What is hepatitis?
Hepatitis means inflammation of the liver. When liver cells become inflamed, they can no longer function normally, become damaged or may even die. If the liver is damaged to such an extent that the bile pigment bilirubin can no longer be excreted properly, this is known as jaundice. In those affected, the skin and the white parts of the eyeball become yellowish in color. However, this is not always the case.
There are various forms of hepatitis, some of which can become chronic. Chronic hepatitis is when the inflammation of the liver lasts longer than six months. Shorter infections are called acute hepatitis.
What types of hepatitis are there?
There are various causes, diverse manifestations and different symptoms: hardly any other disease manifests itself in as many forms as hepatitis.
Five types of hepatitis are caused by viruses and are designated by letters from A to E.
- Hepatitis ALiver infections caused by hepatitis A viruses are rare in Switzerland.
- Hepatitis BThe most common form of hepatitis worldwide, in Switzerland more than 60,000 people are affected by chronic hepatitis B.
- Hepatitis C: Around 30,000 people in Switzerland, mainly men, suffer from this type of viral infection.
- Hepatitis DThis variant always occurs together with hepatitis B; every twentieth hepatitis B patient in Switzerland is also infected with hepatitis D.
- Hepatitis E: In Switzerland, this form of liver inflammation is mainly transmitted through the consumption of undercooked meat or sausage products from infected animals and is usually asymptomatic.
Other types of hepatitis are not caused by viruses, but have a different origin:
Fatty liver hepatitis
It is one of the most common forms of liver inflammation. A distinction is made between alcoholic fatty liver hepatitis and a non-alcoholic form. Non-alcoholic fatty liver disease is present in around 25% of the Swiss population. In medical terminology, this is also known as “metabolic dysfunction-associated steatotic liver disease” (MASLD) and is primarily associated with obesity and diabetes mellitus. About 10-20% of patients with MASLD develop fatty liver hepatitis, MASH.
Autoimmune hepatitis
In this rare liver disease, the immune system attacks the patient’s own liver cells. More about autoimmune hepatitis.
Toxic hepatitis
Drug-induced or toxic liver injury (DILI) is liver damage caused by drugs, herbal products or other chemical substances. It is one of the main causes of acute liver failure and a major reason for discontinuing the use of certain medications. DILI is classified as intrinsic (predictable, dose-dependent) or idiosyncratic (unpredictable, dose-independent). Common medications that cause DILI include paracetamol, antibiotics, non-steroidal anti-inflammatory drugs and statins. Risk factors include genetic predisposition, age, gender, alcohol consumption and pre-existing liver disease. The clinical manifestations range from asymptomatic enzyme elevations to severe liver failure. The diagnosis includes the exclusion of other liver diseases and the identification of the pathogens, often using the RUCAM scale. Treatment focuses on discontinuing the medication and supportive measures.
Ischemic hepatitis
The word “ischemia” means “lack of blood flow”. If the liver is not supplied with sufficient blood and oxygen, for example in the case of very severe heart disease, its cells can die. In ischemic hepatitis, the liver cells are not inflamed but perish – even though the term “hepatitis” translates as “liver inflammation”.
Causes: How does hepatitis develop?
Inflammation of the liver can occur in very different ways. Viruses are one of the most common causes of hepatitis. They can be found, for example, in contaminated water and on food (salad, mussels, raw vegetables). In countries like Switzerland with a high level of hygiene, however, this rarely happens. Other transmission routes for hepatitis viruses are faeces, blood, saliva and other bodily fluids that play a role in sexual contact, for example.
While viral infections are contagious, this is not the case with the other types of hepatitis. Fatty liver hepatitis is caused either by excessive alcohol consumption or severe obesity and diabetes. In autoimmune hepatitis, the disease is triggered by a malfunction of the body’s own immune system, while toxic hepatitis is caused by toxins that lead to inflammation of the liver.
Symptoms: How does hepatitis manifest itself?
Liver inflammation is not noticeable through pain in the liver, as it does not contain any nerves. In the beginning, it is often more mental signs that indicate hepatitis without making it clearly recognizable – for example, lack of concentration, tiredness, declining performance or depressive moods. Physical symptoms of hepatitis can also appear at the beginning of the disease. These include pain in the upper abdominal area, joint or muscle pain, nausea, lack of appetite and a slight fever.
Not all those affected show such symptoms. You may well be suffering from hepatitis without even realizing it at first. You should therefore look out for other signs of hepatitis, which can develop later on in the course of the disease:
- Reddened palms and soles of the feet
- Spider web-shaped veins (“spider naevi”)
- dark urine
- light-colored chair
- Itching (pruritus)
- Excessively red tongue and lips
- in men: enlarged mammary glands, reduced testicles
Probably the most noticeable physical change in hepatitis is the yellowish discoloration of the skin and the white areas of the eye, which is why hepatitis is sometimes colloquially called jaundice. But the yellow discoloration is only a symptom, and it does not occur in every case.
