Chronic Hepatitis

Chronic hepatitis is a long-term inflammation of the liver, lasting for at least six months. This persistent inflammation, if left untreated, can lead to progressive liver damage, scarring (fibrosis), cirrhosis, liver failure, and liver cancer. The most common causes of chronic hepatitis are persistent viral infections (Hepatitis B and C), but it can also result from autoimmune conditions, metabolic disorders, and certain medications. Due to the liver’s remarkable ability to compensate, many individuals with chronic hepatitis may have no symptoms in the early stages, making regular screening and early diagnosis crucial.

Causes:

Chronic hepatitis is primarily caused by specific viruses, autoimmune reactions, or metabolic factors that lead to ongoing liver inflammation and damage.

• Chronic Viral Hepatitis (Most Common):
  • Hepatitis B Virus (HBV): Can persist in the body, leading to chronic infection. Transmitted through blood, semen, and other body fluids.
  • Hepatitis C Virus (HCV): A common cause of chronic hepatitis worldwide. Transmitted primarily through blood-to-blood contact.
  • Hepatitis D Virus (HDV): Only occurs in people who are also infected with Hepatitis B. Can worsen chronic HBV infection.
• Autoimmune Hepatitis:
  • The body’s immune system mistakenly attacks healthy liver cells, causing inflammation.
  • More common in women and often associated with other autoimmune diseases.
• Non-Alcoholic Steatohepatitis (NASH):
  • A severe form of non-alcoholic fatty liver disease (NAFLD), where fat accumulation in the liver leads to inflammation and liver cell damage.
  • Strongly associated with obesity, Type 2 diabetes, high cholesterol, and metabolic syndrome. Can progress to cirrhosis.
• Alcoholic Hepatitis:
  • Chronic and excessive alcohol consumption directly damages liver cells, leading to inflammation. This can progress to alcoholic cirrhosis.
• Genetic (Inherited) Diseases:
  • Hemochromatosis: Excessive iron accumulation in the liver.
  • Wilson’s Disease: Excessive copper accumulation in the liver.
  • Alpha-1 Antitrypsin Deficiency: A genetic disorder that can cause liver and lung disease.
• Drug-Induced Chronic Hepatitis:
  • Certain medications, when taken long-term, can cause chronic liver inflammation in susceptible individuals (e.g., amiodarone, methotrexate, isoniazid, some herbal remedies).

Symptoms:

Many people with chronic hepatitis, especially in the early stages, experience no symptoms. When symptoms do appear, they are often non-specific or indicate more advanced liver disease.

• Fatigue: Persistent and often debilitating tiredness.
• Nausea and Vomiting.
• Loss of Appetite.
• Unexplained Weight Loss.
• Mild Abdominal Pain: Often in the upper right quadrant (where the liver is located).
• Joint Pain.
• Muscle Aches.
• Low-Grade Fever.
• Skin Rash.
• As Symptoms Progress (indicating more severe liver damage/cirrhosis):
  • Jaundice: Yellowing of the skin and eyes, dark urine.
  • Itching (Pruritus).
  • Ascites: Fluid accumulation in the abdomen.
  • Edema: Swelling in the legs and ankles.
  • Easy Bruising and Bleeding.
  • Spider Angiomas: Small, spider-like blood vessels on the skin.
  • Hepatic Encephalopathy: Confusion, memory problems, personality changes, asterixis (“flapping tremor”).

Diagnosis:

Diagnosing chronic hepatitis involves a combination of medical history, physical examination, blood tests, and often imaging and liver biopsy to determine the cause and extent of liver damage.

• Medical History and Physical Exam: The doctor will inquire about risk factors (e.g., alcohol use, travel history, medication use, exposure to viruses) and symptoms. The exam may reveal an enlarged liver or spleen.
• Blood Tests:
  • Liver Function Tests (LFTs): Elevated AST and ALT (liver enzymes) often indicate liver inflammation. High bilirubin and low albumin suggest impaired liver function.
  • Viral Markers: Specific blood tests for Hepatitis B (HBsAg, anti-HBc, HBeAg) and Hepatitis C (anti-HCV, HCV RNA) to identify chronic viral infections.
  • Autoimmune Markers: Anti-nuclear antibody (ANA), anti-smooth muscle antibody (ASMA), anti-liver kidney microsomal type 1 (LKM-1) antibodies for autoimmune hepatitis.
  • Genetic/Metabolic Tests: Iron studies (hemochromatosis), ceruloplasmin/copper levels (Wilson’s disease), alpha-1 antitrypsin levels.
• Imaging Tests:
  • Abdominal Ultrasound: Can assess liver size, texture, and detect fatty liver or signs of cirrhosis.
  • CT Scan (Computed Tomography) or MRI (Magnetic Resonance Imaging): Provide more detailed images of the liver and can identify cirrhosis, tumors, or other abnormalities.
  • Transient Elastography (FibroScan): A non-invasive test that measures liver stiffness, indicating the degree of fibrosis (scarring).
• Liver Biopsy:
  • Often considered the gold standard to confirm the diagnosis, determine the cause, assess the severity of inflammation, and stage the level of fibrosis or cirrhosis.
  • A small piece of liver tissue is removed with a needle and examined under a microscope.

Treatment:

Treatment for chronic hepatitis aims to eliminate the cause (if possible), reduce inflammation, prevent further liver damage, and manage complications. Treatment plans are highly dependent on the underlying cause.

• Treating the Underlying Cause:
  • Antiviral Medications:
    • For Chronic Hepatitis B: (e.g., tenofovir, entecavir) Help suppress viral replication and reduce liver damage.
    • For Chronic Hepatitis C: Direct-acting antiviral (DAA) medications. Highly effective (often over 95% cure rate) in eradicating the virus.
  • Immunosuppressants: (e.g., prednisone, azathioprine) For autoimmune hepatitis to suppress the immune system’s attack on the liver.
  • Weight Loss and Lifestyle Changes: For NASH (diet, exercise).
  • Alcohol Abstinence: For alcoholic hepatitis.
  • Chelation Therapy: To remove excess iron (hemochromatosis) or copper (Wilson’s disease).
• Managing Complications (if cirrhosis has developed):
  • Diuretics for ascites.
  • Lactulose/Rifaximin for hepatic encephalopathy.
  • Beta-blockers or endoscopic banding for varices.
  • Regular screening for liver cancer.
• Supportive Care:
  • Nutritional Support: Maintaining a healthy diet, addressing vitamin deficiencies.
  • Avoid Liver Toxins: Abstain from alcohol, avoid unnecessary medications that are metabolized by the liver.
  • Vaccinations: Get vaccinated against Hepatitis A and B (if not already infected), and influenza, pneumonia.
• Liver Transplantation:
  • Considered for individuals with end-stage liver disease (decompensated cirrhosis) when other treatments are no longer effective.

Regular monitoring by a hepatologist or gastroenterologist is essential for individuals with chronic hepatitis to track disease progression, manage symptoms, and prevent complications.