Hepatitis

What is hepatitis?

Hepatitis is inflammation in your liver. Inflammation is your body’s response to an infection or injury. Many things can injure your liver and trigger hepatitis. Toxic chemicals, heavy substance use, viral infections and bile flow problems are a few examples. Just about any liver disease will cause hepatitis. Sometimes the injury and the inflammatory response are temporary, but sometimes they’re ongoing.

Short-term liver inflammation is called acute hepatitis. It’s an immediate response to an urgent problem. Long-term liver inflammation is called chronic hepatitis. It’s a continuous response to an ongoing problem. Inflammation works to defend and repair your liver tissues from harm. But if it’s too severe or it goes on too long, inflammation itself can harm your liver and interfere with its important functions.

What are the signs and symptoms of hepatitis?

Hepatitis can be stealthy. It doesn’t always cause noticeable symptoms at first. You might notice:

• Upper abdominal pain or soreness, especially on the right side.
• Nausea or loss of appetite.
• Fatigue and malaise (feeling generally unwell).
• Fever (if you have a viral infection).

You might notice additional symptoms when hepatitis begins to interfere with your liver functioning. This can happen in more severe cases of acute hepatitis and in cases of chronic hepatitis that have been going on for a long time. When your liver isn’t able to process bile as it usually does, bile doesn’t go where it needs to in your body and instead overflows into your bloodstream. This may cause:

• Jaundice (a yellow tint to your skin and eyes).
• Dark-colored pee (urine) and light-colored poop (stool).
• Pruritus (itchy skin).
• Confusion, disorientation or drowsiness (hepatic encephalopathy).

How do you get hepatitis?

Hepatitis has many causes. Most of them can cause either acute or chronic hepatitis, depending on how long they’re affecting your liver. Healthcare providers classify common causes into types of hepatitis.

Viral hepatitis

Viral hepatitis is caused by viruses that infect and damage your liver cells, which leads to inflammation (a response from your immune system). Viral infections that cause hepatitis include:

• Hepatitis A. Hepatitis A is an acute infection, which causes acute hepatitis. However, it can last several months, and occasionally it’s severe enough to cause acute liver failure.
• Hepatitis B. Hepatitis B begins as an acute infection, but a small percentage of people develop a chronic infection and chronic hepatitis.
• Hepatitis C. Hepatitis C also begins as an acute infection, but the majority of people who get it develop a chronic infection. It’s one of the most common causes of chronic hepatitis.
• Hepatitis D. Hepatitis D (delta virus) infects people who already have hepatitis B. It can also cause chronic hepatitis. If you get both, it can be especially stressful for your liver.
• Hepatitis E. Hepatitis E is most prevalent in Asia and uncommon in other parts of the world. It causes acute infection with acute hepatitis.
• Epstein-Barr virus (EBV). Epstein-Barr virus causes infectious mononucleosis and acute hepatitis.
• Cytomegalovirus (CMV). CMV infection can cause acute hepatitis in immunocompromised individuals.

Toxic hepatitis

Toxins in your bloodstream can cause toxic hepatitis, especially in higher doses and when your liver is already stressed for another reason. Your liver filters toxins from your blood every day, but if the toxic load gets too heavy, these toxins can slow it down or even damage its cells. The damage can be acute or chronic, depending on how severe it is and how often or how long you’re exposed. Causes include:

• Industrial chemicals, including vinyl chloride, carbon tetrachloride and certain pesticides and herbicides.
• Over-the-counter (OTC) medications, especially high doses of nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen (Tylenol®).
• Prescription drugs, including statins, certain antibiotics and anti-seizure medications.
• Non-prescribed drugs such as ecstasy, cocaine or off-label use of anabolic steroids.
• Some herbs and supplements in large or frequent doses, especially when combined with other factors that may be stressing your liver.

Alcohol-induced hepatitis

Alcohol-induced hepatitis can be chronic or acute. You can get acute hepatitis after a short drinking binge or chronic hepatitis from chronic, heavy alcohol use. Alcohol is always toxic to your liver, but most people can tolerate a certain amount. How much is too much can vary, however. While most people develop hepatitis from heavy drinking, some people are more sensitive to alcohol than others.

