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Hepatitis (inflammation of the liver): forms, symptoms, therapy

by Josephine Andrews
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Hepatitis means inflammation of the liver. This can be caused by viruses, toxins, drugs or autoimmune diseases. Physicians differentiate between different forms of hepatitis depending on the cause, duration and histological characteristics. Read more about the symptoms, causes and treatment of liver inflammation here and find out how you can prevent hepatitis!

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

K73 B19 B18 K75 B16 B17 B15

quick overview

  • What is hepatitis? Inflammation of the liver, which can be acute or chronic
  • Forms: viral hepatitis ( hepatitis A , B, C, D, E), viral hepatitis, autoimmune hepatitis
  • Symptoms: sometimes no symptoms; in other cases, clear to severe symptoms such as nausea, fever, upper abdominal pain and possibly jaundice
  • Causes: viruses , toxins (such as alcohol), drugs, metabolic diseases, autoimmune processes
  • Treatment: depending on the cause and severity of the disease; E.g. rest, light food, abstinence from alcohol, medication, possibly liver transplantation
  • Prognosis: Acute forms usually heal by themselves. Chronic forms can permanently damage the liver. Liver cirrhosis and liver cancer are possible consequences.

forms of hepatitis

The term hepatitis means inflammation of the liver. But that’s the end of the simplicity. Exactly what hepatitis is can only be answered a little more extensively, because there are different forms of the disease.

First of all, hepatitis can be divided into two forms based on its duration:

  • acute hepatitis: lasts less than half a year
  • chronic hepatitis: lasts longer than six months, develops mainly from hepatitis forms B, C and D

Hepatitis can also be classified according to the cause:

  • Viral hepatitis: Inflammation of the liver caused by hepatitis viruses A, B, C, D or E (all notifiable)
  • Viral concomitant hepatitis: liver inflammation as a “side effect” of another viral disease ( herpes , glandular fever )
  • Autoimmune hepatitis: Inflammation of the liver caused by a malfunction in the immune system

Very rarely, hepatitis is caused by parasites, fungi, or bacteria.

Hepatitis A

Hepatitis A is mainly transmitted faecal-orally , i.e. via drinking water that has been contaminated by the excrement of patients. Infection can also occur via smear infection : If patients do not wash their hands thoroughly after going to the toilet, they can transmit the virus to doorknobs, taps, cutlery or towels, for example. From there, the pathogens can get on the hands and subsequently possibly on the oral mucosa of healthy people.

Sometimes hepatitis A is also transmitted through contaminated food (seafood, ice cream, fruit, etc.).

After infection, 15 to 50 days elapse before the first symptoms appear (incubation period). These initially include non-specific symptoms such as fever, nausea or loss of appetite. Later, the skin and eyeballs sometimes turn yellow, the urine becomes dark, and the stools light-colored. It can take a few months for patients to recover. However, hepatitis A infection cannot become chronic. In addition, after surviving the infection, you are immune to hepatitis A viruses for life.

You can read everything you need to know about this form of liver inflammation in the article Hepatitis A.

Hepatitis B

Hepatitis B is one of the most common viral hepatitis diseases worldwide. The infection occurs via blood and sexual contacts ( sperm , saliva ). Hepatitis B viruses can also be transmitted via other body fluids such as tears, brain fluid ( liquor ), urine, gastric juice and breast milk. Overall, medical staff , dialysis patients and drug addicts (injections!) have a high risk of infection.

Type B liver inflammation can be acute or chronic. The first symptoms appear on average two to four months after infection.

Chronic hepatitis B is widespread. According to the World Health Organization (WHO), around 240 million people worldwide suffer from it. As a result of chronic liver inflammation, a shriveled liver (liver cirrhosis) and a malignant liver tumor (liver cancer) can develop.

You can find more information about hepatitis B in the text Hepatits B .

Hepatitis C

Experts estimate that around 71 million people worldwide have chronic hepatitis C. The triggering viruses can be detected in almost all body fluids. However, the infection is mainly transmitted via blood . The risk of infection is particularly high with contaminated cutlery for drug consumption, but also with tattooing or piercing tools. In about 30 percent of all patients with chronic hepatitis C, no clear transmission path can be identified.

Around ten percent of hepatitis C patients are also infected with the hepatitis G virus. So far, no symptoms are known that can be clearly assigned to this pathogen. In addition, hepatitis G viruses are difficult to detect.

The symptoms of hepatitis C are usually mild and rather unspecific: those affected have, for example, muscle and joint pain, a slight fever, nausea and an aversion to certain foods. Later, dark urine, yellowing of the skin and whites of the eyes (jaundice), and discolored stools may occur.

