Chronic hepatitis

Definition - Chronic Hepatitis (CAH) is ongoing injury to the cells of the liver near inflammation which lasts for longer than six months. The cause of chronic hepatitis are several: viruses, metabolic or immunologic abnormality and medications.

Symptoms - Symptoms result from the liver cell injury, the inflammation or from the resulting scarring which is call cirrhosis. Chronic hepatitis may follow acute hepatitis B or C (formerly called bloodborne or transfusion non-A, non-B) or may develop smoothly without an acute sickness.

Liver biopsy is helpful within that it confirms the diagnosis, aids in establishing the motive (etiology) and can demonstrate the presence of cirrhosis. It is less agreeable in judge the response to treatment.

Causes - The most common cause of chronic hepatitis are the viruses of hepatitis B and hepatitis C. Together they information for more than 75% of the cases in the world. Hepatitis B is far more adjectives in China and sub-Saharan Africa and among masculine homosexuals and IV drug users.

Chronic hepatitis C behaves differently from hepatitis B. The disease is mostly mild, with fatigability person the main symptom. However, ten or more years next, the complications of cirrhosis appear in some patients, sometimes unexpectedly. By contrast next to Hepatitis B, the percentage of patients infected who develop cirrhosis is much greater. While primary liver cancer can also develop from hepatitis C, it appears to be much less adjectives than after hepatitis B.

Autoimmune chronic hepatitis varies from mild to serious disease from one lenient to the next and from time to time within the same forgiving. The percentage of patients who develop cirrhosis is high and it may appear hasty. Most of the patients are young women but postmenopausal women and males may obtain the disease. Only a few cases of primary liver cancer have be reported with this disease.

Among 25% of the cases of chronic hepatitis results from defacement to the liver by the immune system. The trigger for this autoimmune chronic hepatitis is unknown, but the damage to the liver is cause by the individual's lymphocytes and by antibodies produced to the individual's own tissue. Autoimmune chronic hepatitis is usually a progressive disease ending surrounded by cirrhosis.

Hepatitis A and E (formerly epidemic or enteric non-A, non-B) are rarely, if ever, responsible for cases of chronic hepatitis.

Hepatitis D infection requests the hepatitis B virus to multiply. Hepatitis D can cause acute hepatitis within someone who is a carrier of the hepatitis B virus and can do acute hepatitis at the same time that the hepatitis B virus does. In any event, the combination of hepatitis B and D is worse than hepatitis B alone and is more plausible to cause serious chronic hepatitis and cirrhosis. IV drug users hold a high incidence of hepatitis D.

Other Causes - Viruses of the Herpes ancestral which cause cold sores, genital herpes, chicken pox, shingles and infectious mononucleosis can grounds acute hepatitis, especially when the immune system is not properly functioning but is unlikely that they produce chronic hepatitis. The AIDS virus does seem to directly attack the liver. Other virus, as yet undiscovered, may be responsible for some cases of chronic hepatitis.

Drug-Induced Hepatitis - Few medication still in use and several that own been withdrawn from the open market can also cause chronic hepatitic (CAH). These include isoniazid, used for tuberculosis; methyldopa, used for hypertension; nitrofurantoin, used for urinary tract infections; phenytoin, used for fit disorders and selected other prescription medication. These medications must be taken for long period of time and the number of cases of CAH produced by these medications is small.

Chronic hepatitis cause by medicines is usually traditional early so that stopping the prescription before cirrhosis have developed reverses the disease.

Inherited Disorders - Some inherited disorders of metabolism also can appear as chronic hepatitis. The most frequent of these singular conditions is Wilson's disease, a familial disorder of copper metabolism Alpha-1-antitrypsin deficiency and tyrosinemia may appear as chronic hepatitis although other features sustain in distinguishing these intermittent conditions from those caused by virus.

Signs and Symptoms - Fatigue, mild discomfort in the upper tummy, loss of appetite and aching joint are the common symptoms of chronic hepatitis. Fatigue is by far the most adjectives symptom and it might be quite disa bling. Often it get worse as the day wear on. Some patients, however, may have no symptoms. Others may hold signs of liver failure, including jaundice, abdominal swelling (due to fluid retention call ascites), or coma, depending on the severity of the liver disease and whether or not cirrhosis has developed. Most complications are evasive and may be mistaken for other diseases or simply a consequence of aging. Disorders of other organs like the thyroid, intestine, eyes, joint, blood, spleen, kidneys and skin may occur within about 20% of patients depending on the exact of the chronic hepatitis.

When the hepatitis is mild and limited contained by extent, it is called chronic harsh hepatitis (CPH). When it is more extensive and seems to be destroying the cell of the liver, it is called chronic alive hepatitis (CAH).

Treatment - Treatment of chronic hepatitis depends first on recognizing its result in. Some patients with chronic hepatitis B and C are one treated with interferon, a fluent substance in the body which improve the immune system and may also have some antiviral resources. Everyone, however, does not respond to interferon treatment. It works best in sicker patients with a more recent beginning of disease and without cirrhosis.

