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THE TERM: CHRONIC HEPATITIS

What Does It Mean?

This term refers to inflammation and ongoing injury to liver cells that continue beyond a period of six months. The causes can be various -viruses, medications, excessive alcohol consumption, immune system abnormalities, and the accumulation of copper. Due to the fact that chronic hepatitis can be mild or it can be severe with scarring of the liver, doctors generally indicate that the patient undergoes a liver biopsy to determine the cause and severity of the condition. During this procedure, a needle is inserted into the liver and a small tissue sample is obtained making observation of the presence or increase in scar tissue (fibrosis/cirrhosis) possible.

What are the symptoms of chronic hepatitis?

While some patients may show no symptoms or only have mild ones such as fatigue, loss of appetite, aching joints and discomfort in the upper-right side of the abdomen, others may have signs of liver failure, jaundice, swelling of the abdomen due to fluid retention (ascites), or coma. These symptoms depend on the severity of the liver disease and cirrhosis. Depending on the cause of chronic hepatitis, about 20% of the patients also develop disorders of the thyroid, skin, joints, eyes, blood, intestine, spleen, and kidneys.

What causes chronic hepatitis?

The most common causes of chronic hepatitis are viral hepatitis B and C, accounting for more than 75% of all the cases worldwide including an estimated 1 million individuals infected with chronic hepatitis B and 4.0 million infected with chronic hepatitis C in the United States. Those infected usually experience mild fatigue at first; however, the complications of cirrhosis may appear years later. The percentage of people infected with chronic hepatitis C that go on to develop cirrhosis is higher than that of people with hepatitis B. Approximately 90% of individuals exposed to the hepatitis C virus will progress to chronic hepatitis. Persons in both groups are at a 30 to 50% risk for developing cirrhosis. Primary liver cancer is another serious concern for these individuals.

Hepatitis A and E are self-limited illnesses and do not progress to chronic hepatitis. However, Hepatitis D (high among IV drug users) it's likely to cause acute hepatitis in hepatitis B carriers. These two viruses combined are potentially more serious than the hepatitis B virus alone, with the possibility of leading to chronic hepatitis and cirrhosis.

Autoimmune Hepatitis is often chronic and progresses to cirrhosis also producing symptoms that vary from mild to serious. Although exactly what triggers this disease is uncertain, it is known that autoimmune hepatitis is a genetic disease mostly affecting young women, although menopausal women and males may also be affected. The disease causes the body to reject its own liver. Damage to the liver is caused by lymphocytes produced by the patient's own immune system and antibodies produced in the tissues.

Primary Biliary Cirrhosis is a liver disease that slowly destroys the bile ducts in the liver. Bile, a substance that helps digest fat, leaves the liver through these ducts. When the ducts are damaged, bile builds up in the liver and damages liver tissue. Over time, the disease can cause cirrhosis and may make the liver stop working. The cause of primary biliary cirrhosis is unknown. The disease affects women more often than men, and usually occurs between the ages of 30 and 60 years. Some research suggests that the disease might be caused by a problem within the immune system.

Primary Sclerosing Cholangitis (PSC), the bile ducts inside and outside the liver become inflamed and scarred. As the scarring increases, the ducts become blocked. The ducts are important because they carry bile out of the liver. Bile is a liquid that helps break down fat in food. If the ducts are blocked, bile builds up in the liver and damages liver cells. Eventually, PSC can cause liver failure.

Researchers do not know what causes PSC. Among the theories under investigation are the possible role of bacteria, viruses, and immune system problems. PSC appears to be associated with ulcerative colitis, a type of inflammatory bowel disease. The disease usually begins between ages 30 and 60, but the disease can also arise during childhood. PSC is more common in men than women. PSC progresses slowly, so a person can have the disease for years before symptoms develop. The main symptoms are itching, fatigue, and jaundice, which cause yellowing of the eyes or skin. An infection in the bile ducts can cause chills and fever.

Wilson's Disease, causes the body to retain copper. The liver of a person who has Wilson's disease does not release copper into bile as it should. Bile is a liquid produced by the liver that helps with digestion. As the intestines absorb copper from food, the copper builds up in the liver and injures liver tissue. Eventually, the damage causes the liver to release the copper directly into the bloodstream, which carries the copper throughout the body. The copper buildup leads to damage in the kidneys, brain, and eyes. If not treated, Wilson's disease can cause severe brain damage, liver failure, and death.

Wilson's disease is hereditary. Symptoms usually appear between the ages of 6 and 20 years, but can begin as late as age 40. The most characteristic sign is the Kayser-Fleischer ring--a rusty brown ring around the cornea of the eye that can be seen only through an eye exam. Other signs depend on whether the damage occurs in the liver, blood, central nervous system, urinary system, or musculoskeletal system. Many signs can be detected only by a doctor, like swelling of the liver and spleen; fluid buildup in the lining of the abdomen; anemia; low platelet and white blood cell count in the blood; high levels of amino acids, protein, uric acid, and carbohydrates in urine; and softening of the bones. Some symptoms are more obvious, like jaundice, which appears as yellowing of the eyes and skin; vomiting blood; speech and language problems; tremors in the arms and hands; and rigid muscles.

Herpes viruses (genital herpes, infectious mononucleosis, chicken pox, cold sores, shingles), although not likely to produce chronic hepatitis, can cause acute hepatitis, especially when the immune system in not functioning properly. Other viruses may also lead to chronic hepatitis.

Medications taken for long periods of time, including phenytoin (seizure disorders), isoniazid (tuberculosis), methyldopa (hypertension), nitrofurantoin (urinary tract infections), can also cause chronic hepatitis. Stopping the medication before cirrhosis has developed will most likely reverse the disease.

© Copyright 2008 - The Latino Organization for Liver Awareness