Chronic hepatitis C usually progresses slowly and unnoticed over many years . However, the patients have a relatively high risk of liver cirrhosis or liver cancer.

You can read more about this form of hepatitis in the article Hepatitis C.

Hepatitis D

Hepatitis D viruses can only multiply and cause infection with the help of hepatitis B viruses. This means: Hepatitis D infection is only possible in people who are either infected with hepatitis B at the same time or who already have a chronic hepatitis B infection.

Together, hepatitis B and D often lead to severe chronic liver inflammation

Hepatitis E

The hepatitis E pathogen is mainly found in Asia and Africa. The disease is mainly transmitted via drinking water or food. Human-to-human transmission is very rare.

Hepatitis E is acute and often only has mild symptoms, similar to hepatitis A. The symptoms become noticeable two to eight weeks after infection and subside after about six weeks.

As a rule, hepatitis E is not particularly dangerous. Only in pregnant women can it be severe and even fatal in rare cases.

Read everything you need to know about this type of liver infection in the article Hepatitis E .

autoimmune hepatitis

In contrast to the forms of hepatitis mentioned above, autoimmune hepatitis is not caused by viruses but by a malfunction of the immune system. However, this form of liver inflammation is very rare. Autoimmune hepatitis most commonly occurs between the ages of 40 and 70. Most patients are female.

Autoimmune hepatitis is almost always chronic. Often there are no or only unspecific symptoms such as tiredness, loss of appetite, abdominal pain and headaches as well as nausea and vomiting for a long time. In severe cases, chronic autoimmune hepatitis leads to liver cirrhosis – with the risk of liver failure .

The treatment of autoimmune hepatitis consists in the administration of immunosuppressants. These are drugs that suppress the immune system. A liver transplant may be necessary in the case of cirrhosis of the liver.

Read more about risk factors, symptoms, and disease progression in the article Autoimmune Hepatitis .

Hepatitis: symptoms

Hepatitis symptoms can vary quite a bit. In some patients, liver inflammation is severe. Others, on the other hand, have no symptoms at all and the disease is only discovered incidentally due to elevated liver values . Sometimes, but not always, jaundice ( jaundice ) occurs, which is often mistaken for hepatitis.

Acute hepatitis: symptoms

Symptoms of acute hepatitis are nonspecific in the early stages and include:

  • nausea and vomiting
  • loss of appetite
  • Fever
  • epigastric pain
  • joint or muscle pain
  • altered sense of smell and taste

The jaundice phase follows after two to eight weeks . The enlarged liver causes tenderness under the lower right costal arch. The skin may turn yellow, as may the eyeballs. This is because the bile pigment bilirubin is no longer released into the intestine via the bile , but accumulates in the blood. Because some of it is excreted through the kidneys, the urine turns dark. The stool, on the other hand, loses its typical color due to the bacterial processing of the bilirubin. Itching is also a common symptom. It occurs because bile acids build up in the skin.

The recovery phase ( convalescence phase ) of acute liver inflammation can last from a few weeks to months. During this time, those affected occasionally feel weak, tired and exhausted.

Chronic hepatitis: symptoms

Symptoms of chronic hepatitis include:

  • reduced performance
  • fatigue
  • loss of appetite
  • Pressure pain under the right costal arch
  • joint pain
  • changing diarrhea

In mild(er) cases, however, it may well be that no symptoms occur at all. Flares with enlarged liver and jaundice are typical. Women can also miss their periods. In men, the mammary glands may enlarge (gynecomastia), the testicles become smaller (testicular atrophy) and/or the hair on the abdomen and pubic area becomes less (abdomen baldness).

Hepatitis: causes and risk factors

In the vast majority of cases, hepatitis is a viral disease ( viral hepatitis ). It is mainly caused by type A, B, C, D or E hepatitis viruses. All are reportable.

Sometimes other viruses can also trigger viral hepatitis, which is usually milder. This applies, for example, to the Epstein-Barr virus (glandular fever), cytomegalovirus (CMV infection), Coxsackie virus and herpes viruses. Then physicians speak of accompanying viral hepatitis .

Occasionally, liver inflammation is the result of a dysregulation of the immune system ( autoimmune hepatitis ).

Bacteria such as Leptospira (leptospirosis), Brucella ( brucellosis ) or Salmonella (salmonellosis) and parasites (causative agents of amoebic dysentery and malaria ) are less common triggers of hepatitis.

