the enlarged liver
• Jaundice may occur as a late symptom. If this feature occurs, the disease is already well advanced.

Hepatitis can be detected on the basis of the medical history (anamnesis), as well as a physical examination.

Various blood tests contribute to the determination of the cause of hepatitis. These include the determination of liver values (mainly so-called transaminases), as well as the search for antibodies against hepatitis viruses. These tests can also be used to determine the stage of the liver inflammation.

In some cases, it is also necessary to perform an ultrasound examination (sonography), a tissue sample (biopsy) of the liver or a stool examination.

The therapy of hepatitis depends on the cause. If drugs or alcohol are considered triggers, these substances should be eliminated and avoided in the future.

If the hepatitis results from another disease (concomitant hepatitis), the underlying disease must first be treated. This usually allows the hepatitis to heal on its own. If the liver inflammation is caused by viruses, the first priority is bed rest and a ban on alcohol.

If the patient suffers from chronic hepatitis B, antiviral substances such as lamivudine and adefovir are administered.

In chronic hepatitis C, pegylated interferon- alpha (PEG-IFN) is given in combination with ribavirin.

Autoimmune hepatitis is treated with drugs that reduce the activity of the immune system. These include cortisone and azathioprine, for example.

What you can do yourself:

• At the first symptoms or diagnosis of hepatitis, alcohol should be avoided at all costs
• A balanced diet is important in this condition
• Information should be obtained about which medications can cause liver damage.
• If symptoms occur during an acute liver inflammation, bed rest should be strictly observed.
• If viruses of type B or C are the trigger for the inflammation, family and sexual partners should be informed. They can protect themselves from infection by vaccination.
• If chronic liver inflammation is present, an examination should be carried out at regular intervals.

Acute hepatitis often goes away on its own. If drugs or alcohol are the trigger for the liver inflammation, the liver has a good regeneration, provided that these substances are avoided and the liver has not yet suffered any permanent damage.

Hepatitis B, C and D can be the precursor to chronic hepatitis.

Chronic hepatitis of type B or C can be the cause of a shrinking liver (cirrhosis) in many affected individuals. In this process, functionless scar tissue takes the place of functional liver tissue. Such a liver cirrhosis is irreversible, i.e. it can no longer be reversed. If one suffers from chronic hepatitis B or C, this can also form the basis for liver cancer.

Other forms of hepatitis can also result in a shrunken kidney.

Hepatitis A can be contracted through contaminated food. Therefore, sufficient food hygiene should be ensured. This applies especially in holiday countries. If some people, such as hospital staff, are at increased risk of infection, vaccination against hepatitis A offers protection.

A vaccination against hepatitis B is also available. It has been part of the standard vaccination for all infants for several years and is reimbursed by health insurance. Hepatitis B is transmitted sexually. The use of condoms and the avoidance of constantly changing sexual partners therefore offer safe protection.

To avoid hepatitis in general, excessive alcohol consumption should be avoided. Some over-the-counter medicinal preparations, as well as being very overweight, can also damage the liver.