Center for Advanced Liver Diseases and Transplantation

Hepatitis

Inflammation of the liver is called hepatitis. Inflammation (or soreness) of the liver can be traced to many different causes, including viral infections, alcohol, fat accumulation in the liver, an incorrectly functioning immune system, exposure to chemicals and other toxins, and certain drugs.

Hepatitis A

The hepatitis A virus is an acute disease that typically is transmitted via contaminated water or food and resolves without becoming a chronic disorder in almost all cases. It is relatively uncommon in the United States, but international travelers (particularly those headed for developing countries or places with poor sanitation systems) are encouraged to be vaccinated against the hepatitis A virus.

Hepatitis B

The hepatitis B virus was once a major public health threat in the United States and it still is in some parts of the world, such as Asia and the Pacific. While the hepatitis B vaccine has become a valuable tool against the virus, those people who currently are infected or are not vaccinated and contract hepatitis B can face serious health problems, including liver cancer, the need for a liver transplant or even death. In the United States, 1.25 million people have chronic hepatitis B, and there are 5,000 to 6,000 hepatitis B- related deaths each year. Fortunately, the hepatitis B virus, which is transmitted via blood and bodily fluids, causes chronic infection in less than five percent of the cases.

Hepatitis C

The hepatitis C virus (formerly referred to as non-A, non-B hepatitis) is by far the leading indication for liver transplantation in the United States, accounting for between 30% and 50% of liver transplants,

depending on the state where the patient lives. According to the American Liver Foundation, more than 4 million people in the U.S. have hepatitis C, but only about 30 percent who have the virus are aware that they do. The hepatitis C virus kills between 10,000 and 12,000 Americans each year, but the future holds even grimmer prospects. According to some estimates, about 10 million Americans will have hepatitis C within the next couple of decades.

Hepatitis C progresses very slowly, often over the course of 10-20 years, and does much of its damage without symptoms to indicate something might be wrong until liver failure sets in. When a person with hepatitis C does have symptoms, they typically are those associated with a damaged liver. The damage to the liver eventually takes the form of cirrhosis in about 25% of patients, in which healthy liver cells are injured and scar tissue forms in their place. Over time, cirrhosis impairs the liver's ability to perform critical functions and reduces the amount of blood that flows through the vital organ.

Alcohol use increases the progress of liver disease in Hepatitis C; further, the risk of liver cancer is increased in patients with the infection.

The hepatitis C virus, discovered in 1989, is transmitted via blood, so anyone who had a blood transfusion before 1992 or has used intravenous drugs could be at risk. It's possible for an infected mother to pass along the virus to her child at birth. Researchers aren't sure whether hepatitis C can be transmitted sexually. If so, it's a rare occurrence, but people who've had multiple partners are encouraged to be tested for the virus. Certain groups of people have higher rates of hepatitis C than the general population, such as military veterans (especially those who served in Vietnam); prisoners; hemophiliacs; the homeless; and people with HIV.

Auto-immune Hepatitis

This is a condition in which a person's immune system starts attacking their own organs, as if they did not belong to that individual. Autoimmune hepatitis primarily affects women and starts as early as adolescence. As the name suggests, autoimmune hepatitis can cause inflammation of the liver and other symptoms

common to liver disease such as jaundice and itching as well as some associated with autoimmune disorders, namely, aching joints. Fatigue, common to both, is a frequently reported symptom. Lab tests show the presence of increased gamma globulin and smooth muscle antibodies in the blood.

Many people with autoimmune hepatitis respond well to prednisone treatment, which can relieve symptoms and cause elevated liver enzyme levels to return to normal. Autoimmune hepatitis is a condition that needs monitoring over the long term, as it can lead to cirrhosis and ultimately, the need for a liver transplant.

Acute Fulminant Viral Hepatitis

This describes a sudden and catastrophic loss of liver function due to infection from any of the three previously described viruses.

Fortunately, only a small percentage of patients (less than 1 percent) that have viral hepatitis develop this variety. The patient deteriorates rapidly from being healthy one day to possibly being comatose in 7-10 days. In addition to causing rapidly progressive liver failure there may be kidney failure, blood-clotting disorders, brain damage and coma.

Toxic Hepatitis

Rarely, medications intended to help patients can cause the liver to become suddenly inflamed, causing toxic hepatitis. For that reason, acetaminophen (Tylenol™), isoniazid (a drug used to treat tuberculosis), and many anti-convulsant medications should not be taken by people with liver disease. Even with a healthy person, an excessive amount of acetaminophen could cause toxic hepatitis. In an occupational setting, toxic hepatitis can occur when workers are exposed to certain chemicals in a confined space and are not wearing or properly using respiratory protective gear.