In the case of toxic hepatitis , on the other hand, alcohol is usually the “culprit”. Doctors also speak of alcoholic fatty liver hepatitis (medical steatohepatitis, ASH). Excessive alcohol consumption damages the liver in those affected. As a result, more fat accumulates and inflammation occurs. If you continue to drink alcohol, cirrhosis of the liver can develop.

There is also non-alcoholic fatty hepatitis (non-alcoholic steatohepatitis, NASH). It is caused, for example, by obesity (obesity) or diabetes mellitus (diabetes).

Excessive use of drugs that damage the liver , such as paracetamol or certain anesthetic gases (eg halothane), can also trigger toxic hepatitis. The same applies to toxins such as that of the death cap mushroom.

Chronic hepatitis results from an existing acute hepatitis such as:

  • Hepatitis B, C or D
  • toxic hepatitis (e.g. caused by certain drugs or alcohol)
  • autoimmune hepatitis
  • a bile stasis (cholestatic) liver disease such as inflammation of the internal and external bile ducts (primary sclerosing cholangitis )
  • liver disease originating from the internal bile ducts (primary biliary cirrhosis)

Furthermore, congenital metabolic diseases can cause chronic hepatitis. These include copper storage disease (Wilson’s disease) and iron storage disease ( hemochromatosis ).

In some cases, the cause of chronic liver inflammation can no longer be reliably identified. The doctor can only make assumptions.

Hepatitis: transmission

The five most common forms of viral hepatitis (types A, B, C, D, and E) can be transmitted in different ways. In general, there is an increased risk of contracting hepatitis in the following cases:

  • Drug addicts who inject the addictive substance into their veins and share the injection equipment with each other
  • Medical staff who often come into contact with infected patient waste (such as blood).
  • unprotected sexual intercourse, especially with frequently changing sexual partners
  • People who have their ears pierced, piercing or tattooed under non-sterile conditions
  • Travelers who are traveling in countries with poor hygienic conditions (applies especially to hepatitis A)
  • Babies born to mothers infected with hepatitis B or C (transmission before or during birth )
  • Blood products (donor blood, blood clotting factors, etc.) that are transmitted as a transfusion (since the introduction of strict controls in Germany only rarely a hepatitis transmission route)
  • Dialysis patients (if the dialysis machine was previously used on a hepatitis patient and was not then thoroughly cleaned as prescribed)

Hepatitis: investigations and diagnosis

If you suspect liver inflammation, you should consult your family doctor or internist. He will first collect your medical history (anamnesis) in a detailed discussion . He will have your complaints described in detail and will inquire about possible liver-damaging influences. Possible questions from the doctor can be:

      • Do you drink alcohol? If so, which ones, how much and for how long?
      • Do you have previous illnesses such as diabetes mellitus or cancer?
      • What do you do for a living? Have you been in contact with toxins such as carbon tetrachloride, vinyl chloride or phosphorus?
      • Are you taking medications such as paracetamol, tetracyclines, methotrexate, isoniazid, rifampicin or azathioprine ?
      • Do you take drugs?
      • Did you receive a blood transfusion ?
      • Have you been abroad lately?
      • Have you had sexual contact with frequently changing partners?
      • Are there any metabolic disorders in the family, such as Wilson’s disease or a1-antitrypsin deficiency?

The doctor will also ask you whether your weight has changed up or down. Also tell him if you have recently had a poor appetite or if the color of your stool and/or urine has changed. An important indication can also be an increased tendency to bleed . It can occur, for example, when the liver produces fewer blood clotting factors than normal due to disease/injury.

Physical examination

After the anamnesis interview, a physical examination follows. Among other things, the doctor will feel your abdomen. If there is pressure pain in the upper right abdomen, this indicates a possible liver disease. During palpation, the doctor can also determine whether the liver and/or spleen are enlarged. He will also look for signs of jaundice during the exam.

blood tests

The performance of the liver can be determined by measuring various blood values. Typically, in liver inflammation, the liver enzymes GOT (AST) and GPT (ALT) are elevated. In technical jargon, these liver enzymes are also called transaminases .

To determine whether it is a viral infection, the blood sample is examined for antibodies against hepatitis viruses (A, B, C, D and E) (hepatitis serology). So this is an indirect hepatitis test : It does not look directly for the pathogens of viral hepatitis, but for specific antibodies that the body produces when infected with such pathogens. The type of antibodies detected also indicates how far the liver inflammation has progressed.

A direct hepatitis test is also possible: This tests whether the genome of the various hepatitis viruses can be detected in the patient’s blood. It may be necessary to multiply the small “snippets” of genetic material using the so-called polymerase chain reaction (PCR) before they can be identified.

