Inflammation of the liver, due to a variety of causes, that lasts more than 6 months
- Gender, genetics, and lifestyle as risk factors depend on the cause
- Age is not a significant factor
Chronic hepatitis is inflammation of the liver that lasts for at least 6 months. Sometimes, the condition persists for many years. Although chronic hepatitis is often mild with no symptoms, it can slowly damage the liver, causing cirrhosis, in which healthy liver tissue is replaced by fibrous scar tissue.
What are the causes?
Chronic hepatitis can have a number of causes, including a viral infection, an auto-immune reaction in which the body’s immune system attacks liver cells, certain drugs, alcohol abuse, and some metabolic disorders.
Some of the hepatitis viruses that cause acute hepatitis are more likely than others to cause persistent inflammation. The virus that most commonly causes chronic inflammation is the hepatitis C virus. Less commonly, the hepatitis B and D viruses are responsible. Infections with the hepatitis A and E viruses never become chronic. Some people may be unaware that they have had a previous episode of acute viral hepatitis until long-term symptoms of chronic hepatitis appear.
The underlying cause of autoimmune chronic hepatitis is still not known, but the condition is more common among women than it is in men.
Rarely, some drugs, such as isoniazid (see Antituberculous drugs) may cause chronic hepatitis. The condition can also result from regular excessive alcohol consumption (see Alcohol-related liver disease).
In addition, chronic hepatitis can be due to rare metabolic diseases in which liver inflammation is caused by excess amounts of certain minerals that accumulate in the body. For example, in the inherited disorder haemochromatosis there are abnormally high levels of iron in the blood and tissues.
What are the symptoms?
In some cases, chronic hepatitis causes no symptoms. If symptoms do develop, they are usually mild but can vary in severity. They may include:
Loss of appetite and weight loss.
Yellowing of the skin and whites of the eyes (see Jaundice).
Swelling of the abdomen.
If cirrhosis develops due to persistent inflammation, there may be increased blood pressure in the blood vessels that connect the digestive tract to the liver. This pressure may lead to bleeding into the digestive tract (see Portal hypertension and varices). In some cases, cirrhosis can result in liver failure, which may be fatal.
What might be done?
Your doctor will give you a physical examination and arrange for blood tests to evaluate your liver function and to look for causes of your symptoms. To confirm the diagnosis, he or she may use an imaging technique such as ultrasound scanning. A liver biopsy, in which a small piece of liver is taken for microscopic examination, may be used to determine the nature and severity of liver damage.
Chronic hepatitis caused by infection with the hepatitis B or C viruses may respond to treatment with antiviral drugs. However, if there is the possibility of ongoing liver damage, a course of injections of interferon or a longer-term course of treatment with specific oral antivirals (such as lamivudine, adefovir, tenofovir, or entecavir) may be recommended for people with hepatitis B. For people with hepatitis C, treatment with interferon injections and oral ribavirin (an antiviral drug) is successful in eradicating the virus in many cases. However, these antiviral medications – particularly interferon – may cause serious side effects, and patients are therefore monitored during treatment.
People with chronic hepatitis caused by an autoimmune reaction are usually treated indefinitely with corticosteroids, which may be given in combination with other immunosuppressant drugs. If the liver has been damaged by a drug, it should recover slowly as long as the drug is stopped. If chronic hepatitis is due to a metabolic disorder, treatment of that underlying disorder may slow the progress of liver damage.
What is the prognosis?
The outlook depends on the cause of the hepatitis. Chronic viral hepatitis usually progresses slowly, and it may take decades before problems such as cirrhosis and liver failure develop. People with chronic hepatitis are at increased risk of developing liver cancer, particularly if hepatitis is due to infection with the hepatitis B or C virus.
Without treatment, approximately 1 in 2 people who have autoimmune chronic hepatitis develop liver failure after 5 years. Hepatitis due to a metabolic disorder tends to get progressively worse, often ending in liver failure. In the case of liver failure, a liver transplant may be considered.
From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.
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