THE LIVER

Liver is responsible for many critical functions within the body. It helps your body digest food, store energy, and remove poisons. If it becomes diseased or injured, the loss of those functions can cause significant damage to the body. There are over 100 different forms of liver disease that affect men, women and children. These diseases include cirrhosis, alcohol abuse, hepatitis A, B, C, D, and E, Epstein Barr virus (infectious mononucleosis), non-alcoholic fatty liver disease and iron overload (hemochromatosis). The main symptoms of liver imbalance include weakness and fatigue, weight loss, nausea, vomiting, and yellow discoloration of the skin (jaundice).

  • Alcoholic and Non-alcoholic Liver diseases
  • Hepatic encephalopathy
  • Fatty liver Disease
  • Primary Biliary Cirrhosis
  • Nonalcoholic Steatohepatitis
  • Acute and Chronic Liver Disease
  • Fulminant Liver failure
  • Liver Cirrhosis
  • Hepatotoxicity

What Is Hepatitis?

Inflammation of the liver of any cause is referred to as hepatitis. It may be caused by viruses, drugs, or alcohol, although the most common cause is viruses, viral hepatitis. There are several types of viral hepatitis, the most common of which are hepatitis A, B, and C.


Symptoms of Hepatitis

Very frequently the onset of hepatitis, the acute phase, is not associated with symptoms or signs, but when they do occur they are usually general and include fatigue, nausea, decreased appetite, mild fever, or mild abdominal pain. Later signs more specific for liver disease may occur, specifically yellowing of the skin and eyes (jaundice) and darkening of the urine. If the infection becomes chronic as is the cause with hepatitis B and C, that is, lasting longer than months, the symptoms and signs of chronic liver disease may begin. At this point the liver often is badly damaged.


What Happens with Hepatitis A?

Viral diseases generally are contagious. Hepatitis A is highly contagious. It usually is spread from person to person via a fecal-oral route, meaning via fecal contamination of food. It usually is a mild hepatitis, and many people do not know they are infected. The virus is eliminated by the body rapidly, and it does not cause long-term damage.


How Does Hepatitis A Spread?

Hepatitis A is spread from person to person via fecal contamination because the virus is present in the stool. It is spread via contaminated food or water by an infected person who gets small amounts of stool on his or her hands, does not wash his or her hands, and passes the stool onto food that is eaten by others. An example of this is outbreaks of hepatitis A in daycare centers for young children when employees don’t wash their hands after changing diapers, and they then pass the viruses to the next child they feed. In addition, fecal contamination of water in which shellfish live can contaminate the shellfish, and the shellfish can pass the virus to people who eat the shellfish raw.


Who Is at Risk for Hepatitis A?

Travelers to countries with high infection rates and the inhabitants of those countries are at higher risk for developing hepatitis A. The Centers for Disease Control issues travel advisories that identify the countries with outbreaks or endemic hepatitis A. Eating raw or uncooked foods increases the risk for hepatitis A.


What Happens with Hepatitis B?

A majority of adults who contract hepatitis B have none to mild symptoms, and then the virus resolves spontaneously; however, about 5% of people are not able to eliminate the hepatitis B virus and develop chronic infection. If a chronically infected mother gives birth, 90% of the time her infant will be infected and develop chronic hepatitis B, usually for life. This may give rise to serious complications of liver disease later in life such as liver damage, liver failure, and liver cancer.


How Does Hepatitis B Spread?

Persons infected with hepatitis B can pass the virus to others through blood or body fluids. In the U.S., the most common way of becoming infected is through unprotected sex, although sharing an infected person’s needles to inject illicit drugs also is quite common. Less common ways are by contaminated razors or toothbrushes. As previously mentioned, hepatitis B is passed from infected mother to infant in over 90% of cases.


Who Is at Risk for Hepatitis B?

Although unprotected sex is the most common way of becoming infected with hepatitis B, infection is more likely for people who have multiple sex partners. Shared needles also are an important means of spreading hepatitis B. Other risk factors are being a health care worker, but infection usually is related to needle sticks. There also is a risk of becoming infected by living with someone who has chronic hepatitis B, in part due to sexual transmission.


Hepatitis B is a liver infection caused by the Hepatitis B virus (HBV). HBV is transmitted through activities that involve percutaneous or mucosal contact with infectious blood or body fluids. HBV can survive outside the body at least 7 days and still be capable of causing infection. The best way to prevent hepatitis B is by getting the hepatitis B vaccine. The pathogenesis and clinical manifestations of hepatitis B are due to the interaction of the virus and the host immune system, which lead to liver injury and potentially cirrhosis and hepatocellular carcinoma. Patients can have either an acute symptomatic disease or an asymptomatic disease.