Metabolic dysfunction-associated steatohepatitis

Steatohepatitis means hepatitis from fat. It’s an advanced stage of fatty liver disease. That means your liver has begun storing extra fat in its tissues. Alcohol use is one common cause of fat storage in your liver. When it’s not alcohol-related, it’s called metabolic dysfunction-associated steatotic liver disease. When this excess fat builds up enough, it can cause metabolic dysfunction-associated steatohepatitis. This is related to:

• Hyperlipidemia (excess fats in your blood).
• Overweight and obesity (BMI of 25 or higher).
• High blood sugar, insulin resistance and Type 2 diabetes.
• High blood pressure and cardiovascular disease.

Autoimmune hepatitis

Some people develop chronic hepatitis as an autoimmune disease. That means their immune systems mistakenly attack their own liver tissues. Autoimmune diseases often develop for no apparent reason. While autoimmune hepatitis causes liver inflammation directly, other autoimmune diseases can affect the bile ducts that run through your liver (primary biliary cholangitis or primary sclerosing cholangitis).

Other causes

Other possible causes of hepatitis include:

• Cholestasis. Cholestasis means that bile flow has stalled within your biliary tract. Your liver is part of your biliary system: It makes and delivers bile through your bile ducts. When bile flow stalls, bile can back up into your liver and cause hepatitis. This can happen suddenly (acute), due to a bile duct obstruction, or gradually (chronic), due to a chronic disease or condition.
• Inherited metabolic disorders. Rare genetic disorders that affect your metabolism can also affect your liver. For example, Wilson disease and hemochromatosis are both conditions that cause toxic levels of metals to build up in your liver. Gaucher disease and glycogen storage disease (GSD) cause metabolic waste products to build up in your blood, which your liver filters.
• Ischemia. Ischemia is a sudden or gradual loss of blood flow to one of your organs. It can cause acute or chronic inflammation anywhere in your body. Common causes include sudden vasoconstriction, occlusions such as blood clots and arterial diseases that narrow your arteries. Sometimes, ischemia is a response to shock from a severe infection or organ failure.

Is hepatitis contagious?

Viral hepatitis is contagious. Other types of hepatitis aren’t. Viruses, however, are the most common cause of hepatitis worldwide. And viruses, by nature, are all contagious. There are at least five distinct hepatitis viruses — hepatitis A, B, C, D and E — as well as other viral infections that can cause hepatitis. These different viruses spread in different ways. Some of the ways viral hepatitis can spread include:

• Food poisoning. Hepatitis A and E commonly spread through contaminated food and water.
• Contaminated blood. Hepatitis B, C and D can spread through contact with blood from an infected person. This commonly happens when sharing needles for intravenous drug use.
• Bodily fluids. Hepatitis B and D can spread through other bodily fluids as well as blood. They commonly spread through sexual contact and from parent to child during childbirth.

What are the risk factors for acquiring hepatitis?

Risk factors for acquiring hepatitis include:

• Intravenous drug use.
• Heavy use of substances such as alcohol.
• Overuse of prescription or over-the-counter medications.
• Metabolic syndromes, such as high cholesterol, high blood sugar and obesity.
• Living in or travelling to places with lower levels of public sanitation.
• Workplace exposure to toxic chemicals.

What are the possible complications of hepatitis?

Severe or persistent hepatitis can lead to:

• Cirrhosis. Cirrhosis is scarring of your liver, which can occur after many years of chronic hepatitis. Chronic inflammation and swelling in your liver tissues cause progressive scarring. As healthy liver tissue is gradually replaced with scar tissue, your liver gradually loses its ability to function. Cirrhosis can eventually lead to chronic liver failure.
• Portal hypertension. While cirrhosis is a gradual process and not everyone will progress to liver failure, other complications can develop, including portal hypertension. Scar tissue compressing the portal veins that run through your liver causes other veins in your stomach and esophagus to expand. These enlarged veins (varices) can rupture, causing serious internal bleeding.
• Liver cancer. Chronic hepatitis and cirrhosis are both risk factors for developing primary liver cancer (hepatocellular carcinoma). Inflammation itself is one risk factor. Viral hepatitis may also be involved in changing the DNA in your liver cells, turning healthy cells into cancer cells. More than half of people who develop liver cancer have chronic hepatitis B or C.
• Liver failure. Liver failure means that your liver begins to lose its ability to function. Like hepatitis, liver failure can also be acute or chronic. Severe toxic overload can cause acute liver failure, while chronic liver failure can develop after many years of chronic hepatitis and cirrhosis. Acute liver failure is sometimes reversible, but chronic liver failure isn’t. Both can be fatal.

How is hepatitis diagnosed?

Healthcare providers use various tests to diagnose hepatitis and its causes, including:

• Liver function tests. Liver function tests are blood tests that measure different substances in your blood that your liver produces. Elevated liver enzymes, proteins or byproducts in your blood can give clues to how well your liver is functioning, whether it’s under stress and why.
• Imaging tests. Imaging tests of your liver can show swelling from hepatitis and issues affecting the bile ducts or blood vessels running through it. Some tests combine radiology with another type of technology to gain more information, like a nuclear liver and spleen scan or elastography.
• Liver biopsy. A liver biopsy is a minor procedure to take a small tissue sample from your liver to test in a lab. A healthcare provider can usually take the sample through a hollow needle. The lab can then test the sample for diseases, infections and toxins that may be causing hepatitis.

What treatment is available for hepatitis?

Healthcare providers treat hepatitis by removing as many stress factors from your liver as they can. Some of these involve changing your diet and lifestyle. Removing toxins and alcohol and reducing fat in your diet can take stress off any liver. Some people might benefit from medications to help manage their blood lipids (fat in your blood) or blood sugar (blood glucose).

Certain types of chronic hepatitis can be treated directly with medications. Chronic hepatitis C is curable with antivirals, while chronic hepatitis B will need lifelong treatment. Inherited metabolic diseases and autoimmune hepatitis are also lifelong conditions. Medications and lifestyle changes can reduce the stress on your liver and limit the severity of chronic hepatitis.

Is hepatitis curable?

Treating the cause can cure certain types of hepatitis. Toxic and alcohol-induced hepatitis can improve when you’re no longer exposed to the toxin. Diet and lifestyle changes may help relieve metabolic dysfunction-associated steatohepatitis. Some diseases that cause chronic hepatitis aren’t curable, but treatment can limit the inflammation and the damage they cause.

Can hepatitis be prevented?

You can help prevent hepatitis by:

• Getting vaccinated. Vaccines are available to prevent viral hepatitis A and B.
• Practicing good hygiene. Handwashing after using the bathroom, safe food handling and safe needle use can help prevent infections from spreading.
• Drinking alcohol in moderation and using medications as directed. If you have a substance use disorder, treatment can help prevent toxic hepatitis.
• Managing metabolic factors such as your blood lipids and blood sugar. A healthcare provider can help with this.

What is the outlook for hepatitis?

Acute hepatitis is usually temporary and goes away by itself, though some types, like viral hepatitis A, may last for months. Most causes of acute hepatitis have no direct treatment, but a healthcare provider can help you manage your symptoms and monitor you for complications. The main risk from acute hepatitis is acute liver failure, which is rare. Contact a healthcare provider if you suddenly start to feel much worse.

Chronic hepatitis can go on for a long time without causing symptoms. Some people never know they have it until they begin to experience complications. Chronic hepatitis does damage your liver over time, but how much, and how fast, varies. Without treatment, about 25% of people progress to cirrhosis, usually over several decades. But with treatment, your liver can often recover from damage.

A note from Cleveland Clinic

Your liver works hard to filter toxins from your blood every day. Sometimes, the toxic load adds up and the burden becomes too heavy. And sometimes, a sudden assault, like a virus or a drug overdose, can put your liver into acute distress. Your liver responds with inflammation, which is both its distress call and its attempt to recover. You can help it recover by eliminating as many stress factors as you can.