Diagnosis: How can hepatitis be diagnosed?
Sometimes hepatitis is indicated by pressure pain in the right upper abdomen. The pain can occur when the inflamed liver has enlarged and displaces the surrounding tissue. Your doctor can determine whether this is actually the case with the help of an ultrasound examination(sonography). It can also show whether the liver has been inflamed for a long time.
Blood tests also help with the diagnosis. Certain liver enzymes (known as transaminases) indicate hepatitis if they are present in excess. In medicine, two of these often suspicious enzymes are called “GOT/AST” and “GPT/ALT”. Other signs of hepatitis can also be found in the blood: If your body is infected by hepatitis viruses, it tries to defend itself against the intruders with antibodies. Each type of virus elicits antibodies that are typical for it. For example, a blood test can determine whether hepatitis A, B or C or another viral form of liver inflammation is present.
In the case of autoimmune hepatitis, the body also produces certain antibodies that are found in the blood. However, they are not directed against disease-causing pathogens, but against the body’s own liver cells.
A diseased liver usually changes not only in size and shape, but also in its elasticity. Such tissue changes can be detected using an imaging procedure called elastography. The liver is exposed to short bursts of sound waves, which is completely painless for the patient. These elastography procedures are mostly based on an ultrasound technique, but magnetic resonance elastography is also available. Elastography can be used to assess whether there is already incipient scarring or even cirrhosis of the liver. In some cases, a liver biopsy is necessary to establish the diagnosis. A tissue sample is taken from the liver and then examined under a microscope in the laboratory.
Therapy: How is hepatitis treated?
The options for treating hepatitis are as varied as the individual types of hepatitis. In general, if your liver is inflamed, you can protect and relieve it by avoiding alcohol. As medicines are also broken down in the liver, you should ask your doctor which medicines you can and should not take if you have an inflamed liver. And if you suffer from fatty liver hepatitis, it would make sense not only to avoid alcohol, but also to avoid or, if present, reduce excess weight with the help of exercise and a healthy diet.
In quite a few cases, hepatitis can heal on its own (for example in the case of acute hepatitis E, if the infected person is otherwise healthy). A diseased liver often recovers if the specific causes of hepatitis are eliminated – for example by eliminating the viruses, toxins (alcohol, toxic hepatitis) or circulatory disorders (ischemic hepatitis).
Drugs are available for hepatitis B, C and D, which are caused by viruses. Autoimmune hepatitis can also often be treated with medication – with substances that have an inhibitory effect on the immune system (e.g. cortisone). If hepatitis treatment is too late or is unsuccessful, a liver transplant can also be considered in certain cases.
Prognosis: How does hepatitis progress?
The liver is an organ that often recovers surprisingly well – if parts of it are removed during an operation, they can even grow back. But it can also happen that a liver is irreparably damaged. In chronic hepatitis B or C, for example, it can scar and lose its function as a result. As long as the scarring is only partial and can be reversed, it is referred to in medicine as liver fibrosis; massive damage, which is usually irreversible and can even develop into liver cancer, is called liver cirrhosis.
In many cases, however, hepatitis does not become chronic, but heals itself in the acute stage. This always applies to hepatitis A infections and usually also to hepatitis E. With hepatitis B, the risk of a chronic course is somewhat higher. And acute hepatitis C infections even develop into a chronic form in more than half of cases. To prevent you from developing chronic hepatitis, you should seek medical advice in good time. Even if you may only be suffering from vague symptoms such as loss of appetite or fever, which initially do not make you think of liver inflammation.
Prevention: How can you avoid hepatitis?
In Switzerland, vaccination against hepatitis B is already recommended for newborns; it is also advisable for adults and protects against hepatitis D at the same time. You can also be vaccinated against hepatitis A.
Eating a healthy diet and avoiding (or reducing) regular alcohol consumption and obesity is a good preventive measure against fatty liver hepatitis. You can reduce the risk of hepatitis B and C if you avoid unprotected sex and use condoms with different sexual partners. Also remember that it is risky to share hygienic utensils such as nail scissors and razors with people infected with hepatitis, as even the smallest injuries can be entry points for hepatitis viruses. This also applies to piercing ears or piercings if the material used is not sterile.
And if you like traveling: The best vacation can end tragically if you forget you are in a country with poor hygiene, where disease-causing hepatitis pathogens could be lurking. This is mainly on unpeeled or uncooked food, in undercooked meat, in tap water and in ice cubes.
