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Dictionary The Digestive System

Hepatitis

Synonyms :  infectious hepatitis, 'delta?virus

Clinical features, Diagnosis, Management, Prognosis, Nutrition, Herbs,

ACUTE LIVER DISEASE

In acute liver disease there is sudden widespread liver damage in which variable numbers of hepatocytes undergo necrosis (death)

Common causes:

           viral infections (hepatitis A, B, C, D and E)

           drugs (such damage may be dose-related and predictable due to direct toxic effects such as with paracetamol overdose, or unrelated to dose and unpredictable idiosyncratic such as with inhalation anaesthetic halothane); most drugs are more likely to produce chronic liver damage

           poisons (mushrooms-amanita phalloides or chemical toxins-carbon tetrachloride, trichlorethylene, phosphorus)

           ischaemic (shock or severe cardiac failure)

Hepatitis A

Hepatitis A, long known as ‘infectious hepatitis?/i>, is a benign, self-limited disease that does not cause chronic hepatitis or a carrier state and only rarely causes serious hepatitis. HAV is an RNA virus that occurs throughout the world and is endemic in countries with substandard hygiene and sanitation. Clinical disease tends to be mild or even asymptomatic and rare after childhood.  

HAV is spread by ingestion of contaminated water and food and is eliminated in the stool. Thus, close personal contact with an infected individual or faecal-oral spreading account for most cases and explains the outbreaks in institutional settings such as schools and nurseries. Waterborne epidemics occur in developing countries where people live in overcrowded, unsanitary conditions. HAV is not excreted in any significant quantities in saliva, urine, or semen. Among developed countries, sporadic infections may be contracted by the consumption of raw or steamed shellfish (oysters), which concentrate the virus from sea water contaminated with human sewage. Blood-borne transmission of HAV practically does not occur and, therefore, donated blood is not specifically screened for this virus.  

Infection in the community is best prevented by improving social conditions. Vaccine is available and is recommended for overseas travellers to certain countries where the disease is more prevalent.

Hepatitis B

Hepatitis B virus is a DNA virus. Blood is the main source of infection and spread may follow transfusion of infected blood or blood products or injections/injuries with contaminated needles, a mode of spread most common among intravenous drug abusers (IDUs) who share needles. Due to careful testing, blood and blood products are now rare source of infection.  

Tattooing, body piercing or acupuncture can also spread this disease if inadequately sterilised needles are used, and the same applies to surgical and dental procedures. The virus can be found in body fluids such as saliva, urine, semen and vaginal secretions. Sexual intercourse, especially in male homosexuals, is an important route. Vaccine consisting of HBsAg produced through recombinant DNA technology given in 3 injections over 6 months is available and is reported to give quite a high degree of protection. Persons at risk for whom immunisation should be considered: infants born to HBsAg positive mothers, health care workers who may be exposed to blood, IDUs, household and sex contacts of persons with chronic HBV infection, men who have sex with men and hemodialysis patients.

Hepatitis C

The major routes of HCV transmission are similar to hepatitis B (inoculations and blood transfusion). In most countries donated blood is tested for HCV, therefore the main mode of transmission is through sharing needles and syringes among IDUs. Transmission from mother to a baby has been documented; transmission by sexual contact appears to be extremely low. Tattooing and body piercing with unsterile instruments is also a possible route.  

Only 10% of infected develop signs and symptoms of acute hepatitis and in the remaining 90% there are no symptoms at acquisition. 20% of all infected manage to clear HCV, but 80% develop asymptomatic or symptomatic chronic liver disease and 25% of these eventually develop cirrhosis and 5% liver cancer. Thus, HCV may in fact be one of the leading causes of chronic liver disease in the Western world. Current estimates for Australia are 200,000 infected and 35 new infections every day! HCV is very unstable, and multiple types and subtypes have been documented (currently numbering more than 40). This variability has seriously delayed efforts to develop an HCV vaccine.

Hepatitis D

Hepatitis D virus (also called ‘delta?virus) has no independent existence, it requires the hepatitis B virus for replication and has the same sources and modes of spread as that virus. It can infect individuals simultaneously with the hepatitis B virus, or it can superinfect those who are already chronic carriers of the hepatitis B virus. 

Hepatitis E

HEV hepatitis is an enterically transmitted infection similar to hepatitis A. It occurs primarily in young to middle-aged adults; sporadic infection and overt illness in children are rare. In most cases, the disease is self-limiting, and HEV is not associated with chronic liver disease.  

