Hepatitis overview

What is hepatitis?

Hepatitis is inflammation of the liver. There are several types of hepatitis. The disease has several causes.

One cause of hepatitis is infection. Most cases of infectious hepatitis in the United States are caused by hepatitis A, B, or C virus.

An infection with one of these viruses might not cause any symptoms. Or it might cause only a mild, flulike illness. Hepatitis A is usually a mild, short-term illness. But hepatitis B and C often cause long-term (chronic) infections.

Hepatitis D is uncommon. Hepatitis E occurs primarily in underdeveloped countries.

Depending on the hepatitis virus, the infection can be spread in a number of ways. These include:

• contact with the stool of an infected person (A)
• eating shellfish from waters contaminated with sewage (A)
• contact with the blood, vaginal fluids, semen, or breast milk of an infected person (B)
• unprotected sex (B and C)
• sharing contaminated needles (B, C, and D).

Improved blood screening techniques have greatly reduced the risk of catching hepatitis B or C from blood transfusions.

Hepatitis has many other possible causes. These include:

• Nonalcoholic fatty liver disease (the medical term is metabolic dysfunction-associated steatotic liver disease, or MASLD)
• Excessive alcohol consumption
• Medications, especially high-dose acetaminophen (Tylenol); many other drugs also can cause liver inflammation
• Other viruses besides the hepatitis viruses, such as Epstein-Barr virus (the most common cause of mononucleosis)
• Some bacteria, fungi, and parasites
• Your immune system. In autoimmune hepatitis, your body attacks its own liver cells.

Symptoms of hepatitis

Symptoms of hepatitis vary. They depend on the cause of the illness and how much the liver has been damaged.

In mild cases, many people do not have any symptoms. Or they may have flu-like symptoms. These can include:

• fever
• a generally tired or ill feeling
• loss of appetite
• nausea and vomiting
• fatigue
• discomfort in the upper right side of the abdomen
• muscle aches.

In more severe cases, chemicals from the liver can build up in the blood and urine. This can cause

• a yellow tint to the skin and whites of the eyes (jaundice)
• dark, tea-colored urine
• light, gray-colored stools.

Diagnosing hepatitis

Your doctor will ask about your

• history of alcohol use
• exposure to toxic chemicals
• use of medications that can cause liver damage
• history of unprotected sex
• history of intravenous drug use
• recent meal of shellfish
• travel to a country where hepatitis infections are common
• exposure to someone known to have hepatitis.

Your doctor will examine you. He or she will look for signs of jaundice. Your doctor will also check for tenderness and swelling near your liver.

To confirm a hepatitis diagnosis, your doctor will order blood tests. You may also need other tests, such as a liver biopsy.

Expected duration of hepatitis

How long hepatitis lasts depends on

• the type of hepatitis
• the age and health of the person.

Most previously healthy people who develop hepatitis A recover completely in about one month.

A small percentage of adults who get hepatitis B develop chronic hepatitis. This is much more likely to happen in babies and young children. A small number of those with chronic hepatitis eventually develop cirrhosis or liver cancer. Cirrhosis is scarring of the liver that results in poor liver function.

More than three-quarters of people infected with hepatitis C develop chronic infection. Prior to antiviral therapy for hepatitis C, about one in five developed cirrhosis. Today the prognosis has improved dramatically. Cirrhosis increases the risk of liver cancer.

Hepatitis caused by bacterial or parasitic infections usually improves when the infection is treated.

Medication- and alcohol-related hepatitis usually improve when the medication or alcohol is withdrawn. But liver damage may persist.

Preventing hepatitis

You can reduce your chance of getting viral hepatitis. Follow these basic guidelines:

• Wash your hands frequently.
• Purchase shellfish only at reputable food stores.
• If you catch your own shellfish, take them only from waters that have been deemed safe by health authorities.
• Before traveling to foreign countries, ask your doctor whether you should be vaccinated against hepatitis A.
• Ask your doctor whether you need to be vaccinated against hepatitis B. This vaccine is now routine for infants. It may make sense for some adults who have a higher risk of getting hepatitis B.
• If you may have been exposed to someone with hepatitis B, ask your doctor whether you need the hepatitis B immunoglobulin and/or vaccine.

Treating hepatitis

Sudden onset of severe hepatitis can be life threatening. It often requires treatment in the hospital.

Most people with hepatitis A do not require hospitalization unless they have persistent vomiting.

Anyone suspected of having acetaminophen-related hepatitis should immediately go to an emergency room. There is an antidote, but it must be given soon after the drug is ingested.

Hepatitis related to MASLD is treated with diet, exercise, and (potentially) medication.

Hepatitis due to excessive alcohol consumption is treated by stopping all use of alcohol and sometimes prednisolone to reduce inflammation.

Certain types of viral hepatitis can become chronic (persistent) - for example, hepatitis B and C and autoimmune hepatitis. A variety of medications are available to prevent and treat chronic hepatitis.

When to call a professional

Call your doctor if you have symptoms of hepatitis. Also call if you believe you have been exposed to someone with hepatitis.

If you are planning to travel abroad, ask your doctor whether you need hepatitis immunization before your trip.

Prognosis

Most people with either hepatitis A or B recover without treatment.

Without treatment for hepatitis B or C, people can develop chronic hepatitis and cirrhosis, which increases the risk of liver cancer and liver failure.

Additional info

American Liver Foundation
https://www.liverfoundation.org/