The suspicion of autoimmune hepatitis can be confirmed if typical auto-antibodies that attack the liver tissue are found in the blood.

Ultrasonic

Ultrasonography can help doctors determine the size and structure of the liver. In the case of chronic liver inflammation, the examination can also provide information as to whether the disease has led to a shriveled liver (liver cirrhosis) or even to liver cancer.

Liver cirrhosis and its “precursor” – liver fibrosis – can also be determined with a special ultrasound examination – the so-called elastography.

tissue sample of the liver

In general, in the case of liver diseases, the doctor will usually take a tissue sample from the liver (liver biopsy) in order to have it examined more closely in the laboratory. In this way, the suspicion of liver inflammation can be finally clarified. The degree of liver inflammation can also be assessed on the basis of the histological examination of the tissue sample.

Hepatitis: treatment

Hepatitis patients should not consume alcohol . In addition, they should (in consultation with the doctor) avoid medicines that damage the liver . This applies not only when the hepatitis is caused by alcohol or medication, but also in all other cases. The breakdown of alcohol and medication takes place in the liver and can put a lot of strain on the inflamed organ. This can worsen the course of the disease.

Further hepatitis treatment depends on the cause, course and severity of the disease.

Patients with acute hepatitis should take it easy . The doctor may even recommend bed rest . It is also advisable to eat light food that is as high in carbohydrates and low in fat as possible. A special diet is not necessary.

Acute hepatitis sometimes clears up on its own. If necessary, symptomatic measures are useful, such as painkillers for severe muscle and joint pain or a remedy for nausea and vomiting.

In some cases, inpatient hepatitis therapy in the hospital is necessary.

In many cases, however, liver inflammation must be treated with medication . For example, people with chronic hepatitis B or C receive antiviral drugs. In autoimmune liver inflammation (autoimmune hepatitis), drugs are used that inhibit the immune system. These include cortisone and azathioprine.

Liver transplantation may be necessary in severe hepatitis. Finding a suitable donor organ is often not easy.

With hepatitis B and C, it is important to tell your family and sexual partner about the condition. They can then have themselves vaccinated so that they do not get infected from you.

Hepatitis: course of the disease and prognosis

Acute hepatitis usually heals on its own. If it is caused by medication or alcohol, not drinking these substances will help the liver to recover. The prerequisite for this is that the organ has not yet been permanently damaged.

Especially in the case of alcohol abuse and chronic hepatitis C, there is an increased risk of the liver becoming scarred (liver cirrhosis) and permanently damaged. Liver cancer (liver cell carcinoma = hepatocellular carcinoma) is also a frequent complication of chronic hepatitis (especially type B). Vaccination can provide effective protection here.

Hepatitis: prevention

Hygiene and (in the case of hepatitis viruses A and B) vaccination (see below) are particularly important for protection against viral hepatitis infection .

Hepatitis A and E are primarily transmitted through contaminated drinking water and food. Therefore, pay attention to careful food hygiene , especially when travelling. You should be particularly careful with tap water, ice cubes, raw vegetables and seafood (especially mussels and oysters). In general, when eating in countries with a high risk of infection, you should follow the rule of thumb: “Cook it, peel it or forget it”.

In Germany and other industrialized countries, hepatitis E is often transmitted via insufficiently cooked pork or game meat. Therefore, meat should always be well cooked.

You can prevent alcohol-related hepatitis by drinking alcohol only in moderation, if at all .

If you take medication, ask your doctor if it can damage the liver. It may be possible to switch to a less liver-damaging preparation .

Being overweight and eating a high-fat diet can promote hepatitis. You should therefore pay attention to a healthy body weight and eat a balanced diet .

Hepatitis Vaccination

You can get vaccinated against hepatitis A and B. A vaccine against hepatitis E is also available in China. However, this is not permitted in Europe.

The Standing Vaccination Committee (STIKO) at the Robert Koch Institute recommends hepatitis A vaccination especially for travelers to regions with an increased risk of infection. Such regions are, for example, many tropical countries as well as the Mediterranean and Eastern Europe. People with an increased risk of infection should also be vaccinated against hepatitis A. These include, for example, medical staff, sewerage workers and people with the bleeding disease hemophilia who receive blood clotting factors.

Vaccination against hepatitis B is also particularly important for people with an increased risk of infection (such as medical staff). The STIKO also recommends vaccination for all infants.

You can read more about the benefits and risks of such vaccinations and whether health insurance companies will cover the costs in the article on hepatitis vaccination

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