Hepatitis

What is hepatitis?

Hepatitis means inflammation of the liver. Inflammation is the body’s response to injury or infection, and when it happens in the liver it can interfere with the organ’s many jobs, such as filtering the blood, storing energy, producing proteins that help blood clot, and processing medicines and alcohol. The word hepatitis describes the inflammation itself rather than a single disease, because it can have several different causes.

Hepatitis can be acute or chronic. Acute hepatitis develops over a short period and often settles within a few weeks or months. Chronic hepatitis lasts longer than six months and, over years, may lead to scarring of the liver (fibrosis), severe scarring (cirrhosis), liver failure or, in some people, liver cancer. Whether an episode becomes chronic depends largely on the cause.

Hepatitis affects people of all ages and backgrounds worldwide. Viral hepatitis, caused by the hepatitis A, B, C, D and E viruses, is the most widely discussed form, but the liver can also become inflamed because of heavy alcohol use, excess fat in the liver, certain medicines, and conditions in which the immune system attacks the liver. In most hospitals, including Acibadem, hepatitis is assessed and managed by the Gastroenterology department, sometimes together with infectious disease specialists and liver (hepatology) teams.

Hepatitis symptoms

Many people with hepatitis, especially chronic viral hepatitis, have no symptoms at all for a long time. This is one reason the condition is often discovered during routine blood tests or screening rather than because someone felt unwell. When hepatitis symptoms do appear, they can be vague and easily mistaken for a flu-like illness.

Common hepatitis symptoms include:

• Tiredness or a general feeling of being unwell
• Loss of appetite and nausea, sometimes with vomiting
• Pain or discomfort in the upper right part of the abdomen, where the liver sits
• Low-grade fever
• Jaundice, a yellowing of the skin and the whites of the eyes
• Dark urine and pale or clay-colored stools
• Itchy skin
• Joint or muscle aches

Jaundice happens when the liver cannot properly clear bilirubin, a yellow substance made when old red blood cells are broken down. It is one of the more recognizable signs of liver inflammation, but not everyone with hepatitis develops it.

Symptoms can differ by type and stage. Hepatitis A and E often cause a sudden illness with fever, nausea and jaundice that usually resolves on its own. Acute hepatitis B may cause similar symptoms, although many adults notice little or nothing. Hepatitis C is frequently silent in its early phase and may only become apparent decades later when the liver is already damaged. In chronic hepatitis of any cause, later-stage signs can include swelling of the abdomen or legs due to fluid buildup, easy bruising or bleeding, confusion or drowsiness, and weight loss. These later signs suggest the liver is struggling and should always be evaluated promptly.

Causes and risk factors

Understanding hepatitis causes helps explain why treatment and outlook vary so much from one person to another. The main groups are outlined below.

Viral infections. Five main viruses are named for the liver disease they cause:

• Hepatitis A spreads mainly through food or water contaminated with stool from an infected person, or through close contact. It causes acute illness and does not become chronic.
• Hepatitis B spreads through blood, semen and other body fluids, for example through unprotected sex, sharing needles, or from mother to baby around the time of birth. It can become chronic, particularly when acquired in infancy.
• Hepatitis C spreads mainly through blood-to-blood contact, such as sharing injecting equipment, unsterile medical or tattooing equipment, or, historically, blood transfusions before screening became routine. It often becomes chronic.
• Hepatitis D only occurs in people who already have hepatitis B and can make liver disease more severe.
• Hepatitis E is usually spread through contaminated water and typically causes a short-lived illness, although it can be more serious in pregnancy or in people with weakened immunity.

Alcohol. Heavy drinking over time can inflame and damage liver cells, a condition called alcoholic hepatitis. It ranges from mild to life-threatening.

Fat in the liver. Excess fat stored in liver cells, often linked with obesity, type 2 diabetes and high cholesterol, can trigger inflammation. This is known as metabolic dysfunction-associated steatohepatitis (previously called non-alcoholic steatohepatitis).

Medicines, supplements and toxins. Some prescription drugs, over-the-counter painkillers taken in excess (such as acetaminophen), certain herbal products, and industrial chemicals can injure the liver.

Autoimmune hepatitis. In this condition the immune system mistakenly attacks the liver. It is more common in women and may be associated with other autoimmune diseases.

Other causes. Less commonly, other infections, inherited conditions such as Wilson disease or hemochromatosis, or reduced blood flow to the liver can cause inflammation.

