HEPATITIS: BEING AWARE OF THE SILENT KILLER
Hepatitis means inflammation of the liver. Its causes can vary greatly from being secondary to a viral infection, side effects of alcohol and certain medications, or it may be due to autoimmune conditions in others.
It is an important condition to know about and have treated where possible, but diagnosis of it is often in late stages – a reason why liver disease is sometimes referred to as the ’silent killer’. In the acute phase an affected person often only has mild symptoms or may be asymptomatic. If severe the symptoms will usually be obvious and treatment rapidly commenced. However, if the hepatitis does go unnoticed – so no help/treatment is sought – the condition may become chronic, leading to scarring of the liver called fibrosis. In turn this can lead to irreversible damage and failure of the liver to function properly – cirrhosis. Such scarring also increases the risk of future liver cancer.
As an affordable private GP practice, London Doctors Clinic aims to help raise awareness of some causes leading to hepatitis. As well as the hepatitis symptoms to look out, we will explain how a hepatitis diagnosis is made and the possible treatments available.
What does the Liver do?
The liver is found in the right sided of the abdomen, just under the ribs, and it has many roles:
- Breakdown of toxins, like alcohol and drugs
- Release of energy from stores/food
- Storage of iron and other vitamins
- Production of clotting factors – to help stop/prevent bleeding
- Production of bile to help carry fats to the intestines and out of the body
- Regulation of many hormones
- Regulation of parts of the immune system
What Causes Hepatitis?
- Vascular – if there is a lack of blood supply to the liver
- Infections – see figure 2 below for the various types of hepatitis infections
- Toxins – alcohol is usually the main culprit as a binge can cause acute hepatitis and long term consumption of high levels of alcohol can cause a chronic hepatitis. Other toxins may include too much Paracetamol or from certain foods like mushrooms
- Autoimmune – a type of hepatitis in which the own body may produce immune cells that ‘attack’ the liver as they do not recognise the liver cells as part of their body
- Metabolic – poor diabetic control can lead to non-fatty steatohepatitis (NASH)
- Iatrogenic – This refers to medically induced hepatitis, which can occur in those taking certain antibiotics (co-amoxiclav, rifampicin…)
- Neoplasm – some cancers (may have spread from elsewhere in the body or started in the liver first) may lead to liver damage
What are the Symptoms of Hepatitis?
Most are not very specific
- Jaundice – yellowing of the skin and whites of the eyes may be seen
- Diarrhoea/Vomiting – if due to Hepatitis A/E usually
- Loss of appetite
- Pain may be felt in the right upper part of the abdomen or at the shoulder tip – if the liver capsule is stretched by swelling of the liver (acutely)
Chronic hepatitis may lead to liver failure, for which symptoms include:
1) Weight/muscle loss
2) Bruising (poorer clotting of the blood)
3) Swelling of the abdomen – fluid accumulate
Types of Hepatitis Infection:
Length of infection:
Faecal/oral (e.g. infected foods/drinks)
Acute only usually
Can be vaccinated against it, although once you’ve had it once you can become immune naturally
Blood-to-blood (healthcare workers, needle sharing in drug use…), sexual routes (oral/anal included), from mother to child at birth, if mother is affected
Acute – many adults can clear the infection naturally, but some become chronically infected.
If a child is infected they have a higher risk of becoming chronically infected.
One of the most infectious blood borne viruses –more so than HIV and hepatitis C
If it becomes chronic then liver cancer risk increases
Vaccination to try and prevent it
‘Safe sex’ – use of condoms to prevent transmission between partners, and regular STD testing
Many anti-virals are available – these are not always effective though
Blood-to-blood, sexual (current high prevalence in men who have sex with men)
Acute – people are rarely able to clear this naturally, so become chronically infected
Higher risk of liver cancers, as it usually becomes chronic and so leads to long term scarring of the liver
No vaccine yet
Regular STD testing
More and more anti-virals are available, but courses are very long – usually >24 weeks and are still not always effective
Can only acquire if already have Hepatitis B (via blood to blood/sexual contact)
This is a ‘superinfection’ on top of existing hepatitis B
Can make the hepatitis more severe – with increased risk of liver failure
Highest fatality of the hepatitis infections
Need to clear the hepatitis B – harder when there is co-infection with D though
Acute only usually (days)
If pregnant – increased risk of a miscarriage
Usually cleared alone by the immune system
Diagnosis of Hepatitis:
Diagnosis using a blood test is usually the first step. A liver function test will show high levels of a marker called Alanine Transaminase (ALT) – if high this can show that there has been damage to liver cells and that they have broken down. If due to the harmful effects of alcohol levels of other markers may be raised too – γ-GT.
There may further blood tests depending to try and see what the cause of the hepatitis is. For example looking at whether there are particles of one of the viruses in the affected person’s body or if immune cells against one of the viruses are found – showing that the person has been infected with it in the past, but managed to clear the infection. Other immune cells may be looked at to see if it is an autoimmune hepatitis – like high levels of IgG and auto-antibodies like anti-smooth muscle antibody.
The treatments are mentioned in the table above, but for other types of hepatitis treatment depends on the cause. For example – if due to medications these may simply need to be stopped, but in some severe cases hospitalisation and transplantation is needed. Others still may need immunosuppressant drugs like steroids initially and then Azathioprine. However, all of these will be decided on and started by a specialist hepatologist, once a specialist referral has been made.
The symptoms of hepatitis can be vague, so greater awareness of what to look out for, and what may cause it, is needed. If you're at all concerned about hepatitis, book in today for a consultation with one of our experienced private doctors. We offer a variety of blood tests for hepatitis, for both infection and immunity.
For more information please also visit the British Liver Trust.
By Dr Marianne Phillips