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Hepatitis is a condition which, although unpleasant, usualy resolves in a few months with therapy and lifestyle change. But sometimes, this illnes can become chronic, sometimes even lifelong.

Hepatitis is the inflammation of the liver. It can be caused by a number of different factors. Since the liver is the organ that processes all of the food that we eat, exposure to toxins and heavy metals — which can sometimes be found in certain types of food — can lead to the inflammation. Alcohol, which is a toxin too, can also cause liver inflammation. Certain medications are known to cause hepatitis, when used for a longer period of time. Sometimes our immune system turns against us, and attacks certain cells. This can also happen in the liver, so one of the forms of hepatitis is auto-immune hepatitis. And these are all non-infectious causes.

There are also many different types of infectious hepatitis. A lot of different types of intestinal parasites, at one point in their life, pass through liver, although there are some (liver flukes) that spend all of their lives in liver tissue or bile ducts. Bacteria can also cause liver infections, but the most common of all forms of hepatitis is viral hepatitis. There are five hepatitis viruses (A, B, C, D and E), but some other viruses can cause viral hepatitis too.

Not all viruses cause a chronic infection (hepatitis A, for instance, causes only an acute form of the disease), but some do (such as hepatitis B and C). Chronic hepatitis can be defined as a chronic inflammatory reaction in the liver, as shown by liver function tests and histology, that continues without improvement for at least six months. Chronic hepatitis is usually caused by alcohol or drug abuse, and hepatitis viruses B and C.

What are the symptoms of chronic hepatitis?

As the illness progresses and the liver slowly deteriorates, the organ starts losing the capacity to do what it's supposed to do. The liver has many functions, such as processing the food and liquid, producing different proteins, enzymes and blood clotting factors, eliminating toxins and byproducts of the metabolism and storing vitamins, among others.

The symptoms of chronic hepatitis include:

  • Fatigue
  • Loss of appetite
  • Nausea
  • Pain in the upper right quadrant of the abdomen
  • Jaundice
  • Joint pain
  • Hives
  • Prolonged bleeding and getting bruised easily
  • Light colored stool
  • Dark urine

The symptoms are usually mild to non existent in the beginning. Most patients only notice that, no matter how much rest they get, they still feel tired. But, as the illness progresses, the symptoms become more severe. Chronic hepatitis can lead to liver failure, fatty liver, cirrhosis and liver cancer.

How is chronic hepatitis diagnosed?

The liver has a great capacity for regeneration, so, in the early stages of hepatitis, the symptoms often lack or are mild. One of the ways to determine if you have liver inflammation is checking the blood for certain parameters. Liver enzymes should be checked. If there is a liver tissue inflammation, AST, ALT, ALP and GGT levels will be elevated.

Since the tissue is being destructed, the liver slowly loses its capacity to process hemoglobin released following the normal destruction of the red blood cells. After a number of biochemical reactions, hemoglobin is, eventually, turned into bilirubin, which is transported to the gallbladder.

In the case of hepatitis, because of the tissue destruction, a certain amount of bilirubin ends up in the blood, leading to elevated levels of bilirubin and jaundice (since bilirubin is yellow, it colors the tissue in which it gets accumulated). The doctor might also order some tests to determine the levels of proteins, albumin, globulins and blood clotting factors.

Ultrasound, X-rays and CT might also be carried out to determine the size and structure of the liver, which might tell us about the levels of liver tissue destruction, or help us determine if the patient has cirrhosis.

Ultimately, a biopsy can be performed. A small piece of liver is surgically extracted. It is then processed into slides which the doctor examines under the microscope to determine the cell structure and the level of damage the liver cells have taken. If it is suspected that the hepatitis is caused by viruses, blood tests can be done to diagnose the cause. Specific virus antibodies can be found in the serum, and PCR is available too.

How is chronic hepatitis treated?

The treatment of chronic hepatitis depends on the cause. If it is drug induced, the doctor might adjust the dosage of the therapy, or switch to other medications. In the case of viral hepatitis, some antiviral drugs are available. The drugs don't cure the illness, but keep it under control and help the liver maintain its function. There is also a vaccine available for hepatitis B, and it is highly recommended for every person to get immunized, thus preventing infection. If liver failure or cirrhosis occur, liver transplantation is the only option.

Regardless of the cause, a lifestyle change is necessary. Quitting alcohol and drugs is the first step. A doctor can recommend a diet suitable for the condition. The diet won't cure your hepatitis, but it will take the pressure off your liver and allow it to regenerate. Exercise is also very important. Not only will weight loss positively affect the state of your liver, but exercising boosts immune system and partially removes stress from the liver, since the muscles metabolize the glucose from which they get the energy.

In conclusion

Chronic hepatitis is a condition which can last for years, sometimes even all your life, and can lead to death if left untreated. Specific therapies for certain types of chronic hepatitis exist, and should be taken, but lifestyle changes are necessary. Stop drinking alcohol, taking drugs, and eating junk food. Exercise regularly. Even a 10 minute walk is good for a start. Even though some types of chronic hepatitis are incurable, with the right therapy and a healthy lifestyle, the patients can lead a normal, lengthy life.

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