  • Hepatitis B: Management strategies
  • Novel Therapies for HBV
  • Prevention, Care and for Hepatitis B Infection

What Happens with Hepatitis C?

With acute hepatitis C, the virus is eliminated in 25% of people. The rest of the people become chronically infected and later may develop serious complications such as liver failure and liver cancer. There is treatment, however, for hepatitis C that usually can prevent the complications.


How Does Hepatitis C Spread?

Hepatitis C is transmitted primarily by infected blood, for example by sharing needles when injecting illicit drugs. The virus is spread much less commonly with tattoos or body piercing with a contaminated needle. Mothers pass the virus to their infants at birth, and the infant becomes chronically infected. The risk of spreading hepatitis C with unprotected sex is small, but having multiple sex partners, HIV, or rough sex increases the risk.


Who Is at Risk for Hepatitis C?

It only takes one exposure to hepatitis C to become chronically infected, so people who have injected illegal drugs even one time or many years previously could have chronic hepatitis C, and not know it since there are often no symptoms. People with blood transfusions prior to 1992 - when they started testing blood for transfusion for hepatitis C - also may have become chronically infected.


How Is Hepatitis Diagnosed?

Chronic hepatitis slowly attacks the liver over many years without causing symptoms. If the infection is not diagnosed and treated, many people will develop damaged livers. If suspected, viral hepatitis of all types can be diagnosed easily by blood tests.


Who Should Be Tested for Hepatitis?

It is important to test people with symptoms or exposure to hepatitis as well as people at high risk such as illicit drug users and people with multiple sex partners. There is a high prevalence of chronic hepatitis individuals of Asian heritage, and they also should be tested. It is estimated the 10% of Asians living in the U.S. has chronic hepatitis that probably has been present from birth.


What If You Test Positive for Hepatitis?

If testing discloses that you have viral hepatitis there are steps to prevent your passing the viruses to family and friends. Washing the hands helps prevent transmission of hepatitis A. Not sharing needles, razors, nail clippers, or toothbrushes also will reduce transmission of viral hepatitis. Everyone should be vaccinated against hepatitis B.


Hepatitis A Treatment

No treatment is needed for hepatitis A since the infection almost always resolves on its own. Nausea is common, though transient, and it is important to stay hydrated. It is recommended that strenuous exercise be avoided until the acute illness is over.


Chronic Hepatitis B Treatment

For hepatitis B, treatment is aimed at controlling the virus and preventing damage to the liver. Antiviral medications are available that will benefit most people, but the medications need to be chosen carefully, and the treatment needs to be monitored in order to assure successful treatment and prevent or treat medication-related side effects. For some individuals, the risks of treatment may not be justified.


Chronic Hepatitis C Treatment

Treatment of chronic hepatitis C has evolved, rendering many earlier drugs obsolete. The drugs currently used (as of March 2016) include pegylated interferon, ribavirin, elbasvir, grazoprevir, ledipasvir, sofosbuvir, paritaprevir, ritonavir, ombitasvir, dasabuvir, simeprevir, daclatasvir. These are always used in various combinations, never alone. Interferon is given by injection while the other medications are pills. Studies have shown that combinations of these drugs can cure all but a small proportion of patients; however, serious side effects of treatment can occur.


Treatment options need to be discussed with a knowledgeable physician, as the appropriate combination is dependent upon multiple factors. These include genotype (there are 6), prior treatment and results, drug intolerances, presence of compensated liver disease or uncompensated cirrhosis, presence of HIV co-infection, other complicating conditions and liver transplantation


Monitoring Chronic Hepatitis

Monitoring of the progression of liver disease and its treatment are the cornerstones of managing hepatitis B and C. Doctors regularly follow blood tests to determine how well the liver is functioning. Ultrasound examinations and CT scans can determine if there are complications such as cirrhosis or liver cancer that can be treated more effectively if found early. Some people will not need treatment.


Complications: Cirrhosis

Cirrhosis is the most common complication of chronic hepatitis. Cirrhosis can be detected with simple tests, but the liver biopsy is the best way to diagnose it. Cirrhosis occurs as the liver is destroyed and it is associated with liver failure, a life-threatening condition. The signs of cirrhosis include retention of fluid (swelling of the abdomen or lower extremities, fatigue, nausea, and weight loss. Later, confusion and jaundice occur due to the accumulation of chemicals normally removed by a healthy liver.


Complications: Liver Cancer

The major cause of liver cancer is hepatitis B and C, and can develop silently as the liver becomes cirrhotic. Blood tests, ultrasound examinations, CT and MRI scans can identify the cancers (seen here in green). Biopsy of the liver is needed to definitely make a diagnosis of cancer. If the cancers are found early, a small proportion of patients can be cured.


