Chronic Hepatitis: An In-Depth Exploration

Corresponding Author:

Rajesh Kanthe
Department of Hepatology,
Tirana University,
Tirana,
Albania
E-mail: drrajeshkan@gmail.com

Received: 04-Jul-2024, Manuscript No. oarcd-24-140742; Editor assigned: 09-Jul-2024, PreQC No. oarcd-24-140742 (PQ); Reviewed: 23-Jul-2024, QC No. oarcd-24-140742; Revised: 01-Aug-2024, Manuscript No. oarcd-24-140742 (R); Published: 29-Aug-2024, DOI: 10.37532/OARCD.2024.8(4).202-203

Introduction

Chronic hepatitis is a prolonged inflammation of the liver, lasting six months or longer. Unlike acute hepatitis, which resolves within a few weeks, chronic hepatitis can persist for years and may lead to severe complications such as liver cirrhosis, liver failure and hepatocellular carcinoma (liver cancer). This article delves into the causes, symptoms, diagnosis, treatment and prevention of chronic hepatitis, providing a comprehensive understanding of this significant health issue.

Description

Causes of chronic hepatitis

The primary causes of chronic hepatitis are viral infections, autoimmune disorders, metabolic diseases and drug-induced liver injury.

Viral hepatitis

Hepatitis B Virus (HBV): HBV infection is a major cause of chronic hepatitis worldwide. The virus is transmitted through contact with infectious body fluids, including blood, semen and vaginal fluids. Perinatal transmission (from mother to child at birth) is also common in endemic areas.

Hepatitis C Virus (HCV): HCV is another leading cause of chronic hepatitis. It spreads primarily through blood-to-blood contact, often via intravenous drug use, unsafe medical procedures and less commonly through sexual contact.

Hepatitis D Virus (HDV): HDV can only infect individuals already infected with HBV, as it requires the HBV surface antigen to replicate. Co-infection with HDV and HBV can lead to more severe liver disease.

Autoimmune hepatitis

Autoimmune hepatitis is a condition in which the immune system attacks liver cells, leading to inflammation. The exact cause of autoimmune hepatitis is unknown, but genetic and environmental factors are believed to play a role.

Metabolic diseases

Non-Alcoholic Fatty Liver Disease (NAFLD): This condition, associated with obesity, diabetes and metabolic syndrome, can progress to Non-Alcoholic Steatohepatitis (NASH), causing liver inflammation and damage.

Hemochromatosis: This genetic disorder leads to excessive iron accumulation in the liver, causing chronic inflammation and damage.

Drug-induced liver injury

Certain medications and toxins can cause chronic hepatitis. Long-term use of drugs such as methotrexate, isoniazid and acetaminophen in high doses can lead to liver inflammation and damage.

Symptoms of chronic hepatitis

Chronic hepatitis often presents with subtle symptoms that may be mistaken for other conditions. Common symptoms include.

Fatigue: Persistent tiredness and lack of energy are frequent complaints.

Jaundice: Yellowing of the skin and eyes due to elevated bilirubin levels.

Abdominal discomfort: Pain or discomfort in the upper right quadrant of the abdomen.

Loss of appetite: Reduced interest in food, leading to unintended weight loss.

Itchy skin: Persistent itching caused by bile salt accumulation in the skin.

Diagnosis of chronic hepatitis

Diagnosis of chronic hepatitis involves a combination of medical history, physical examination, laboratory tests, imaging studies and liver biopsy.

Medical history and physical examination

A thorough medical history, including risk factors such as alcohol use, medication history and potential exposure to hepatitis viruses, is essential. Physical examination may reveal signs of liver disease such as jaundice, ascites and hepatomegaly (enlarged liver).

Laboratory tests

Liver function tests (LFTs): Elevated levels of liver enzymes (ALT and AST) indicate liver inflammation.

Viral serologies: Tests for HBV, HCV and HDV markers help identify viral infections.

Autoimmune markers: Tests for autoantibodies such as ANA, SMA and LKM-1 aid in diagnosing autoimmune hepatitis.

Iron studies: Elevated ferritin and transferrin saturation suggest hemochromatosis.

Liver biopsy

A liver biopsy involves taking a small tissue sample from the liver for microscopic examination. It provides definitive information on the degree of inflammation, fibrosis and presence of specific diseases.

Treatment of chronic hepatitis

Treatment strategies for chronic hepatitis depend on the underlying cause and the extent of liver damage.

Antiviral Therapy: HBV-Antiviral medications such as tenofovir and entecavir help suppress HBV replication and reduce liver damage. HCV-Direct-Acting Antivirals (DAAs) like sofosbuvir and ledipasvir can achieve high cure rates, eliminating the virus from the body. HDVInterferon- based therapies may be used, although they have limited efficacy.

Immunosuppressive therapy: For autoimmune hepatitis, immunosuppressive drugs such as prednisone and azathioprine help reduce immune-mediated liver inflammation.

Liver transplantation: In cases of advanced liver disease or liver failure, a liver transplant may be necessary. This involves replacing the damaged liver with a healthy donor liver.

Prevention of chronic hepatitis: Preventive measures can significantly reduce the risk of chronic hepatitis.

Vaccination

Vaccines are available for HBV and HAV (hepatitis A virus). Routine vaccination of infants, high-risk adults and healthcare workers can prevent HBV infections.

Regular screening: High-risk individuals, such as those with a family history of liver disease or chronic HBV/HCV infection, should undergo regular screening for early detection and management of chronic hepatitis.

Conclusion

Chronic hepatitis is a complex condition with diverse causes and significant health implications. Understanding the etiology, recognizing symptoms, obtaining a proper diagnosis and adhering to appropriate treatment can effectively manage the disease and prevent complications. Through vaccination, lifestyle modifications and safe practices, the burden of chronic hepatitis can be significantly reduced, improving the quality of life for affected individuals.