Steroid analysis with or lacking azanthioprine, is still widely used but as more specific causes of chronic hepatitis are discovered the number of patients so treated is diminishing. Steroid psychotherapy remains the only adjectives treatment for autoimmune disease, but it may have to be given for a lifetime and may also not prevent the state-of-the-art development of cirrhosis.

Liver transplantation have become an accepted form of dream therapy when chronic hepatitis becomes life-threatening, usually as a result of complications of cirrhosis. Recurrence of hepatitis C or autoimmune hepatitis does not come across to occur, but hepatitis B, if virus is still present and the lenient is contagious, will recur in the bright liver and often be acute. Attempts are person made to prevent this recurrence beside interferon and with monocional antibody directed to hepatitis B surface antigen.

The most impressive treatment is prevention. Hepatitis B vaccine should be given to all who are exposed to this disease on a regular justification. The vaccine is being given within some areas to all newborn babies. All pregnant women should be tested for hepatitis B. Carriers of hepatitis B, frequent of them unaware that they are infected, can slip away it on to their babies. The newborn can be vaccinated at birth, providing protection from this disease.

Testing of blood for hepatitis B and C is going to provide as secure a blood supply as possible. Health care personnel must be extremely measured in handling sharp instruments, they should other wear gloves and be immunized against hepatitis B. Attempts are human being made to offer needles to addict to try to stem this means of spreading the disease.

An substantial aspect of treatment is supportive care. Diet should be capably balanced. The use of elevated carbohydrate or high protein or low oil diets has no solid basis, and within some instances, such diets may be harmful. Vitamin and mineral supplementation also have no place in the headship of chronic hepatitis unless some deficiency is present. No substance is agreed that will help the fundamental symptom, fatigue. However, a good physical fitness program may lessen this distressing symptom. Patients should be advise to limit the amount of saline that they use in an attempt to forestall the collection of fluids as ascites or ankle swelling. Since almost all drugs must be detoxified by the liver, and since the injured liver does not achieve this task powerfully, limiting the amount of drugs that a patient uses to with the sole purpose essential ones is important. This includes discouraging the use of sedative and tranquilizers.

Looking to the Future - Learning more about the virus responsible for chronic hepatitis and how to control them will occur within the next decades. Similarly, erudition about the body's immune system and how to control it have already begun. Preventive pains will be enhanced so that fewer cases of chronic hepatitis will develop. The objective of eliminating this group of diseases seem to be just over the horizon, and while our skills at transplantation are fast increasing, the form of therapy for chronic hepatitis, similar to the disease itself, will disappear.

Interferon is given by injection (like insulin, by the patient himself) three times a week for three or four months. Side effects are numerous and include flu-like symptoms next to fever and achiness. These diminish but do not disappear beside time. Abnormalities in blood counts may develop, making frequent monitoring mandatory. Often a flare-up of hepatitis occur as the virus disappears. In some studies, when a patient is not particularly sick before treatment, prednisone have been given for a few weeks to certification the virus to multiple more vigorously so that the interferon may be more important. Trials of antiviral therapy are still self assessed in roomy multicenter studies.

Interferon does not seem to work capably in patients

* who are not intensely sick,

* whose tests results are not really abnormal,

* whose immune system is not functioning very well because of AIDS,

* with hepatitis B who be infected from their mothers at birth,

* or carriers who are no longer contagious or infectious.

Knowing the raison d`être of the disease is more helpful surrounded by estimating prognosis than what the liver biopsy shows in the absence of cirrhosis.

Only a small percentage of patients beside chronic hepatitis B develop cirrhosis. In those patients, cirrhoris develops early contained by the course of the disease with complications appearing in the first few years of the disease. Chronic hepatitis most commonly causes acute hepatitis or flare-ups and p eriods beside no signs. Scarring becomes more extensive beside each flare-up. Patients contained by the Orient have in the region of a 15% chance of developing primary liver cancer, usually after the age of 50 next to men more likely candidate than women. This complication is much less adjectives in the Western World.

The disease become life-threatening only after cirrhosis have developed in most instances and the complications of cirrhosis are adjectives causes of extermination. More than half of adjectives patients live at least 15 years from the time of t he first diagnosis and this number is continuously shooting up. Previously, prognosis was feel to depend on what was found on liver biopsy. This is in a minute only moderately true. Prognosis is worse and complications more numerous and severe if cirrhosis has already developed. Much attention have been rewarded to the location and extent of the inflammation in the liver.

Chronic hepatitis C responds differently to interferon than hepatitis B. The initial response is more rapid as far as the return of the blood experiment results to normal, sometimes surrounded by a couple of weeks. Side effects are the same but unless interferon is given for longer period of time, usually a year, the disease will recur. Prednisone prior to interferon does not seem to be accommodating, nor is it helpful when it is given lacking interferon. No other antiviral treatment has be found as yet.