What Is It?
Hepatitis is an inflammation of the liver. In chronic hepatitis, inflammation continues for six months or longer, with ongoing injury to liver cells. This condition may be mild, causing little damage (called chronic persistent hepatitis), or more serious, resulting in liver-cell destruction and possible cirrhosis or liver failure (called chronic active hepatitis).
Viruses are the most common cause of chronic hepatitis. Less common causes include autoimmune disease, reactions to medications and inherited metabolic disorders.
Viral causes include:
- Hepatitis B and C: Two-thirds of all cases of chronic hepatitis result from infection with hepatitis B and C viruses. Both of these viruses usually begin with mild symptoms. Over time, perhaps a decade or more, both may lead to serious complications, such as cirrhosis, liver failure caused by irreversible damage and scarring, and, less commonly, liver cancer. People infected with hepatitis C have the greatest risk of developing chronic hepatitis. Chronic hepatitis C is nearly equal to alcoholism as a risk factor for cirrhosis.
- Hepatitis D: Hepatitis D by itself won’t lead to chronic hepatitis. However, in people also infected with hepatitis B, hepatitis D may increase the risk of chronic hepatitis and worsen any complications.
- Autoimmune chronic 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. In most cases, it’s a progressive disease that leads to cirrhosis. It may appear with other autoimmune diseases, such as systemic lupus erythematosus (lupus or SLE) and antiphospholipid antibody syndrome (APS). Young women have the highest rate of autoimmune chronic hepatitis, but it may affect women and men of all ages.
Medications: Some medications also can lead to chronic hepatitis. These medications include:
- Isoniazid (Laniazid, Nydrazid) for tuberculosis
- Methyldopa (Aldomet, Amodopa) for high blood pressure (hypertension)
- Phenytoin (Dilantin) for seizure disorders
However, chronic hepatitis caused by medications is uncommon because regular blood-test monitoring helps to ensure that liver problems are noticed early. Discontinuing the medication usually reverses early liver inflammation.
Some rare, inherited metabolic disorders also can lead to chronic hepatitis. They include:
- Wilson’s diseases, a condition in which the body has difficulty metabolizing copper
- Hemochromatosis, a condition of excessive iron deposits in many of the body organs that can lead to chronic hepatitis and cirrhosis
- Sarcoidosis, an inflammatory disease that can affect the liver
At first, chronic hepatitis often does not cause any symptoms. 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
- Aching joints
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
Because chronic hepatitis often does not cause any early symptoms, the disorder frequently is discovered during a routine blood test. If your doctor suspects you may have chronic hepatitis, he or she may examine you for jaundice, tenderness in the abdomen (especially the right upper corner where the liver is located) and signs of ascites (fluid that fills the abdomen during liver failure).
Blood tests may be performed 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
If these tests show signs of liver inflammation or liver failure, you will undergo tests for viral infection with Hepatitis B and C and for antibodies that signal autoimmune hepatitis. Your doctor will review medications you take now or have taken recently to determine if they could be causing your chronic hepatitis. If the cause still is not known, further blood tests will be ordered to check for uncommon causes. An Ultrasound or computed tomography (CT) test may be done to assess the size of the liver. A small liver that appears scarred suggests cirrhosis.
A liver biopsy may be recommended. In a biopsy, a small piece of tissue from your liver will be examined under a microscope to help determine the amount of scarring and the extent and type of liver damage. This information helps to guide determine the best treatment and to assess your chances of developing cirrhosis and liver failure. A liver biopsy also can help to rule out other disorders, such as alcoholic liver injury or fatty liver.
By definition, chronic hepatitis is inflammation that continues for more than six months. With mild or nonexistent symptoms, you may have chronic hepatitis for some time before it is discovered. Treatment for some types of viral chronic hepatitis can eliminate active infection. However, the virus can remain dormant in cells, so the condition can return.
Usually, chronic hepatitis is caused by infection with the hepatitis B or C viruses. These viruses primarily are passed from person to person through sexual contact or through contact with blood or other bodily fluids when needles are shared or during blood transfusions. The reason some cases of viral hepatitis become chronic hepatitis and others do not remains unknown. The best prevention is to protect yourself against the hepatitis B and C viruses.
