Hepatitis is inflammation of the liver. The liver is a major organ in the body located in the right upper part of the abdomen. The liver has numerous functions which include;

  1. Production of bile which is needed in the absorption of fats and oil
  2. Removal of toxins from the body
  3. Storage of glycogen
  4. Storage of vitamin A, D,E,K
  5. Breakdown of carbohydrates, protein, and fats
  6. Production of clotting factors (substances that aid in blood clot formation)
  7. Excretion of bilirubin (a product of broken-down red blood cells), cholesterol, hormones, and drugs
  8. Production of blood proteins such as albumin

The most common cause worldwide is viruses. In 2015, hepatitis A occurred in about 114 million people, chronic hepatitis B affected about 343 million people and chronic hepatitis C about 142 million people. Hepatitis results in more than a million deaths in a year, most of which occur indirectly from liver scarring or liver cancer.

 

Causes

Hepatitis can be acute or chronic depending on the underlying cause. The causes of hepatitis include;

  • Infectious;

Viral; hepatiis A,B, C,D, E, F

  • Noninfectious;

Alcohol

Toxins

Autoimmune

Hepatitis A; this is caused by hepatitis A virus which is transmitted by the consumption of food and water contaminated by faeces from a person infected by the virus. Infections are usually mild, with most people making a full recovery and remaining immune from further HAV infections. However, it can also be severe and life-threatening

Hepatitis B; this can be transmitted from mother to child, via blood, vaginal secretion, semen, during sex and sharing of a razor blade. It can cause both acute and chronic liver disease. About 257 million people are living with hepatitis B virus infection (defined as hepatitis B surface antigen positive), also in 2015, hepatitis B lead to 887 000 deaths. The virus can last outside the human body for at least 7 days.

Hepatitis C; this is transmitted via contaminated blood and sharing of needles.

Hepatitis D; this is a rare form of hepatitis that only occurs in conjunction with hepatitis B. It leads to fatal liver disease.

Hepatitis E; this is gotten from the consumption of faeces contaminated water. It is common in regions with poor sanitation

Alcohol; this is inflammation of the liver caused by excessive alcohol consumption. Excessive alcohol leads to the excessive fat collection in the liver which then leads to liver hepatitis and cirrhosis.

Toxins; exposure to certain toxins such as; overdose of over the counter medication such as paracetamol, ibuprofen, some herbal supplements, herbicides and some prescribed medications (ketoconazole. augmentin. phenytoin) can cause direct damage to the liver cells leading to hepatitis.

Autoimmune; this occurs when the body sees the liver cells as a foreign object and begins to attack it.

Genetic; hepatitis can be due to some conditions that are genetically acquired; Wilson’s disease (excessive deposition of copper in the liver), alpha-1-antitrypsin deficiency.

 

Sign and symptoms

Hepatitis can be symptomatic or asymptomatic. The common feature of hepatitis includes;

  • Yellowish discolouration of the eyes
  • Pale and Bulky stool
  • Abdominal pain
  • Fever
  • Fatigue
  • Weight loss
  • Dark urine

When hepatitis lasts for more than 6 months it is said to be chronic. It takes a while for symptoms to begin to manifest in chronic hepatitis. They can then further present with;

  • acne, hirsutism (abnormal hair growth) and amenorrhea (lack of menstrual period) in women
  • bleeding disorders
  • ascites (abdominal fluid collection)
  • leg edema

 

Diagnosis

This is usually done based on a good history and examination. Liver function test, imaging and liver biopsy can be done to further access the liver and find out the underlying cause.

Treatment

Treatment of hepatitis depends on the cause and whether it is acute or chronic.

Hepatitis a; treatment is supportive and you can give intravenous fluids and give adequate nutrition

Hepatitis B; this resolves in most patients without the need for antiviral. However, if it becomes chronic there will be need for antivirals such as entecavir or tenofovir.

Hepatitis B can be prevented by  vaccination against the virus. it is given to all children and those at high risk (such as health workers) of contacting the virus.

Hepatitis C; this is usually managed by the use of antivirals. If it becomes chronic it damages the liver and there might be need for liver transplant. There is no known vaccine against this infection.

Hepatitis D; there is no antiviral drug to treat hepatitis D. Vaccination against hepatitis B can protect against hepatitis D infection.

Hepatitis E; there is no treatment for this infection. Supportive treatment is given in its management; adequate rest, drink plenty of fluids, get enough nutrients, and avoid alcohol.

Auto immune hepatitis; Corticosteroids such as prednisone or budesonide are extremely important in the early treatment of autoimmune hepatitis. They’re effective in about 80 percent of people with this condition. Other drugs that suppress the immune system  such as Azothioprine (Imuran) can also be used.

Complication

Hepatic encephalopathy; a decline in brain function due to liver disesae

Esophageal varices; these are abnormal veins in the lower part of the tube running from the throat to the stomach. They occur due to liver failure and can lead to death when the vein ruptures.

Hepato-renal syndrome; this is a life-threatening medical condition that consists of rapid deterioration in kidney function in individuals with liver failure

Liver cancer

Liver failure; the inability of the liver to perform its normal synthetic and metabolic function.

 

Prevention

  • Vaccination; there are vaccines that can be given to prevent infection with hepatitis A and B virus
  • Avoid unscreened blood transfusion
  • Avoid sharing sharp objects
  • Avoid unprotected sex
  • Prevention of mother to child transmission can be achieved by giving the child hepatitis immunoglobulin with the first 24 hours of life.
  • Avoid excessive consumption of alcohol. Maximum amount of alcohol for Women is ≤ 3 drinks on any given day and ≤ 7 drinks per week and for men – ≤ 4 drinks on any given day and ≤ 14 drinks per week
  • Ensure proper sanitation and avoid contamination of food by feaces
  • Avoid sharing toothbrush
  • Practice safe sex and use condom or dental dams