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Hepatitis

Definition

Hepatitis is inflammation of the liver.

Causes

The disease can be caused by:

• Infections from viruses (such as hepatitis A, B, or C), bacteria, or parasites
• Liver damage from alcohol or poisonous mushrooms
• Medications, such as an overdose of acetaminophen, which can be deadly
• Immune cells in the body attacking the liver and causing autoimmune hepatitis

Medications that can cause damage to the liver include methyldopa (used uncommonly for high blood pressure), isoniazid for tuberculosis, seizure medications (like valproate and phenytoin), chlorpromazine, amiodarone (for irregular heart rhythm), and certain antibiotics (including trimethoprim-sulfamethoxazole and erythromycin). If you need to take any of these, your doctor may need to check your liver function.

Liver disease can also be caused by inherited disorders such as cystic fibrosis and Wilson's disease, a condition that involves having too much copper in your body (the excess copper deposits in the liver).

Other causes include:

• Systemic lupus erythematosus
• Rheumatoid arthritis
• Sjögren syndrome
• Scleroderma
• Inflammatory bowel disease
• Glomerulonephritis
• Hemolytic anemia

Hepatitis may start and resolve quickly (acute hepatitis), or cause long-term disease (chronic hepatitis). In some instances, progressive liver damage, liver failure, or even liver cancer may result.

The severity of hepatitis depends on many factors, including the cause of the liver damage and any underlying illnesses you have. Hepatitis A, for example, is generally short-lived, not leading to chronic liver problems.

Common risk factors include:

• Intravenous drug use
• Overdosing on acetaminophen -- the dose needed to cause damage is close to the effective dose, so be careful to take it only as directed -- ask your doctor what amount of acetaminophen is safe for you; if your liver disease is severe, your doctor may also tell you to avoid certain anti-inflammatory medicines
• Engaging in risky sexual behaviors (like having multiple sexual partners and unprotected intercourse)
• Eating contaminated foods
• Traveling to an area where certain diseases are common
• Living in a nursing home or rehabilitation center
• Having a family member who recently had hepatitis A
• Using or abusing alcohol
• Being an organ transplant recipient
• Having HIV or AIDS
• Having received a blood transfusion before 1990 (hepatitis C blood test was not available)
• Being a newborn of a mother with hepatitis B or C (can be transmitted during delivery)
• Being a health care worker, including dentist and dental hygienist, because of blood contact
• Receiving a tattoo

See also:

• Alcoholic hepatitis
• Autoimmune hepatitis
• Delta agent (hepatitis D)
• Drug-induced hepatitis
• Hepatitis A
• Hepatitis B
• Hepatitis C

Symptoms

The symptoms of hepatitis include:

• Abdominal pain or distention
• Breast development in males
• Dark urine and pale or clay-colored stools
• Fatigue
• General itching
• Jaundice (yellowing of the skin or eyes)
• Loss of appetite
• Low-grade fever
• Nausea and vomiting
• Weight loss

Many people with hepatitis B or C do not have symptoms when first infected and can still develop liver failure later. If you have any risk factors for either type of hepatitis, you should be tested periodically.

Exams and Tests

A physical examination may show yellowing of the skin, an enlarged and tender liver, or fluid in the abdomen (ascites) that can become infected.

Your doctor may order laboratory tests, including:

• Hepatitis virus serologies
• Liver function tests
• Autoimmune blood markers
• Abdominal ultrasound
• Liver biopsy to determine severity of the liver damage
• Paracentesis if fluid in your abdomen is present

Treatment

Your doctor will discuss possible treatments with you, depending on the cause of your liver disease. Your doctor may recommend a high-calorie diet if you are losing weight.

Support Groups

There are support groups for people with all types of hepatitis, which can help you learn about the latest treatments and better cope with having the disease.

See: Liver disease support groups

Outlook (Prognosis)

The outlook depends on many factors, including the cause of the hepatitis and whether or not you have additional illnesses or conditions that complicate treatment or recovery. Many people recover fully. However, it may take months for the liver to heal.

Eighty percent of those with hepatitis C go on to have chronic liver disease and, possibly, liver failure (cirrhosis) or liver cancer. Hepatitis C is the number one reason for receiving a liver transplant in the United States.

Possible Complications

Permanent liver damage, liver failure, or liver cancer can occur. Other complications include spontaneous bacterial peritonitis (when fluid in the abdomen becomes infected), and esophageal varices, which can bleed significantly.

When to Contact a Medical Professional

Seek immediate care if you:

• Have symptoms related to acetaminophen or other medicines -- you may need to have your stomach pumped
• Vomit blood
• Have bloody or tarry stools
• Are confused or delirious

Call your doctor if:

• You have any symptoms of hepatitis or believe that you have been exposed to hepatitis A, B, or C.
• You cannot keep food down due to excessive vomiting. You may need to receive nutrition intravenously (through a vein).
• You feel sick and have travelled to Asia, Africa, South America, or Central America.

Prevention

The following hepatitis vaccines are available:

• Hepatitis A vaccine is available for people in high-risk groups, like day care and nursing home workers, laboratory workers, and those traveling to parts of the world where hepatitis is common. Routine childhood immunization against hepatitis A is also recommended.
• Hepatitis B vaccine is now given to all infants and unvaccinated children under 18. The vaccine is available for adults at high risk, such as health care professionals, IV drug users, and those with risky sexual behavior.

A shot of immunoglobulin may also prevent infection. This is true even after you have been exposed:

• It may be given soon after you have had close contact (like kissing or sharing utensils) with someone who was diagnosed with hepatitis A within the last two weeks.
• It should be given right away, along with the hepatitis B vaccine, to an infant born to a woman with hepatitis B.

Other steps to take:

• Avoid contact with blood or blood products. Take precautions if this is part of your work.
• Avoid sexual contact with a person infected with hepatitis or unknown health history. Practice safe sex at all times.
• Wash your hands after going to the bathroom and before handling food.
• Avoid sharing plates, utensils, or bathrooms with someone who has hepatitis A.
• DO NOT share razors, needles, or toothbrushes.
• When traveling to endemic areas, DO NOT eat uncooked or partially cooked foods. Drink bottled water.
• DO NOT use recreational IV drugs. If you are already an IV drug user, never share needles and seek help from a needle exchange or drug treatment program.
• Be cautious when receiving tattoos or piercings.
• DO NOT drink alcohol at the same time that you take acetaminophen. If you already have hepatitis, do not use either (to avoid further liver damage).

When to get tested for hepatitis:

• Get tested for hepatitis B or C if you had sexual contact or shared needles with someone who may have had one of these viruses.
• Do this even if you have no symptoms.

References

Dienstag JL. Hepatitis B virus infection. N Engl J Med. 2008;359:1486-1500.

Jou JH, Muir AJ. In the clinic. Hepatitis C. Ann Intern Med. 208;148:iTC6-1-ITC6-16.

Sjogren MH. Hepatitis A. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa:Saunders Elsevier;2006:chap 74.

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