Clinical features:  < BACK TO TOP >

           In the beginning (prodromal phase) patients usually complain of non-specific symptoms such as chills, fatigue, Headaches,  malaise, arthralgia.

           Then they develop gastrointestinal problems such as Anorexia, Nausea, vomiting and Diarrhoea.

           Steady upper abdominal discomfort or pain as a result of liver swelling and stretching of the liver capsule is frequently reported.

           The liver may be tender and enlarged on palpation.

           Most patients after 1-2 weeks develop jaundice (icteric phase), accompanied by dark urine and pale stools. However mild illnesses may run a course without jaundice (anicteric hepatitis).

           Complete clinical recovery is to be expected in 6-8 weeks in all cases of hepatitis A, in 80% of cases of hepatitis B but in only 20% of cases of hepatitis C.

           The remainder of cases of HBV and HCV develop various forms of asymptomatic or symptomatic chronic hepatitis that can progress to hepatic cirrhosis.

Diagnosis:  < BACK TO TOP >

           A plasma aminotransferase (ALT and AST) activity exceeding 400 units/L (normally up to 40 U/L), even before jaundice develops, is the most striking abnormality (it does not however correlate well with the degree of liver cell damage).

           The plasma bilirubin (both types conjugated and unconjugated) is variably modestly or markedly elevated.

           Alkaline phosphatase activity rarely exceeds 250 units/L (normally up to 100 U/L), reflecting mild intrahepatic cholestasis.

           Albumin concentration is normal, whereas mild to moderate prolongation of prothrombin time could be found.

           Bilirubinuria is an early finding, occurring in the prodromal (initial) phase and usually continuing into the convalescent period.

           The white cell count is normal or low (neutropenia) in most cases.

           Serological tests described earlier can identify the particular virus causing the illness and also can help distinguish between past and current infection.

    Hepatitis A: IgM-anti-HAV (IgG-anti-HAV is a marker of past exposure and does not indicate current infection)

    Hepatitis B: it is usual to find HBsAg with HBeAg (high grade carrier) or without HBeAg (low grade carrier), as well as IgM-anti-HBc (IgG-anti-HBc can persist for years after recovery); anti-HBe can also be found in acute disease and disappears during convalescence; anti-HBs starts to rise only after disappearance of HBsAg and it persists for years/decades conferring immunity.

    Hepatitis C: anti-HCV

Management  < BACK TO TOP >

           There is no specific treatment for acute viral hepatitis.

           Although hospitalisation may be required for clinically severe illness, most patients do not require hospital care.

           When symptoms are marked, bed-rest should be advised and continued until symptoms and signs have disappeared and liver function tests have returned substantially towards normal.

           A nutritious diet, rich in protein is given, the content being dictated largely by patient’s wishes.

           Drugs should be avoided especially in severe hepatitis because many are metabolised in the liver.

           Alcohol must be avoided during the illness and should not be taken in the following 6 months.

           The overall mortality of acute viral hepatitis is about 0.5%, hepatitis B, C and D accounting for most fatalities.

           The most feared outcome of viral hepatitis is fulminant hepatitis (massive hepatic necrosis), which is a rare event primarily seen in hepatitis B and D.

           Avoid orange

Prognosis  < BACK TO TOP >

  • -

Nutrition < BACK TO TOP >

Nutrition that alleviate or prevent Hepatitis :-
Folic acid, Selenium, Zinc, Vitamin B complex, Vitamin B6, Vitamin B12, Vitamin C, beta-carotene, Vitamin E,

Herbs < BACK TO TOP >

Herbs that alleviate or prevent Hepatitis :-
Andrographis paniculata (Andrographis), Astragalus membranaceus (Astragalus root), Camellia sinensis (Green Tea), Curcuma longa (Turmeric), Cynara scolymus (Globe artichoke), Echinacea purpura (Coneflower), Eclipta alba (Eclipta), Glycyrrhiza glabra (Licorice), Hydrastis canadensis (Goldenseal), Lentinus edodes (Shiitake), Schisandra chinensis (Schizandra berry), Scutellaria baicalensis (Chinese Scullcap), Picrorhiza kurroa (Katuka), Phyllanthus amarus (Phyllanthus) - Hepatitis B, Silybum marianum (Milk thistle)

(source : -)

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