Risk factors depend on the cause but commonly include:

• Unprotected sex with a partner whose hepatitis status is unknown, or multiple partners
• Sharing needles, syringes or other drug-injecting equipment
• Receiving tattoos, piercings or medical procedures with equipment that was not properly sterilized
• Being born to a mother with hepatitis B or C
• Travel to or residence in regions where hepatitis A, B or E is common, especially with limited access to clean water
• Working in healthcare or other jobs with exposure to blood
• Heavy or long-term alcohol use
• Obesity, type 2 diabetes or metabolic syndrome
• Having HIV or another condition that weakens the immune system
• A personal or family history of autoimmune disease

Hepatitis diagnosis

Because symptoms are often absent or nonspecific, hepatitis diagnosis relies mainly on laboratory tests. Your doctor will usually begin by asking about your symptoms, medical history, medicines and supplements, alcohol use, travel, and possible exposures, and by examining you for signs such as jaundice, an enlarged liver or tenderness in the abdomen.

Tests that may be used include:

• Liver function tests. These blood tests measure liver enzymes such as ALT and AST, which rise when liver cells are injured, as well as bilirubin, albumin and clotting factors, which reflect how well the liver is working.
• Viral hepatitis blood tests. Specific tests look for antibodies (proteins the immune system makes against a virus) and antigens or viral genetic material (RNA or DNA). They can show whether an infection is current or past, whether it is acute or chronic, and, for hepatitis B and C, how much virus is present in the blood (the viral load).
• Autoimmune and other blood tests. Antibody tests may point to autoimmune hepatitis, while iron and copper studies can screen for inherited causes.
• Imaging. An ultrasound scan is a common first step to look at the liver’s size, texture and blood flow and to check for fat, scarring or masses. CT or MRI scans may be used when more detail is needed.
• Elastography. A specialized ultrasound- or MRI-based test measures liver stiffness, which helps estimate the degree of scarring without a biopsy.
• Liver biopsy. In some cases a small sample of liver tissue is removed with a needle and examined under a microscope. This can confirm the cause, grade the inflammation and stage the amount of scarring when other tests are inconclusive.

Screening is also part of diagnosis. Health authorities in many countries recommend that all adults be tested at least once for hepatitis B and C, and more often if they have ongoing risk factors, because early detection allows treatment before serious damage occurs.

Hepatitis treatment options

Hepatitis treatment options depend on the cause, whether the condition is acute or chronic, and how much the liver has already been affected. Your doctor will explain which approach fits your situation.

Observation and supportive care. Acute hepatitis A and E, and many cases of acute hepatitis B, usually clear on their own. Treatment focuses on rest, fluids, adequate nutrition, avoiding alcohol and avoiding medicines that may stress the liver. Doctors typically monitor blood tests until they return to normal. Hospital care may be needed if someone is dehydrated, very unwell or shows signs of liver failure.

Antiviral medications. Chronic hepatitis C can, in many cases, be cured with a course of direct-acting antiviral tablets taken over several weeks. Chronic hepatitis B generally cannot be fully eliminated, but long-term antiviral medicines can suppress the virus, reduce liver inflammation and lower the risk of cirrhosis and liver cancer. Not everyone with hepatitis B needs treatment immediately; some people are monitored regularly and start medication if the virus becomes more active. Treatment for hepatitis D is more limited and is an area of ongoing research.

Immune-suppressing medications. Autoimmune hepatitis is usually treated with corticosteroids, often combined with other drugs that calm the immune system. Many people need long-term maintenance therapy and periodic blood tests to check for relapse.

Treating the underlying cause. For alcoholic hepatitis, stopping alcohol completely is the most important step, and support programs, counseling and sometimes medication are offered to help. Severe alcoholic hepatitis may be treated with corticosteroids in the hospital. For fat-related hepatitis, gradual weight loss through diet and physical activity, and good control of diabetes and cholesterol, form the foundation of care; medicines are becoming available for some patients. For drug-induced hepatitis, the responsible medicine is stopped under medical supervision.

Managing complications. When cirrhosis has developed, treatment aims to prevent and manage complications. This may include medicines to reduce fluid buildup, procedures to control bleeding from enlarged veins in the esophagus, and regular ultrasound and blood tests to screen for liver cancer.

Liver transplantation. When the liver fails or cancer develops and other treatments are no longer effective, a liver transplant may be considered. This is major surgery followed by lifelong medication to prevent rejection, and eligibility is assessed carefully by a specialist team.

Vaccination for protection. Although vaccines are prevention rather than treatment, people with one form of chronic hepatitis are often advised to be vaccinated against hepatitis A and B if they are not already immune, to avoid additional strain on the liver.

Living with hepatitis and outlook

The outlook for hepatitis varies widely. Most people with acute hepatitis A or E recover fully without lasting liver damage. Many adults who acquire hepatitis B clear the virus on their own, although infection acquired in early childhood is more likely to become chronic. Hepatitis C frequently becomes chronic, but modern antiviral treatment cures the infection in the great majority of people who complete a course, which markedly lowers the risk of future liver problems. Chronic hepatitis of any cause carries a risk of progressive scarring, but this often develops slowly, and early diagnosis and treatment can reduce or sometimes halt progression.

