Hepatitis: Summary of The Different Types

Hepatitis is the medical term describing an inflammation of the liver. There are different types and causes of hepatitis, and the severity of each may range from mild to severe. While the most common cause is a viral infection, other causes such as drinking alcohol, consuming harmful medications, drugs, and toxins can also give rise to this condition. 

The treatment depends on its type and cause. For example, viral causes can be prevented through vaccine immunisation while hepatitis caused by alcohol consumption can be prevented through lifestyle changes. 

Epidemiology

Viral infections are the most frequent cause of hepatitis worldwide. In 2015, the World Health Organisation (WHO) estimated that 1 in 3 people were infected by either the hepatitis B or C virus and this resulted in the death of 1.3 million people.

Types of hepatitis

It can be categorised as follows:

• Acute – short-duration illness
• Chronic – an illness that lasts for 6 months or more 

Commonly, acute hepatitis resolves on its own. However, it can also advance to be chronic in nature, which can result in liver injury. 

Causes of hepatitis

Each cause presents uniquely and is treated differently. The principal causes are:

Viral causes

Viral infections are the most common culprits of hepatitis. Five different variants of hepatitis caused by 5 different viral infections can be summarised as:

Hepatitis A

Caused by an infection from the hepatitis A virus (HAV). It is commonly acquired from consuming contaminated food or water and it is usually a short-term illness. 

Hepatitis B

Hepatitis B virus (HBV) can be contracted through exposure to infected bodily fluids, such as blood, vaginal secretions, or semen. Such exposure may occur as a result of unprotected sex with an infected person, using razors of an infected person, or using contaminated needles (by drug users). New-born babies are also susceptible to being infected from their mother. This condition usually progresses to chronic illness and can result in liver damage.

Hepatitis C

This can be transmitted through blood or bodily liquids and is expected to progress to a chronic illness. 

Hepatitis D

This can only affect an individual who has contracted the hepatitis B virus and similarly can only spread to individuals with hepatitis B.

Hepatitis E

This is similar to a hepatitis A infection and can be contracted through food or drinks, it is generally a short-term illness and patients usually recover fully. 

Non-infectious/ non-viral causes

Alcohol and Toxins

Non-infectious hepatitis can be caused by excessive alcohol consumption over many years. Alcohol damages the tissues of the liver and over time this may develop into an irreversible injury which can lead to liver failure and scarring of the liver. Other causes include the consumption of medication that may have side-effects such as paracetamol overdose, statins that lower cholesterol levels, and some antibiotics.

Autoimmune causes

In some instances, the body’s own immune system attacks and damages the liver. This is a type of chronic hepatitis.

Signs and Symptoms

The signs and symptoms differ and can be mild or severe. Symptoms also depend on whether the nature of the illness is acute or chronic. Some examples of symptoms include:

• Yellowing of the skin or eyes 
• Fatigue 
• Pain in the muscles and joints
• Abdominal pain
• Loss of appetite
• Nausea 
• Dark urine and pale stools
• Headache
• Fever 

Diagnosis

Accurate diagnosis begins by obtaining a detailed medical history and physical examination. Following which diagnostic tests are usually ordered by physicians and these include:

Liver Function Tests

These tests are done by obtaining and examining blood samples to determine how effectively the liver is working. Abnormal findings may indicate an ongoing problem with the liver even if the patient is asymptomatic. 

Ultrasound

Ultrasound waves are utilised to produce an image of the internal organs in the abdomen. This can show any abnormalities within the abdomen such as the presence of fluid, an enlarged liver, the presence of excess fats or masses in the liver, and the presence of stones in the gallbladder. 

Liver Biopsy

A biopsy is an invasive method by which the doctor retrieves a sample of tissue from the liver to be able to determine the extent of inflammation and damage to the liver. 

Treatment

Management and treatment of hepatitis depends on the type, severity, and whether the illness is acute or chronic. 

Hepatitis A

This is an acute illness hence treatment is generally not necessary. Bed rest and hydration are usually suggested. Prevention from this infection can be achieved through vaccination. 

Hepatitis B

Acute hepatitis B might not require any particular treatment. However, antiviral medicines are used for treating chronic hepatitis B. Long term treatment is prescribed and regular follow-ups are necessary to check the effectiveness of the treatment. Hepatitis B vaccine is available which helps to prevent the infection and is recommended for everyone including members of the healthcare system.

Hepatitis C

A mixture of antiviral drugs is utilised for the treatment of the acute and chronic types. If severe liver cirrhosis is present, a liver transplant may be necessary. No vaccine is currently approved. 

Autoimmune Hepatitis

Immunosuppressants are drugs which suppress the immune systems and these include corticosteroids like prednisone (prednisolone) or azathioprine are recommended for the treatment of autoimmune hepatitis. 

Complications

Serious and life-threatening problems are common with chronic hepatitis B or C infections. Patients are at an increased risk of progression to chronic liver disease, liver cancer, or liver cirrhosis. Other complications might occur when the liver does not function properly and these include:

• Bleeding  
• An accumulation of fluid in the abdomen (ascites)
• Increased pressure in the blood vessels that enter the liver (portal hypertension)
• Kidney damage
• Hepatic encephalopathy 

Prevention 

Preventative methods are dependent on the type of hepatitis infection:

• In order to prevent hepatitis A or E, individuals are recommended to maintain healthy hygiene habits, such as cooking food properly, drinking boiled or clean water, and avoiding raw or undercooked shellfish and oysters.
• For hepatitis B, C, and D, prevention can be achieved by not sharing drug needles or razors, and avoiding unprotected sex. Individuals are also encouraged to avoid excessive consumption of alcohol and to seek medical attention if they are unable to quit drinking alcohol. 

Consult your doctor if you experience any of the symptoms mentioned above.