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Hepatitis

Inflammation of the liver, caused by infectious or toxic agents is known as hepatitis.
A group of viruses known as the hepatitis viruses cause most cases of liver damage worldwide. Hepatitis can also be due to toxins (notably alcohol), other infections or from autoimmune process. It may run a subclinical course when the affected person may not feel ill. The patient becomes unwell and symptomatic when the disease impairs liver functions that include, among other things, removal of harmful substances, regulation of blood composition, and production of bile to help digestion.
There are two types-
1.Acute
2.Chronic

Causes-
Acute

  • Viral hepatitis: Hepatitis A through E (more than 95% of viral cause), Herpes simplex, Cytomegalovirus, Epstein-Barr, yellow fever virus, adenoviruses.
  • Non viral infection: toxoplasma, Leptospira, Q fever, rocky mountain spotted fever
  • Alcohol
  • Toxins: Amanita toxin in mushrooms, carbon tetrachloride, asafetida
  • Drugs: Paracetamol, amoxycillin, antituberculosis medicines, minocycline and many others.
  • Ischemic hepatitis (circulatory insufficiency)
  • Pregnancy
  • Auto immune conditions, e.g., Systemic Lupus Erythematosus (SLE)
  • Metabolic diseases, e.g., Wilson's disease
Chronic
  • Viral hepatitis: Hepatitis B with or without hepatitis D, hepatitis C (neither hepatitis A nor hepatitis E causes chronic hepatitis)
  • Autoimmune: Autoimmune hepatitis
  • Alcohol
  • Drugs: methyldopa, nitrofurantoin, isoniazid, ketoconazole
  • Non-alcoholic steatohepatitis
  • Heredity: Wilson's disease, alpha 1-antitrypsin deficiency
  • Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic hepatitis
Viral Hepatitis
Many viruses, for example, the virus of mononucleosis and the cytomegalovirus can inflame the liver. Here are several hepatitis viruses; they have been named types A, B, C, D, E, F (not confirmed), and G. The most common hepatitis viruses are types A, B, and C.

Hepatitis A
This form is caused by the hepatitis A virus (HAV), which lives in the stools (feces or poop) of infected individuals. Infection with the hepatitis A virus leads to inflammation of the liver, but complications are rarely serious.
HAV is spread:
  • when someone ingests anything that's contaminated with HAV-infected stool (this makes it easy for the virus to spread in overcrowded, unsanitary living conditions)
  • in water, milk, and foods, especially in shellfish
 Symptoms-
It is possible to experience mild or no symptoms. Many people who become infected with HAV will have symptoms that include:
  • A short, mild, flu-like illness.
  • Nausea, vomiting and diarrhoea.
  • Loss of appetite.
  • Weight loss.
  • Jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces).
  • Itchy skin.
  • Abdominal pain.
About 15% of people who have hepatitis A have symptoms of HAV infection that return or last for 6 to 9 months after infection first occurred. Symptoms of hepatitis A usually last less than 2 months.

Diagnosis-
1.Medical history and physical examination
2.Liver Function test.
3.Antibody (antiHAV) test.

Treatment-
There is no specific treatment for HAV and most people fight off the virus naturally, returning to full health within a couple of months. The doctor will advise avoiding alcohol and fatty foods as these can be hard for the liver to process and may exacerbate the inflammation.
Patients should get plenty of rest and eat a nutritious diet. They should also ensure they do not spread HAV by washing their hands after using the toilet and before preparing food. Patients with more severe symptoms may be monitored in hospital for a short period.

Hepatitis B
Hepatitis B is a serious disease caused by the hepatitis B virus (HBV). Infection with this virus can cause scarring of the liver, liver failure, liver cancer, and even death.
HBV spreads through:
  • infected body fluids, such as blood, saliva, semen, vaginal fluids, tears, and urine
  • a contaminated blood transfusion (uncommon in the United States)
  • shared contaminated needles or syringes for injecting drugs
  • sexual activity with an HBV-infected person
  • transmission from HBV-infected mothers to their newborn babies
Symptoms
Many people who become infected with HBV experience mild symptoms or no symptoms at all, but they may still carry the infectious virus and pass it on to others. When symptoms do appear they are similar to those of hepatitis A.

Diagnosis
1.Complete medical history and physical examination
2.Liver function Test
3.Test to detect hepatitis virus by blood test.
4.In chronic cases- liver biopsies




Treatment-
In most countries a patient with a positive test result will be referred to a specialist who will carry out further tests to determine the degree to which hepatitis B may be affecting the liver, and what may be the best treatment options.
In the majority of patients with active HBV, symptoms will not be severe and treatment will not be required. The patient will be monitored and after a few months the patient's immune system should fight off the virus, giving the patient natural immunity.
Medication is given as treatment to those with chronic symptoms to help prevent further liver damage.
Immunization is also given to prevent it.

