Hepatitis is an inflammation of the liver. Liver is one of vital organs and largest internal solid organ. Liver has large blood supply and functions as a chemical factory removing many unwanted substances from the body. This exposes  liver to many insults including infections, drugs or toxins . When liver is inflamed,  the levels of liver enzymes in blood is increased.  Hepatitis is a common cause of jaundice, but may present without jaundice or any other symptoms.

There are many types of Hepatitis. These are identified as Hepatitis A, B, C, D, E and G.

Hepatitis can be acute (lasting less than 6 months) or chronic (lasting more than 6 months). It can be self-limiting without permanent liver damage or may  cause a liver failure, cirrhosis of liver or liver cancer. Hepatitis E can be a serious disease during pregnancy.

Causes

There are several causes for hepatitis. The most common causes are listed below:

Viruses:

• Hepatitis A and E are transmitted by contaminated water and food. So poor sanitary and hygienic conditions help spread the infection. However these viruses do not lead to chronic hepatitis.
• Hepatitis B (with or without Hepatitis D) is transmitted by body fluid (unprotected sex, needle sharing, blood transfusion) and mother to fetus/child.
• Hepatitis C is transmitted by body fluid.
• Epstein-Barr virus.
• Herpes simplex virus.
• Human immunodeficiency virus (HIV).

Drugs/toxins:

• Anti tuberculosis drugs.
• Paracetamol (acetaminophen) overdose.
• Alcohol.
• Antiepileptic (valproate).
• Mushroom poisoning.

Other causes:

• Poor blood flow to the liver: due to low blood pressure or blockage in blood vessels cause ischemic hepatitis.
• Autoimmune hepatitis-  body’s own defense system attacks the liver
• Hereditary: Wilson disease (excess copper deposition)

Symptoms

Hepatitis due to virus does not cause symptoms most of the time. Majority of those who have symptoms will recover — only small number progress to  liver failure or chronic hepatitis. Some of the symptoms are:

• Anorexia, vomiting and nausea.
• Jaundice.
• Pain upper abdomen.
• Rashes, arthritis and fever is seen in some patients.

When to seek care

If you notice any of the following signs, you should seek medical care:

• Jaundice.
• Disturbed sleep pattern.
• Confusion, agitation, abnormal behavior.
• Fits (seizures), unconsciousness.
• Lethargy.
• Abnormal bleeding.

Diagnosis

Hepatitis is diagnosed by history, physical exam and these tests:

• Blood test — can tell us the cause of hepatitis.
• Imaging —  An ultrasound of the liver.

Treatment options

Treatment of hepatitis depends upon its cause.

• All cases of hepatitis are managed with supportive care – Adequate hydration and nutrition.
• Stopping alcohol and drugs causing hepatitis.
• Antidote for toxin when available – Acetylcysteine for Acetaminophen toxicity.
• Antiviral medicine for Hepatitis B and C.
• Hepatitis during pregnancy requires close monitoring.

Preventive measures

• Hepatitis A vaccine is available for children above one year of age. It is not included in the Expanded Program on Immunization (EPI) or most government-supplied vaccines yet. It is also used by travelers to endemic areas. Immunoglobulin is used before and after exposure to Hepatitis A when person is not previously immunized.
• Hepatitis B vaccine has been incorporated in EPI schedule. High risk adults including medical professionals, who haven’t been immunized previously need vaccination. In case of accidental needle-stick injury or newborn babies of Hepatitis B positive mothers, hepatitis immunoglobulin is needed.
• Hepatitis A and E can be prevented by avoiding contaminated water and food and by adopting proper sanitation and hygiene.
• Hepatitis B and C can be prevented by practicing safe sex habits, avoiding needle sharing and by screening blood before transfusions.
• Liver function should be checked before taking anti TB medications and patients should report any signs of liver disease to the doctor.
• Do not drink alcohol.