Day-to-day, people living with chronic hepatitis are generally advised to:

• Avoid alcohol, or discuss with their doctor whether any amount is safe
• Check with a doctor or pharmacist before taking new medicines or herbal supplements
• Eat a balanced diet and aim for a healthy weight
• Keep up with scheduled blood tests, imaging and specialist appointments
• Take prescribed antiviral or immune-suppressing medicines exactly as directed
• Stay up to date with recommended vaccinations

For viral hepatitis, simple steps help protect others: not sharing razors, toothbrushes or needles, covering cuts, practicing safer sex, and informing healthcare providers of your diagnosis. Close household contacts and sexual partners are often offered testing and vaccination. Hepatitis is not spread by hugging, sharing meals, coughing or sneezing, and most people can continue to work, study and enjoy normal social life.

A chronic diagnosis can be emotionally difficult, and feelings of worry, guilt or isolation are common. Talking with your care team, a counselor or a patient support group may help.

Frequently asked questions

What is hepatitis and is it always caused by a virus?

Hepatitis simply means inflammation of the liver. Viruses are a very common cause, but the liver can also become inflamed because of heavy alcohol use, fat buildup in the liver, certain medicines or supplements, toxins, and autoimmune disease. Identifying the cause is essential because it determines both the treatment and the likely outcome.

What are the first hepatitis symptoms people notice?

Early hepatitis symptoms, when present, are often tiredness, loss of appetite, nausea, mild fever and discomfort in the upper right abdomen. Jaundice, dark urine and pale stools may follow. However, many people, particularly those with chronic hepatitis B or C, have no symptoms for years, so the absence of symptoms does not rule out the condition.

How is hepatitis diagnosed if I feel well?

Hepatitis diagnosis in someone without symptoms usually starts with blood tests, either as part of routine screening or because liver enzymes were found to be raised on an unrelated test. If results suggest liver inflammation, further blood tests to identify the cause, an ultrasound scan and sometimes elastography or a biopsy may be arranged.

Can hepatitis be cured?

It depends on the type. Acute hepatitis A and E almost always resolve on their own. Chronic hepatitis C is now curable in most people with a course of antiviral tablets. Chronic hepatitis B can usually be controlled but rarely eliminated completely. Autoimmune hepatitis can often be kept in remission with medication. Alcohol- and fat-related hepatitis may improve substantially when the underlying cause is addressed.

What hepatitis treatment options are available for chronic infection?

For chronic hepatitis B, long-term antiviral medicines can suppress the virus and protect the liver. For chronic hepatitis C, direct-acting antiviral tablets are taken for a set number of weeks. Regular monitoring, vaccination against other hepatitis viruses, avoiding alcohol and, where scarring is advanced, screening for complications are also part of care. Your doctor will tailor the plan to your test results.

How can I avoid getting hepatitis?

Safe and effective vaccines exist for hepatitis A and B, and the hepatitis B vaccine also protects against hepatitis D. Other measures include practicing safer sex, never sharing needles or personal items that may carry blood, choosing licensed tattoo and piercing providers, washing hands and being careful with food and water when traveling, drinking alcohol within recommended limits or not at all, and maintaining a healthy weight.

Does hepatitis always lead to cirrhosis or liver cancer?

No. Most acute cases resolve completely, and many people with chronic hepatitis never develop cirrhosis, especially if the condition is found early and treated or the cause is removed. That said, untreated long-standing inflammation does raise the risk of scarring and cancer over time, which is why regular follow-up is recommended even when you feel well.

When to see a doctor

You should arrange to see a doctor if you notice yellowing of the skin or eyes, dark urine, pale stools, persistent tiredness, or ongoing pain in the upper right abdomen, or if you learn that you may have been exposed to hepatitis through a contact, needle-stick injury or travel. Anyone with risk factors who has never been tested for hepatitis B or C may wish to ask about screening.

Seek urgent medical care if you or someone you are with has any of the following warning signs, which may indicate liver failure or another emergency:

• Confusion, unusual drowsiness or difficulty staying awake
• Vomiting blood or passing black, tarry stools
• Severe or rapidly worsening abdominal pain or swelling
• Rapidly deepening jaundice
• Bleeding that will not stop, or widespread bruising
• Inability to keep fluids down, with signs of dehydration
• High fever with shaking chills in someone with known liver disease
• Suspected overdose of acetaminophen or another medicine

Early assessment allows the cause to be identified and treatment, when needed, to begin before lasting damage develops.