Hepatitis: Liver Inflammation That Must Be Treated
What is hepatitis?
Hepatitis is a disease that causes your liver to be inflamed.
There are 5 types of hepatitis caused by viruses along with other causes.
- Viral: A, B, C, D, E
- Non-alcoholic steatohepatitis (NASH)
- Liver inflammation can also be triggered by certain medications or toxins (for example, from some supplements)
Symptoms can include abdominal pain and yellowing of the skin and eyes (called jaundice). But in many cases, there are no obvious signs of the disease. It is very important that any type of hepatitis be diagnosed and treated to protect the liver from permanent damage.
Treatment depends on which type you have. It can include rest (supportive care), medications, or lifestyle changes. It is very important that any type of hepatitis be diagnosed and treated to protect the liver from cirrhosis, which is permanent liver damage.
Certain conditions or experiences put people at increased risk for hepatitis: People who had a blood transfusion in the 1980s or before, or who have a history of IV drug use or unprotected sex; certain demographic groups, such as those born in China, Southeast Asia, or Subsaharan Africa; and people with an autoimmune disease such as Hashimoto’s, Sjorgens, or rheumatoid arthritis. —Dr. Shria Kumar
Though there are many different types of hepatitis, symptoms are usually similar:
- Pain in the upper right part of abdomen.
- Flu-like symptoms such as fever, nausea, vomiting, fatigue, and muscle aches.
- Yellowing of skin and white parts of the eyes (jaundice).
If you don’t have jaundice, you may think you are sick with the flu or another infection.
Some people with autoimmune hepatitis or with NASH, which is a buildup of fat in the liver along with inflammation, may not have any symptoms until the disease progresses to cirrhosis (when the liver has permanent, not-treatable damage).
Other symptoms you may have
People with chronic viral hepatitis B or C may also have:
- Joint pain
- Purple-colored spots on the skin (called purpura)
- Red, itchy rash, usually on the legs
People with severe hepatitis, usually caused by drinking too much alcohol, may have:
- Vomit blood, or vomit that looks like coffee grounds
- Black, tar-like stool
- Swelling of the abdomen due to fluid accumulation
Cause of hepatitis
Hepatitis most often occurs when a virus causes inflammation and damages the liver. It either kills liver cells directly or by triggering an immune system response to kill them. Viral hepatitis A and E, are usually caught when traveling in underdeveloped parts of the world or eating contaminated imported food.
Hepatitis B and C can be passed through sexual activity, intravenous drug use, or when an infected mother passes it to her baby during birth. Anyone who received a blood transfusion before the early 1990s is also at risk of having hepatitis C.
In NASH, fat builds up in the liver and leads to inflammation and cell death. Genetics may play a role. NASH is more likely in people who are obese, have diabetes, or have metabolic syndrome.
“Hepatitis” usually makes people think of viral hepatitis. But in the U.S., hepatitis due to fatty liver disease (non-alcoholic steatohepatitis or NASH) and alcoholic hepatitis are becoming much more common. NASH in particular is becoming a problem with the rise in obesity and associated metabolic diseases. —Dr. Kumar
Alcoholic hepatitis is caused by drinking too much alcohol. But too much is different for everyone because of the interplay of genetics and other factors. There is no clear “safe amount” of alcohol.
While moderate alcohol use for healthy adults is considered up to one drink a day for women and up to two drinks a day for men, some people who drink this amount may still get alcoholic liver disease (or other problems).
Autoimmune hepatitis is when a person’s immune system attacks an otherwise healthy liver. Some people may have a genetic difference that makes them more at risk for this immune response.
Rarely, certain prescription or over-the-counter medications may cause drug-induced hepatitis. Toxins (including some herbal supplements such as aloe vera, black cohosh, cascara, kava, and others) can also damage liver cells leading to hepatitis.
If you vomit blood or anything that looks like dark coffee grounds, call 911. If your skin or the whites of your eyes turn yellow, or if you have black, tar-like stool, go to the ER. If you notice abdominal swelling, see a doctor within a few days. They will probably request blood tests of your liver function.
If a doctor suspects that you have hepatitis, they will likely refer you to a specialist—either a gastroenterologist or a hepatologist (a liver specialist). They will order imaging tests such as an ultrasound or an MRI of the abdomen. In many cases, the only way to accurately diagnose the cause of hepatitis is a liver biopsy. This procedure, done in an outpatient setting, removes liver cells that can be studied under a microscope.
Can hepatitis be cured?
In many cases, the treatments for hepatitis can stop ongoing damage to the liver and even allow healing. But it depends on the type of hepatitis and the degree of inflammation and liver damage you have. If the hepatitis has not progressed to permanent damage (cirrhosis), and there is a way to stop the inflammation, you have a good chance of recovery. —Dr. Kumar
The best treatment for hepatitis depends on the specific diagnosis.
- Viral hepatitis A and E: generally no treatment is needed. With rest and fluids, these viruses go away, and long term damage is rare unless you already have chronic liver disease.
- Viral hepatitis B: Depending on whether the infection is new or chronic, it may be treated with antiviral medications.
- Viral hepatitis C: Antiviral medications, usually taken for 8-12 weeks.
- Autoimmune hepatitis: Long-term immunosuppressive medications, including steroids.
- NASH: Weight loss through diet and exercise. Also, if you have metabolic syndrome or diabetes, those diseases will be treated.
- Alcoholic hepatitis: May treat with steroids initially. The only definitive treatment is to stop drinking alcohol.
- Drug-induced or toxin-associated hepatitis: Stopping the drug or removing the toxin. More therapies may be needed depending on the drug/toxin and severity.
In all cases, drinking alcohol should be avoided because alcohol can worsen any type of liver disease. Your doctor will go over other considerations too, such as limiting acetaminophen (Tylenol) use and reviewing your medication and supplement list to ensure you’re not taking anything that can harm your liver.
Does hepatitis require long-term follow up?
If you have hepatitis, your doctor will want to monitor your treatment and liver. You’ll have periodic blood tests to check if your liver is improving. Complete recovery may take months. Depending on how advanced the hepatitis was when you were diagnosed, you could have permanent liver damage, known as cirrhosis. You will need regular imaging of your liver because cirrhosis can lead to liver cancer.
Hepatitis in children
Children can get most forms of hepatitis. In countries with poor sanitation, almost all children have been exposed to the hepatitis A virus by the age of 5. In the U.S., children are vaccinated against hepatitis A. The disease can still occur in rare circumstances.
In areas where hepatitis B is common, including China, Southeast Asia, and parts of Africa, the most common method of infection is from mother to baby during childbirth. Unfortunately, children infected this way are much more likely to have a chronic infection (if they don’t receive treatment) than people who are infected as adults.
- Get vaccinated with the hepatitis A and B vaccines before you are exposed.
- Do not share dirty needles or personal items such as razors and toothbrushes.
- Always practice safe sex.
- Maintain a healthy weight and eat a diet low in saturated fats.
- Do not drink alcohol or drink only moderately.
- Carefully review any over-the-counter supplements you take with your doctor to avoid getting hepatitis from them.
Dr. Pont is currently a fellow in Gastroenterology at New York Presbyterian Hospital/Columbia, where he also completed his residency in Internal Medicine. Dr. Pont received his medical degree and PhD at the New York University School of Medicine. He earned his BS in Biological Systems Engineering at the University of Nebraska-Lincoln.