Hepatitis C
The hepatitis C virus (HCV) is spread by direct contact with an infected person's blood. However, infection with HCV can lead to chronic liver disease and is the leading reason for liver transplant.
The hepatitis C virus can be spread by:
  • sharing drug needles
  • getting a tattoo or body piercing with unsterilized tools
  • blood transfusions (especially ones that occurred before 1992; since then the U.S. blood supply has been routinely screened for the disease)
  • transmission from mother to newborn
  • sexual contact (although this is less common)
Symptoms-
Many people do not experience any symptoms when they become infected with hepatitis C. Symptoms may emerge later, taking anywhere between 15 and 150 days to develop. Occasionally a person will not develop any symptoms and their immune system will successfully clear the virus without their knowledge. An infected person without symptoms can still act as a carrier and pass the virus on to others. When symptoms do appear they are similar to those of hepatitis A.

Diagnosis-
A doctor can diagnose hepatitis C by carrying out blood tests that detect HCV antibodies in the blood.

Treatment
If a patient has been diagnosed with hepatitis C infection, they will be advised to have regular blood tests and physical check-ups.
The infected person should limit the amount of alcohol they drink as alcohol puts strain on the liver. The doctor may also advise avoiding fatty foods and following a low-salt diet with the medications.

Hepatitis D, E, F, G
There also are viral hepatitis types D, E, F (not confirmed yet), and G. The most important of these at present is the hepatitis D virus (HDV), also known as the delta virus or agent. It is a small virus that requires concomitant infection with hepatitis B to survive. HDV cannot survive on its own because it requires a protein that the hepatitis B virus makes (the envelope protein, also called surface antigen) to enable it to infect liver cells. The ways in which hepatitis D is spread are by shared needles among drug abusers, contaminated blood, and by sexual contact, essentially the same ways as for hepatitis B.
Patients who already have chronic hepatitis B infection can acquire delta virus infection at the same time as they acquire the hepatitis B infection or, alternatively, on top of a chronic hepatitis B infection. Patients with chronic hepatitis due to hepatitis B and hepatitis D viruses develop cirrhosis (severe liver scarring) rapidly. Moreover, the combination of delta and B virus infection is very difficult to treat.

Symptoms of hepatitis
Acute
Clinically, the course of acute hepatitis varies widely from mild symptoms requiring no treatment to fulminant hepatic failure needing liver transplantation. Acute viral hepatitis is more likely to be asymptomatic in younger people. Symptomatic individuals may present after convalescent stage of 7 to 10 days, with the total illness lasting 2 to 6 weeks.[4]
Initial features are of nonspecific flu-like symptoms, common to almost all acute viral infections and may include malaise, muscle and joint aches, fever, nausea or vomiting, diarrhea, and headache. More specific symptoms, which can be present in acute hepatitis from any cause, are: profound loss of appetite, aversion to smoking among smokers, dark urine, yellowing of the eyes and skin (i.e., jaundice) and abdominal discomfort. Physical findings are usually minimal, apart from jaundice (33%) and tender hepatomegaly (10%). There can be occasional lymphadenopathy (5%) or splenomegaly (5%).
Chronic
Majority of patients will remain asymptomatic or mildly symptomatic, abnormal blood tests being the only manifestation. Features may be related to the extent of liver damage or the cause of hepatitis. Many experience return of symptoms related to acute hepatitis. Jaundice can be a late feature and may indicate extensive damage. Other features include abdominal fullness from enlarged liver or spleen, low grade fever and fluid retention (ascites). Extensive damage and scarring of liver (i.e., cirrhosis) leads to weight loss, easy bruising and bleeding tendencies. Acne, abnormal menstruation, lung scarring, inflammation of the thyroid gland and kidneys may be present in women with autoimmune hepatitis.

Diagnosis-
1.Complete blood count.
2.Liver function Test
3.Laboratory test to identify virus in blood
4.Bleeding time.
5.Clotting time
6.Imaging- Ultrasonography, CT- scan, MRI
7.Liver biopsy

Treatment-
Treatment of acute and chronic hepatitis is different.
Acute Hepatitis
In patients with acute hepatitis, the initial treatment consists of relieving the symptoms of nausea, vomiting, and abdominal pain. Careful attention has to be given to prevent complications. Liver functions should be thoroughly monitored. The patient must abstain from drinking alcohol since alcohol is toxic to the liver. It occasionally is necessary to provide intravenous fluids to prevent dehydration caused by vomiting. Patients with severe nausea and/or vomiting may need to be hospitalized for treatment and intravenous fluids.
Chronic Hepatitis
Treatment of chronic infection with hepatitis B and hepatitis C usually involves medication or combinations of medications to eradicate the virus. Alcohol aggravates liver damage in chronic hepatitis, and can cause more rapid progression to cirrhosis. Therefore, patients with chronic hepatitis should stop drinking alcohol. Smoking cigarettes also can aggravate liver disease and should be stopped.

Role of homoeopathy
Homeopathic medicines are effective in many functional and pathological disorders. It also helps in preventing further damage to tissues and complications. Homoeopathic medicines will help not just in curing hepatitis, but also in correcting the cause/s responsible for it.

A study about homeopathic treatment in hepatitis can be seen at: http://www.wynoacademicjournals.org/Viral%20load%20reduction.pdf

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