Hepatitis is a disease that includes any type of inflammation of the liver, the result of a complex process that occurs when the liver suffers an injury. This can be confusing if you have a type of hepatitis that is not an infectious disease. The word hepatitis can simply be broken down into the words “hepa” which refers to the liver, and “itis” which refers to inflammation.
Acute vs. Chronic Hepatitis
The terms acute and chronic do not refer to any particular hepatitis but are based only on the duration of the symptoms (or infection.) Healthcare providers say that if inflammation lasts less than six months, it’s acute hepatitis and inflammation that lasts longer than six months, chronic hepatitis.
Infectious vs Non-Infectious Hepatitis
While there are many causes of liver inflammation, clinicians divide them into two main categories: viral hepatitis and non-infectious hepatitis.
There are also many different causes of both infectious hepatitis and non-infectious hepatitis. Let’s take a look at some of these
Viral Hepatitis (Infectious Hepatitis)
When most people think of hepatitis, they are usually thinking about viral hepatitis. Since these viruses spread from person to person, healthcare providers also call viral hepatitis infectious hepatitis. There are five viruses that commonly infect the liver, names using the letters of the alphabet from A through E. What makes viral hepatitis confusing is that each one of these viruses causes a slightly different disease and has a different way of spreading. Some of these viral infections can result in acute, chronic, or both forms of hepatitis.
Hepatotropic viruses A to E include:
Infections other than viral hepatitis may cause inflammation of the liver, or hepatitis. These include:
- Cytomegalovirus (CMV)
- Epstein-Barr virus (EBV) – Commonly known as infectious mononucleosis or “mono”
Not all causes of hepatitis are infectious. Chemicals such as alcohol or medications can be harmful to the liver and can cause inflammation. In addition, other health problems like genetic and metabolic disorders, immune-related injury and obesity, can damage the liver and lead to inflammation. Since these types of hepatitis cannot spread from one person to another, clinicians call it non-infectious hepatitis. In fact, any “insult” to the liver which results in inflammation is considered hepatitis. Some non-viral causes of hepatitis include:
- Autoimmune hepatitis – Autoimmune diseases are those in which the body makes antibodies and attacks itself
- Alcoholic hepatitis (alcohol intake can cause three separate syndromes including alcoholic hepatitis, fatty liver, and cirrhosis of the liver)
- Drug-induced hepatitis (there are many drugs which can cause inflammation of the liver which can vary from very mild to life-threatening)
- Chemical and toxic exposures (since the liver acts simplistically as a “detoxification” system, it’s not surprising that many chemicals and toxins in the environment can lead to inflammation)
- NASH or non-alcoholic steatohepatitis (non-alcoholic fatty liver disease is a condition which occurs most often in those who are overweight or obese)
It’s important to note that it’s not uncommon for people to have more than one type of hepatitis, and in fact, hepatitis D only occurs in people who are or have been previously infected with the hepatitis B virus.
In addition to exposures above, such as alcohol, there are a few genetic conditions which can lead to liver disease, and increase the severity of viral or non-infectious hepatitis should it occur. One of these is hemochromatosis, a condition in which excess iron is stored in the liver, and another is alpha-1-antitrypsin deficiency, a genetic condition that causes both liver failure and emphysema.
A variety of symptoms may develop in the setting of acute or chronic liver injury. Because the liver reacts in different ways depending on the cause and the duration of the inflammation, and some people have symptoms and some do not (a condition known as asymptomatic), only a healthcare provider can tell you if you have hepatitis.
The symptoms of acute viral hepatitis usually include fatigue, fever, nausea, and vomiting, but these are common to many diseases.
While many people associate hepatitis with jaundice, a yellowing of the skins and white of the eyes, this often occurs after the infection has been going on for some time. Other very common symptoms as hepatitis progress are fatigue, muscle and joint aches, and loss of appetite.
There are many more symptoms of hepatitis which are less common but no less important.
The many causes of hepatitis create many ways to test for the disease. One basic test is to feel for an enlarged liver, known as hepatomegaly. Your healthcare provider will do this test during the clinical examination; if he finds an enlarged liver, they will look for causes and may order a blood test.
Some blood tests look for levels of enzymes and other proteins that may be disturbed when there is liver damage. Elevations of liver enzymes (ALT and ALT) may be detected with a simple blood test, and other tests can look for signs of autoimmune hepatitis and much more.
Still, other blood tests will look for evidence of specific viruses, levels of toxins such as alcohol or Tylenol or even markers of genetic diseases such as iron or alpha-1 antitrypsin.
Usually, the diagnosis of hepatitis is made using a combination of tests. More advanced tests might include using imaging technology such as ultrasound, computerized axial tomography (CT) scans or magnetic resonance imaging (MRI).
A liver biopsy, where a healthcare provider removes a small piece of the liver and sends it to a laboratory for further testing, may be necessary if a clear cause of the inflammation cannot be identified or if the healthcare providers need to clarify how much of the liver is involved. Since inflammation of the liver can lead to bleeding problems, a liver biopsy is not usually done unless the origin of hepatitis cannot be found based on other tests.
While some types of hepatitis resolve quickly, other types last for decades and will need to be managed closely by your healthcare provider. Living with any type of hepatitis requires having regular medical appointments and following your medical treatment plan.
In addition to medications, your treatment plan may include modifying your lifestyle, such as restricting alcohol and maintaining a healthful body weight, which helps prevent the disease from getting worse. Other lifestyle changes may be necessary to prevent spreading the disease, if infectious, to others.
Finally, seek out others who live with hepatitis. Many support groups exist to help educate and assist people and their families. With a little education and support, people with hepatitis can live full and complete lives.