Hepatitis: What You Need to Know

Hepatitis is a medical term that describes irritation and inflammation of the liver; it
does not indicate what caused it. There are many types of hepatitis caused by
many different problems. I want to give a brief overview of the major different
forms of hepatitis.

How is it diagnosed? Initially, most patients with any form of hepatitis are found
during routine blood tests or screenings by the American Red Cross to have an
elevation in liver enzymes, ALT and AST. Sometimes, these are erroneously
referred to as liver function tests. Liver function is more related to
clearance of bilirubin from the blood as well as the liver's ability to
maintain Albumin and clotting factors, the creation of proteins by the liver.

Viral Hepatitis: There are three classic forms of viral hepatitis. Hepatitis A
typically is transmitted orally although blood transmission can occur. Patients
can develop an acute illness characterized by jaundice, fever, malaise, nausea.
The infection, while potentially severe in the short term, is typically cleared
and more than 99 percent of patients will clear the acute phase leaving them immune to reinfection.

Hepatitis B is more virulent. This is the leading cause of viral hepatitis in the world.
It can be easily transmitted via almost any route. IV drugs, blood
transfusions, vertically from mother to child, sexual contact, even from dried
blood on a countertop. Fortunately, while this virus is quite aggressive, about
90-95 percent of patients will clear the virus acutely. The illness can be mild to
severe. The liver is actually injured due to the body's own immune response
rather than the virus itself. People may report mild flu-like symptoms or it
can also cause acute liver failure. As with Hepatitis A, there is a vaccine for
Hepatitis B.

Hepatitis C is the number one reason people go for a liver transplant. It is not
completely clear, but, the majority, 80-90 percent of patienst infected with hepatitis C, will go on to develop chronic liver disease. While not typically transmitted sexually it is very contagious with blood-to-blood contact. Depending on the amount of virus initially present and many other factors, the infection can
take many years to cause significant inflammation and damage to the liver.

A history of of risky behavior, IV drug use, home tattoo, blood transfusion,
needle stick injury in the healthcare field, can occur 20-30 years earlier.
Long standing infection can lead to cirrhosis, liver cancer and death due to
liver failure. No vaccine is yet available but multiple new treatments are
available that are rapidly improving the success rate of treatment. It is
possible to cure a patient of Hepatitis C.

Autoimmune hepatitis, AIH, is an error in an individual’s immune system. The body, for unclear reasons, begins to react against different parts of the normal liver cells. As with acute Hepatitis B, the immune response can cause great harm to the liver.

This can cause such severe disease the liver can become completely scarred,
cirrhosis. Once this happens, patients are at increased risk of liver cancer
and may even need a liver transplant. Very effective medication exists that can
treat AIH but it is a lifelong treatment, not a cure.

Non-alcoholic steatohepatitis, NASH, indicates the presence of large amounts of fat in the liver that interfere with the normal liver function. This fat causes
inflammation and eventual scarring of the liver. NASH is frequently associated
with obesity, insulin resistance, type 2 diabetes and even male hypogonadism.

It is becoming more evident that by reducing insulin resistance with
medications combined with low carbohydrate diet, exercise and weight loss this
process can be reversed. Of course, a major consequence of this treatment is
that hyperlipidemia and hypertension are frequently resolved as well thereby
decreasing the risk of a heart attack or stroke.

This is just a glimpse at what can cause problems with the liver. Chronic
medications, Tylenol, alcohol and others, cause chronic hepatitis. If you have
a history of elevated liver enzymes don't just ignore it. Deal with it. Talk to
your physician and discuss whether or not you should be seen by a hepatologist,
liver specialist.

When getting a referral, please be sure to determine if the doctor you will be seeing has training in liver disease; most gastroenterologists do not have separate training in liver disease as I have.

If you have further concerns or questions, please contact my office to schedule an
appointment, 678-475-1606.