Hepatitis: Causes, Symptoms, and Treatment Options

Hepatitis is inflammation of the liver. There are different types of Hepatitis, which differ according to their cause, among other things. Some forms of liver inflammation can be prevented by vaccination against hepatitis viruses. What exactly is Hepatitis, how can it be infected, and what are the typical symptoms of the disease? How is Hepatitis treated and is it curable? This and

What is Hepatitis?

Hepatitis is the medical term for inflammation of the liver. There are different types of liver inflammation. What they all have in common, however, is that initially the liver cells, also known as hepatocytes, are damaged and the immune system responds with a defence reaction.

Hepatitis (this is the plural of Hepatitis) differ in the cause of the damage. Hepatitis is most commonly caused by viruses (viral Hepatitis). Numerous viruses can cause liver inflammation, and in rare cases, these include adenoviruses or the Epstein-Barr virus. The most common triggers, however, are the hepatitis viruses A, B, C, D and E. Up to now, it is only possible to be vaccinated against hepatitis A and B.

Liver inflammation can also be caused by substances harmful to the liver, such as alcohol, medication, toxins (toxic liver inflammation) or autoimmune processes ( autoimmune Hepatitis).

 

Transmission: how to get infected with Hepatitis?

You can only get infected with liver inflammation, which is triggered by pathogens such as the hepatitis virus.

The transmission routes of the hepatitis viruses are different: Hepatitis A and E are transmitted faecal-orally. This means that the viruses are excreted in the stool and then taken up again through the mouth. Even the most minor remnants in contaminated water, on food, objects or in personal contact are sufficient to become infected. The contagion rate is relatively high in warmer regions such as the tropics and the Mediterranean. For this reason, travellers to these target regions are recommended to be vaccinated against hepatitis A.

In contrast, hepatitis B, C and D are transmitted parenterally, i.e. via contaminated body fluids. Such bodily fluids include blood, saliva, semen, tears, urine, bile, and breast milk. These hepatitis viruses are usually transmitted during unprotected sex or through sharing needles (needle-sharing) in the context of drug use. In rare cases, infection can also occur through contaminated tattooing and piercing tools or surgical instruments.

Hepatitis D differs from hepatitis B and C in that it can only be transmitted to people who have already been infected with hepatitis B.

How does liver inflammation become noticeable?

Inflammation of the liver can manifest itself through a variety of symptoms. These include general symptoms such as:

• exhaustion
• a general feeling of illness
• joint pain
• loss of appetite
• nausea
• Vomit
• Diarrhea
• Fever

In addition, there may be more specific signs of liver inflammation, such as:

• Pain in the upper right abdomen, just below the ribs
• itching
• jaundice (yellowing of the eyes and skin)
• skin rash ( eczema )
• pale stool
• orange-brown urine

 

What to do in case of acute liver inflammation?

If you notice the symptoms mentioned, you should seek medical treatment. During the examination, blood will be drawn from you and different blood values, the so-called liver values, will be tested. In addition, if viral Hepatitis is suspected, the blood or stool, depending on the virus, can be tested for endogenous antibodies against the virus. These tests allow for a more definite diagnosis. This is the best way to determine how serious the situation is and to decide on possible therapy.

Therapy: Is it possible to cure liver inflammation?

Depending on the cause and course of the Hepatitis, it will either heal or become chronic. Therefore, in the case of acute Hepatitis, only the symptoms are usually treated.

Depending on the trigger, chronic Hepatitis can be treated with different medications. Virus-related liver inflammation can be treated with antivirals, for example. The treatment is accompanied by repeated examinations of the liver values ​​in the blood by the doctor. This gives a more accurate picture of the condition of the liver. If the liver inflammation worsens drastically, a liver transplant may also be necessary.

In the case of alcoholic Hepatitis, alcohol consumption should be stopped altogether. Ultimately, a liver transplant may also be necessary in this case.

Autoimmune Hepatitis is treated with glucocorticoids. Glucocorticoids suppress the immune system and are intended to prevent your immune system from destroying the liver.

Diet in Hepatitis: what should be considered?

Those affected with Hepatitis should stop drinking alcohol and avoid potentially liver-damaging medications until the disease has healed. In the case of alcoholic liver inflammation, alcohol consumption should be eliminated.

