Hepatitis refers to an inflammatory condition of the liver. It’s commonly caused by viral infection. The disease can lead to fibrosis (scarring), cirrhosis or liver cancer. Hepatitis viruses are the most common cause of this inflamatory disease but other infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune diseases can also cause it.
There are 5 main viruses, these are A, B, C, D and E. In particular, type B and C lead to chronic disease and most common cause of liver cirrhosis and cancer.
Type A and E are typically caused by ingestion of contaminated food or water.
Type B, C, and D caused by parenteral contact with infected body fluids. Common modes of transmission for these viruses include ingestion of contaminated blood or blood products, contaminated equipment and for type B transmission from mother to baby at birth, from family member to child, and also by sexual contact.
Acute infection may occur with limited or no symptoms or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.
Normal functions of the liver:
Incubation period of Hepatitis
Type A = 14-28 days.
Type B = 4-6 months
Type C = 2 weeks – 6 months.
Type D = 45-160 days.
Type E = 30-40 days.
What Causes Hepatitis?
Causes of this inflammatory of liver can be divided into the following categories:
Infectious agents include viruses, bacteria, and parasites. Toxins, drugs, alcohol, and non-alcoholic fatty liver disease are metabolic causes of liver injury and inflammation. Autoimmune and genetic causes of this disease involve genetic predispositions.
1) Viral hepatitis
Viral hepatitis is the most common type of the disease. It is caused by five different viruses (type A, B, C, D, and E). Hepatitis A and hepatitis E both transmitted by the fecal-oral route, are more common.
Hepatitis B, hepatitis C, and hepatitis D are transmitted when blood or mucous membranes are exposed to infected blood and body fluids, such as semen and vaginal secretions. Viral particles have also been found in saliva and breastmilk.
2) Parasitic hepatitis
Parasites can also infect the liver and activate the immune response, resulting in symptoms of acute hepatitis with increased serum IgE(through chronic hepatitis is possible with chronic infections).The protozoans, Trypanosoma cruzi, Leishmania species, and the malaria-causing Plasmodium species all can cause liver inflammation. Another protozoan, Entamoeba histolytica, causes this disease with distinct liver abscesses.
3) Bacterial hepatitis
Bacterial infection of the liver commonly results in pyogenic liver abscesses, acute hepatitis, or granulomatous (or chronic) liver disease.Pyogenic abscesses commonly involve enteric bacteria such as Escherichia coli and Klebsiella pneumonia and are composed of multiple bacteria up to 50% of the time. Acute hepatitis is caused by Neisseria meningitis, Neisseria gonorrhoeae.
4) Alcoholic hepatitis:
Excessive alcohol consumption is a significant cause of this inflammatory disease and is the most common cause of cirrhosis of the liver. The most important risk factors for the development of alcoholic hepatitis are quantity and duration of alcohol intake. Long-term alcohol intake in excess of 80 grams of alcohol a day in men and 40 grams a day in women is associated with the development of alcoholic hepatitis (1 beer or 4 ounces of wine is equivalent to 12g of alcohol). This type can vary from asymptomatic hepatomegaly (enlarged liver) to symptoms of acute or chronic hepatitis to liver failure. Toxic and drug-induced hepatitis
5) Toxic and drug-induced hepatitis
Many chemical agents, including medications, industrial toxins, and herbal and dietary supplements, can cause this disease.Toxins and medications can cause liver injury through a variety of mechanisms, including direct cell damage, disruption of cell metabolism, and causing structural changes.
Some drugs such as paracetamol exhibit predictable dose-dependent liver damage while others such as isoniazid cause idiosyncratic and unpredictable reactions that vary among individuals. Exposure to other hepatotoxins can occur accidentally or intentionally through ingestion, inhalation, and skin absorption.
6) Non-alcoholic fatty liver disease
Non-alcoholic hepatitis is within the spectrum of non-alcoholic liver disease (NALD), which ranges in severity and reversibility from non-alcoholic fatty liver disease (NAFLD) to non-alcoholic steatohepatitis (NASH) to cirrhosis to liver cancer, similar to the spectrum of alcoholic liver disease.
The non-alcoholic liver disease occurs in people with little or no history of alcohol use and is instead strongly associated with metabolic syndrome, obesity, insulin resistance and diabetes, and hypertriglyceridemia.The non-alcoholic fatty liver disease can progress to non-alcoholic steatohepatitis, which additionally involves liver cell death, liver inflammation, and possible fibrosis.
