Infection with a virus (viral hepatitis A, B, C, D, or E): Viral hepatitis has been recognized as a serious public health problem in India by the World Health Organisation (WHO). Nearly 119,000 cases of all cause viral hepatitis were reported in India in 2012. The Integrated Disease Surveillance Programme of the NCDC received notification of 290,000 cases of acute viral hepatitis in 2013.
Acute Viral hepatitis is most commonly seen due to acute Hepatitis A or Hepatitis E virus infection The proportion of young adults at risk for HAV infection is very low in India. The Indian population is showing a recent upward shift in the average age at first HAV infection, among the socio-economically developed population resulting in pockets of susceptible populations.
HEV is the most important cause of epidemic hepatitis though HAV is more common among children. Most acute liver failures diagnosed in India are attributable to HEV, and HEV is the most common cause of hepatitis during pregnancy. The transmission of both HAV and HEV is through the fecal–oral route, that means due to ingestion of contaminated water — sewage-contaminated and inadequately-treated water
Overdose of drugs (such as acetaminophen, paracetamol): There is always a history of drug intake in suh individuals. Most often these medicines have been self administered in wrong doses or accidentally ingested.
Chemical exposure (such as dry cleaning chemicals, and some wild mushrooms)
Acute hepatitis has the same features to be mistaken for flu because of its symptoms. The following are the most common symptoms
FeverBody aches/ sore musclesJaundicenausea and vomitingloss of appetitepainful jointsabdominal discomfort.
The symptoms of acute hepatitis can be easily missed or may resemble other conditions or medical problems. A physician must be contacted for timely diagnosis.
Diagnosis of Acute hepatitis involves:
a complete medical history and medical examination
Blood tests especially Liver function tests, PT-INR, coagulation profile
Specific laboratory tests for virus detection
Ultrasonography as an imaging tool
Treatment of Acute Hepatitis
Treatment for acute hepatitis depends on the condition of patient. The patients may need admission to a hospital in the initial phase for complete evaluation and stabilization. Most patients need supportive medical care which is determined by the treating liver physician based on the individual patient and disease severity parameters.
Majority of the people recover uneventfully with just supportive care. Severe acute hepatitis may require ICU care and appropriate management as per the treating team.
Hepatitis is considered chronic if symptoms persist longer than six months. These are a small proportion of those patients who did not recover fully from acute hepatitis and developed chronic hepatitis.
Cause of Chronic Hepatitis
Common causes of chronic hepatitis are:
Chronic viral hepatitis
Chronic alcoholic hepatitis
Autoimmune hepatitis (when the body attacks its own tissues)
Drug induced chronic hepatitis (methotrexate, TB medicines)
Metabolic disorders (such as Hemochromatosis or Wilson's Disease)
Chronic Hepatitis Symptoms
Majprity of individuals experience no symptoms and are diagnosed during a health check up or otherwise. Symptoms for chronic hepatitis are usually non specific such as: loss of appetite, weight loss, fatigue, low grade temperature. Some patients present with, upper abdominal pain, jaundice, and other symptoms of liver failure.
Diagnosis
Diagnosis of chronic hepatitis involves:
a complete medical history and medical examination
Blood tests especially Liver function tests, PT-INR, coagulation profile
Specific laboratory tests for virus detection
Ultrasonography as an imaging tool
Liver biopsy
Treatment
When the diagnosis of chronic hepatitis is established treatment is aimed toward the cause. One must consult a liver specialist for further treatment. All steps should be taken to identify the cause of chronic hepatitis. Even then a few set of patients will be fall under a category where no specific cause is identified.
Treatment may include one/more of the following:
Antiviral Agents ? There has been incredible success in treating chronic Hepatitis B or C in recent times. These medicines stop the viral multiplication and finally eliminate them from our blood. Recently launched medication like Sofosbuvir and daclatasavir has increased the success rate of treating HCV to more than 90%. In addition, in Hepatitis B, oral anti-viral agents such as lamivudine or Entecavir has been utilized with high rate of success.
Steroids ? Steroids have been used to treat for a variety of chronic liver disease including alcoholic hepatitis and autoimmune liver diseases. This is decided by treating physician.
Discontinuation of medicines/drugs - If a medicine or drug is identifies as the inciting cause it should be withdrawn and a substitute should be used. In case of patients taking anti tubercular treatment it is advisable to switch to second line drugs. Patients with Psoriasis (skin disorder) should be switched over from methotrexate.
Abstinence from alcohol ? It is the most important step and treatment for recovery in alcohol induced chronic liver disease. It is highly advisable in Hepatitis C and other chronic diseases of the liver. Patients taking anti tubercular treatment or with Psoriasis (skin disorder) who are on methotrexate should be advised not to consume alcohol.