There is no specific diet for Hepatitis. However, care should be taken to ensure a balanced, healthy diet. Loss of appetite and possibly unwanted weight loss often occur during Hepatitis.

 

Which is the most dangerous Hepatitis?

There are different forms of Hepatitis:

• acute Hepatitis
• chronic Hepatitis
• recurrent Hepatitis
• fulminant hepatitis
• asymptomatic course
• cholestatic course

Acute, chronic and recurrent Hepatitis

Acute liver inflammation occurs suddenly and is reflected in the symptoms already mentioned.

Chronic Hepatitis progresses rather insidiously over more than half a year. Symptoms tend to be mild or non-existent. 

Recurrent Hepatitis is healed liver inflammation that flares up again. About a fifth of all people who have or have had Hepatitis are affected.

Lightning Hepatitis

Fulminant Hepatitis is the worst course of liver inflammation. It runs for days or weeks. The liver tissue dies so quickly that the liver can no longer do its usual job. The body’s waste substances are no longer filtered out of the blood and accumulate in the body.

As a result, those affected can fall into a coma within a few days because the brain suffers from the toxic substances. This harmful effect of liver inflammation on the brain is called hepatic encephalopathy. A hepatitis B infection usually triggers the fulminant liver inflammation.

 

Asymptomatic course

In addition, there are liver inflammations that go completely unnoticed because they do not cause any symptoms. These asymptomatic courses can only be proven retrospectively by a so-called seroconversion. This involves changing the structure of the antibodies that are directed against the causative virus. The seroconversion can be detected in the blood and shows whether the person examined has recently been infected or whether there was an infection in the past.

cholestatic course

The cholestatic course includes the signs of liver inflammation that make up the most well-known picture of Hepatitis: the damaged liver can no longer metabolize bilirubin, a yellow substance in the body, causing yellowing of the skin. The skin discolouration is called jaundice or jaundice.

The end products of bilirubin metabolism are usually excreted in the stool, turning it brown. However, since the end products are missing in a cholestatic course, the stool loses its colour and becomes pale. The body now tries to excrete the bilirubin through the urine. This changes colour to orange or even brown due to bilirubin.

What is the difference between viral Hepatitis?

Depending on the causative agent of viral Hepatitis, the signs, courses and incubation periods of the disease are also different.

• Hepatitis A:  It develops within two weeks to two months. Jaundice is common. Hepatitis A does not become chronic and severe courses are rare.
• Hepatitis B: This disease develops over one to six months and is often asymptomatic. If symptoms do occur, they usually disappear within three to six weeks. Most people affected will heal entirely on their own. A fifth of chronically ill people develop what is known as cirrhosis of the liver, a scarring of the liver that can progress to liver cancer.
• Hepatitis C:  Hepatitis C has an incubation period of approximately eight weeks. The majority of those infected get chronic liver inflammation in the course of the disease. A fifth of those affected with chronic hepatitis C develop cirrhosis of the liver. Acute hepatitis C primarily causes jaundice. Serious courses are rare.
• Hepatitis D:  The virus can only infect people with hepatitis B. Simultaneous infection of hepatitis B and D increases the acute symptoms. However, in the majority of those affected, Hepatitis heals on its own. Chronic hepatitis B infection with the hepatitis D virus increases the risk of liver cirrhosis.
• Hepatitis E: After infection with the virus, it takes two weeks to two and a half months for the disease to break out. Jaundice is common. As a rule, there are no chronic courses. In pregnant women, about a fifth of those infected develop fulminant, potentially life-threatening courses.

 

How often should you get vaccinated against Hepatitis?

Vaccination is only available against hepatitis A and B. Vaccination is an effective way to prevent these forms of Hepatitis.

Hepatitis B vaccination is given in childhood and infancy. The vaccines are offered in three doses. The last dose of vaccination should be given approximately six months after the second. For certain groups of people with an exceptionally high risk of infection, it is recommended to refresh the vaccination protection in adulthood. The most common side effects of hepatitis B vaccination are fatigue, pain, redness, and irritation at the injection site.

The Hepatitis A vaccination is only recommended for certain groups of people with an increased risk of contracting Hepatitis A infection. Two doses of vaccine are given six months apart. The most common side effects are fatigue, pain at the injection site, and headache. For more information on hepatitis A and hepatitis B vaccinations, see this article.