Vaccinations for hepatitis B are recommended for health-care workers and people traveling to certain countries. Infants are now routinely vaccinated against hepatitis B. Condoms always should be used during sexual contact to help prevent infection. Needles should never be shared. When getting a tattoo or any body piercing done, make sure to choose an establishment where all equipment is sterilized adequately.
Causes of and measures to prevent autoimmune chronic hepatitis remain unknown.
If you are taking a medication that could affect your liver, make sure to have your blood tested regularly to avoid the development of chronic hepatitis or liver damage.
The goal of treatment for chronic hepatitis is to prevent the disease from getting worse, and to prevent cirrhosis and liver failure. In mild cases of chronic hepatitis from hepatitis B or hepatitis 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 fairly high chance that active infection will return.
Therapy with a drug called interferon alpha is the most common treatment for chronic hepatitis B and C. The drug is injected several times a week for several months (usually five to six months, but sometimes a year). Clinical trials are continuing to determine the best dosage and duration of therapy to improve response and lower the chance that the condition will return. Another medication approved for use alone in the treatment of hepatitis B is the antiviral drug lamivudine (Epivir). While it may work as well as interferon in some cases, it also may lead to the development of viruses that are resistant to the medication.
A combination of drugs may be used in some people. However, combination therapy is not for everyone because it may cause more adverse reactions than a single drug. Combination therapy has not been shown to work as well in the treatment of hepatitis B, except in specific cases. Examples of drugs used in combination therapy include lamivudine with interferon for chronic hepatitis B, and ribavirin (Virazole) with interferon for chronic hepatitis C.
Common side effects with interferon include:
- Muscle aches
- Nausea and vomiting
- Weight loss
- Irritability and depression
If you have hepatitis C, you should receive the vaccine for hepatitis A and B unless blood tests show that you are already immune to these viruses. You can develop more serious infection from hepatitis A or B than someone who does not have hepatitis C.
If you already have evidence of cirrhosis, you should have an endoscopy to look for esophageal varices, enlarged veins in the esophagus that can cause life-threatening bleeding. In an endoscopy, a flexible viewing tube is inserted through your mouth into your esophagus.
Corticosteroid drugs are the main treatment of autoimmune chronic hepatitis. These drugs suppress the immune system and may decrease symptoms, improve liver condition and prolong survival. Your doctor may prescribe prednisone alone or prednisone with azathioprine (Imuran), another drug that works on the immune system.
Treatment for the less common forms of chronic hepatitis focuses on the disease that is causing the condition. Medication-related chronic hepatitis requires stopping or changing the drug.
If cirrhosis or liver failure develops, a liver transplant may be needed.
If you have chronic hepatitis, you must avoid further liver damage from alcohol or Tylenol. Discuss with your doctor how much Tylenol you can take, if any. Remember that certain cold formulations and pain medications also contain Tylenol.
Supportive care is key in coping with chronic hepatitis. A well-balanced diet and good physical fitness can help you battle fatigue and improve overall health. Limit salt intake to counteract the accumulation of fluids and bodily swelling that may occur, especially if you develop cirrhosis. Also, always talk to your physician before taking any additional drugs, including prescription, nonprescription and alternative medications. Your injured liver may not be able to detoxify these
When To Call A Professional
If you experience persistent fatigue, the most common symptom of chronic hepatitis, make an appointment to see your doctor. If you show signs that could come from chronic hepatitis or liver failure, such as jaundice, abdominal swelling or weight loss, you should call your doctor for an evaluation.
Cirrhosis can lead to liver failure and death unless a liver transplant can be performed. The likelihood of developing cirrhosis depends on the severity of the disease as and the response to treatment. When a biopsy shows more severe signs of 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.
Anyone with cirrhosis also has an increased risk of developing liver cancer and must be screened regularly with a blood test and ultrasound examination of the liver.
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 percent to 30 percent of people who have had chronic hepatitis infection for more than 20 years.
Here is the outlook for specific forms of chronic hepatitis:
- Persistent chronic hepatitis, a milder type of hepatitis, may last years, causing few problems, disappear with time, or may lead to cirrhosis 10 or more years later.
- Chronic active hepatitis commonly progresses to cirrhosis and liver failure, especially when left untreated. Autoimmune chronic hepatitis is likely to progress to cirrhosis. Treatment, however, can help control the symptoms and improve survival.
Diseases and Conditions Center
All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.