chronic hepatitis

Hepatitis is an inflammation of the liver. In chronic hepatitis, liver inflammation continues for at least six months. This condition may be mild, causing relatively little damage, or more serious, causing many liver cells to be destroyed. Some cases lead to cirrhosis and liver failure. 

Viruses are the most common cause of chronic hepatitis.Viruses that cause hepatitis include: 

• Hepatitis B and C. 
  
• Hepatitis D 

Hepatitis B and C :

These viruses cause two- thirds of all cases of chronic hepatitis. People infected with hepatitis C have the greatest risk of developing chronic hepatitis. Both of these viruses usually begin with mild symptoms. Over time, perhaps a decade or more, both may lead to the serious complication of cirrhosis due to ongoing destruction of liver cells and resultant scarring. A minority of patients with cirrhosis develop liver cancer over time. 

Hepatitis D :

Hepatitis D infects only patients already infected with hepatitis B, and it generally results in a flare of active hepatitis. 

Other commonly diagnosed causes of non-infectious chronic hepatitis include: 

Alcohol. Alcohol can cause a chronic hepatitis, especially if associated with inadequate nutrition. Also, even moderate intake of alcohol can make chronic hepatitis from other cause (especially hep C) worse, with an increased risk of advancing to cirrhosis. 

Non-alcoholic steatohepatitis (NASH). Non alcoholic steatohepatitis or NASH has become a relatively common cause of persistent liver inflammation. "Steato" means fat and the hallmark of NASH is fat in the liver AND active on-going liver damage. Most people have no symptoms. They are usually discovered when a routine blood test is performed and the level of liver enzymes are found to be above normal. 

Autoimmune hepatitis. In this form of chronic hepatitis, the immune system mistakenly destroys the body's own liver cells. What triggers autoimmune chronic hepatitis is unknown. If left untreated, it's a progressive disease that can lead to cirrhosis. It may appear with other autoimmune diseases, such as Sjogren's syndrome and autoimmune hemolytic anemia. Autoimmune hepatitis most often is found in young women, but it can affect women and men of all ages. 

Some Medications also can lead to chronic hepatitis: 

Isoniazid (Laniazid, Nydrazid) for tuberculosis Methyldopa (Aldomet, Amodopa) for high blood pressure (hypertension)
Phenytoin (Dilantin) for seizure disorders Macrodantin for urinary tract infections 

However, chronic hepatitis caused by medications is relatively uncommon. Periodic blood tests are warranted when patients are placed on drugs known to cause hepatitis. Discontinuing the medication usually reverses early liver inflammation. 

Some rare, inherited metabolic disorders also can lead to chronic hepatitis: 

Wilson's disease, a condition in which the body has difficulty metabolizing copper 

Hemochromatosis, a condition of excessive iron deposits in the liver and many other parts of the body 

SYMPTOMS Of Chronic Hepatitis

People with symptoms most commonly complain of fatigue. Fatigue worsens throughout the day and may even be debilitating. Other common symptoms include: 

• Mild upper abdomen discomfort Loss of appetite
• Nausea
• Body aches 

If chronic hepatitis becomes more severe, people may experience additional symptoms, including: 

• Jaundice (yellowing of the skin and eyes) Abdominal
• swelling
• Weight loss
• Muscle weakness 
• Dark urine
• Easy bruisability and spontaneous bleeding 
• Confusion that may progress to coma 

DIAGNOSIS Of Chronic Hepatitis

Blood tests may be done to measure: 

• Liver enzymes, which are released when liver cells become inflamed or damaged 
• Bile duct enzymes 
• Levels of bilirubin, a pigment produced by the breakdown of red blood cells. High levels of bilirubin cause jaundice. 
• Protein levels and clotting factors to assess how the liver is functioning. 

Other tests: 

Ultrasound CT
Biopsy 

Treatment Of Chronic Hepatitis 

The goals of treatment for chronic hepatitis are to prevent the disease from getting worse and to prevent cirrhosis and liver failure. In mild cases of chronic hepatitis from hep B or hep C, treatment may not be necessary, and the condition may not get worse. With active infection, or if a liver biopsy shows early signs of damage, treatment is more likely to be recommended to eliminate active infection. Treatment isn't recommended for everyone because of the side effects and the risk that active infection may return. 

Viral hepatitis is treated with antiviral medications. Drugs used to treat hep C include alpha interferon, ribavirin and boceprevir. For hep B, the drugs include lamivudine, tenofovir & entecavir. 

Complications

      •  Liver failure.

• Portal hypertension: ascites, hypersplenism, lower oesophageal and rectal varices.
• Hypoalbuminaemia.
• Coagulopathy.
• Osteoporosis.
• Hepatopulmonary syndrome (defect in arterial oxygenation induced by pulmonary vascular dilatation in patients with liver disease).
• Hepatorenal syndrome.
• Encephalopathy.
• Cirrhosis.
• Hepatocellular carcinoma: In most cases of hepatocellular carcinoma are associated with cirrhosis which are related to chronic hepatitis B virus or hepatitis C virus infection.

PROGNOSIS OF CHRONIC HEPATITIS

In its most severe stages, cirrhosis can lead to liver failure and death unless a liver transplant can be done. The likelihood of developing cirrhosis depends on the severity of the disease and the response to treatment. When a biopsy shows more severe damage, treatment can be important to help decrease the risk of developing cirrhosis even if you do not have symptoms. Other factors that affect the prognosis include age, other medical illnesses, the subtype of virus and alcohol use. 

Cirrhosis increases the risk of developing liver cancer. Periodic screening with a blood test and ultrasound examination of the liver improves the chance of early detection. 

The risk of developing cirrhosis depends on the cause of the hepatitis and the degree of inflammation. Symptoms and signs of cirrhosis may develop in 15% to 30% of people who have had chronic hepatitis infection for more than 20 years.