7) Autoimmune Hepatitis
Autoimmune hepatitis is a chronic disease caused by an abnormal immune response against liver cells.The disease is thought to have a genetic predisposition as it is associated with certain human leukocyte antigens involved in the immune response
Autoimmune hepatitis can present anywhere within the spectrum from asymptomatic to acute or chronic hepatitis to fulminant liver failure. Patients are asymptomatic 25–34% of the time, and the diagnosis is suspected on the basis of abnormal liver function tests.Up to 40% of cases present with signs and symptoms of acute hepatitis. As with other autoimmune diseases, autoimmune type of such infection usually affects young women (though it can affect patients of either sex of any age), and patients can exhibit classic signs and symptoms of autoimmunity such as:
Nephritis and maculopapular rash.
8) Genetic Hepatitis
Genetic causes of hepatitis include alpha-1-antitrypsin deficiency, hemochromatosis, and Wilson’s disease.In alpha-1-antitrypsin deficiency, a co-dominant mutation in the gene for alpha-1-antitrypsin results in the abnormal accumulation of the protein within liver cells, leading to liver disease. Hemochromatosis and Wilson’s disease are both autosomal recessive diseases involving abnormal storage of minerals. In hemochromatosis, excess amounts of iron accumulate in multiple body sites, including the liver, which can lead to cirrhosis. In Wilson’s disease, excess amounts of copper accumulate in the liver and brain, causing cirrhosis and dementia.
9) Ischemic hepatitis
Ischemic hepatitis (also known as shock liver) results from reduced blood flow to the liver as in shock, heart failure, or vascular insufficiency.The condition is most often associated with heart failure but can also be caused by shock or sepsis. Blood testing of a person with this type of the virus will show very high levels of transaminase enzymes (ASTand ALT). The condition usually resolves if the underlying cause is treated successfully. This form or type of infection rarely causes permanent liver damage.
Hepatitis can also occur in neonates. Congenital or perinatal infection with the disease’s viruses, toxoplasma, rubella, cytomegalovirus, and syphilis can cause neonatal hepatitis. Structural abnormalities such as biliary atresia and choledochal cysts can lead to cholestatic liver injury leading to neonatal hepatitis. Metabolic diseases such as glycogen storage disorders and lysosomal storage disorders are also implicated.
Neonatal hepatitis can be idiopathic, and in such cases, biopsy often shows large multinucleated cells in the liver tissue. This disease is termed giant cell hepatitis and may be associated with viral infection, autoimmune disorders, and drug toxicity.
What Are The Different Types?
There are 5 types of this inflammatory disease: A, B C, D and E
How is it Transmitted?
Hepatitis A: In this type, the virus is transmitted primarily by the faecal-oral route; ingests food or water that has been contaminated with the feces of an infected person. The virus can also be transmitted through close physical contact with an infectious person.
The hepatitis A virus is transmitted primarily by the fecal-oral route; ingests food or water that has been contaminated with the feces of an infected person. The virus can also be transmitted through close physical contact with an infectious person.
This type is transmitted through contact with infectious body fluids, such as blood, vaginal secretions, or semen, containing the hepatitis B virus (HBV). Injection drug use, having sex with an infected partner, or sharing razors with an infected person and mother to baby at birth, The HBV can survive outside the body for at least 7 days. During this time, the virus can still cause infection if it enters the body of a person who is not protected by the vaccine.
This type comes from the hepatitis C virus (HCV). It is transmitted through direct contact with infected body fluids, typically through injection drug use and sexual contact. HCV is among the most common bloodborne viral infections Many people withthis disease have no symptoms.
Also called delta hepatitis, this type of inflammatory condition is a serious liver disease caused by the hepatitis D virus (HDV). HDV is transmitted through direct contact with infected blood. Type D is a rare form of the disease. The HDV can’t multiply without the presence of hepatitis B.
This type is a waterborne disease caused by the hepatitis E virus (HEV). This type is mainly found in areas with poor sanitation and typically results from ingesting fecal matter that contaminates the water and through the consumption of uncooked or undercooked meat.
Sign and Symptoms
Sign and Symptoms of Hepatitis A virus:
Sign and Symptoms of Hepatitis B virus:
Sign and Symptoms of Hepatitis C virus:
Sign and Symptoms of Hepatitis D virus:
Sign and Symptoms of Hepatitis E virus:
Investigations To Be Done ?
1) Serum Bilirubin
2) Serum Transaminases
3) Blood Urea
4) Serum Creatine
5) Complete Blood Count
6) Liver Function Test
7) USG of abdomen
8) CT scan
9) Liver Biopsy
What Are The Risk Factors
How To Prevent the disease?
4) Carduus mar
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