Hepatitis A and B Vaccines

Vaccines can protect against hepatitis A and B. The Centers for Disease Control recommends hepatitis A vaccination for children 12 to 23 months of age and for adults who travel or work in locations with a higher prevalence of hepatitis A infection. Vaccination for hepatitis A also should be given to people with hepatitis B and C. If the mother has chronic hepatitis B, the infant should receive the hepatitis B vaccine as well as hepatitis B immune globulin to prevent the development of chronic hepatitis B. There is no vaccine for hepatitis C.


Protecting Your Liver

If you have chronic hepatitis, you should prevent further damage to your liver, for example, by not drinking alcohol. Since some medications and supplements can damage the liver, before taking them you should discuss it with your doctor. Regular appointments for follow-up are important. Early progression of the disease or complications are likely to change treatment.


Hepatitis C Could Become Rare Disease in 20 Years: Study

Health Day news article on MedicineNet 


MONDAY, August 4, 2014 -- "The once tough-to-treat liver infection hepatitis C could become a rare disease in the United States in the next two decades, a new study estimates..." Read full article on MedicineNet


Who is at risk of having hepatitis B?

Anyone who has come in direct contact with HBV-infected bodily fluids (blood, semen, and vaginal secretions) is at risk.

  • Were born to an HBV-infected mother
  • Have ever worked with or come in contact with infected bodily fluids
  • Have ever lived with an infected person
  • Have ever had unprotected sex with an infected person
  • Have ever had multiple sexual partners
  • Have ever had a sexually transmitted disease
  • Are a man who has sex with men
  • Have ever injected or inhaled drugs (even once)
  • Have ever worked or been housed in a prison
  • Have ever traveled to countries where HBV is common

What are symptoms of hepatitis B?

Many people with acute or chronic HBV have no symptoms. When symptoms occur, they may include

Tiredness, fever,

Loss of appetite,

Nausea,

Headache,

Muscle soreness,

Pain near the liver,

and jaundice (a yellowing of the skin and whites of the eyes).

Symptoms often begin two to five months after infection. Symptoms usually last for several weeks, but can last up to six months.


How is hepatitis B diagnosed?

Hepatitis B is diagnosed by blood tests.

Blood tests are done to check if HBV antibodies are in the body. Antibodies are proteins created by the immune system in response to viruses.

How is hepatitis B treated?

Acute HBV
Doctors often recommend bed rest, drinking lots of fluids, eating a healthy diet and avoiding alcohol. Medicines are not used to treat acute HBV. It is important to see your doctor regularly to make sure your body has fully recovered from the virus.


Chronic HBV
There are several treatment options for chronic HBV: tenofovir, adefovir dipivoxil, interferon alfa 2b, pegylated interferon alfa 2a, lamivudine, entecavir, and telbivudine. These medicines may not work for all people with hepatitis B. Also, patients taking these medicines need to be monitored by their doctors for side effects.


HBV medications should not be taken by pregnant women unless recommended by their doctors. Some pregnant women with HBV can be treated to prevent transmitting HBV to their babies.

If you have HBV, it is important to talk to your doctor about treatment options and liver cancer screenings every 6-12 months. Also, talk to your doctor about the hepatitis A vaccine.

What is the best way to stop the spread of hepatitis B?

Hepatitis B vaccination in people who have not been exposed to HBV is the best way to prevent infection. The hepatitis B vaccine is given in 3 doses. The first 2 doses are given one month apart and the final dose is given 6 months later.


Other ways to stop the spread of HBV are:

  • Get tested if you are pregnant or want to become pregnant
  • Not sharing needles
  • Practicing safe sex
  • Not sharing razors, toothbrushes, or other personal items
  • Not donating blood, organs, or tissue
  • Using only clean needles and equipment for tattoos or body piercings
  • Telling your doctors, dentists, and other healthcare providers

Who should be vaccinated against hepatitis B?

Those who should be vaccinated against HBV include:

  • All newborns and children
  • People with liver disease not caused by HBV
  • People with HIV
  • Healthcare and emergency workers, military personnel, morticians and embalmers
  • People who have ever been on hemodialysis
  • People working or housed in prisons
  • Staff and patients at institutions for the developmentally challenged
  • People with multiple sexual partners
  • Men who have sex with men
  • People who have ever injected or inhaled drugs
  • Sexual partners and household members of people with HBV
  • Travelers to countries where HBV is common
  • Members of ethnic or racial groups with a high rate of HBV infection including Asian and Pacific Islander Americans, African Americans, Latino Americans, Native Americans and Alaskan Natives