Main reasons
Most often, chronic inflammation is caused by hepatitis B and C viruses, transmitted through blood: during medical and cosmetic manipulations with non-sterile instruments, injections, less often through sexual contact and from mother to child. Virus D attaches only to hepatitis B and makes it worse. The second large group is metabolic and toxic lesions: fatty liver disease due to obesity, diabetes and lipid metabolism disorders, as well as regular alcohol consumption. Less common are autoimmune hepatitis, drug-induced lesions and hereditary storage diseases.
- Viral hepatitis B, C and D
- Alcoholic liver disease
- Fatty liver disease in obesity and diabetes
- Autoimmune hepatitis
- Drug-induced liver damage
- Hereditary storage diseases
Why is it hard to notice?
The liver has a large margin of safety and continues to work even with significant damage. Symptoms, if any, are nonspecific: fatigue, decreased performance, heaviness in the right hypochondrium, nausea, decreased appetite. They can easily be attributed to fatigue and stress. Jaundice, edema, abdominal enlargement and bleeding appear already at the stage of cirrhosis. This is why hepatitis is most often found by accident: during examination before surgery, during pregnancy, when donating blood as a donor, or by elevated liver enzymes in the analysis.
- Fatigue and decreased performance
- Heaviness in the right hypochondrium
- Nausea and decreased appetite
- Itchy skin
- Long absence of complaints
- Incidental detection during examination
Who needs what tests?
Every adult should be tested for hepatitis B and C at least once in their life, and repeated if there are risk factors. The basic set includes HBsAg, antibodies to the hepatitis C virus, ALT and AST, bilirubin and a complete blood count. Normal enzymes do not exclude disease, so in case of risk factors, it is viral markers that are checked. If the result is positive, clarifying studies are carried out: determination of the viral load and genotype, assessment of the degree of fibrosis using elastography or calculated indices, ultrasound of the liver.
- HBsAg - marker of hepatitis B
- Antibodies to hepatitis C virus
- ALT and AST, bilirubin
- Viral load with positive screening
- Elastography for fibrosis assessment
- Ultrasound of the liver and spleen
Why is it dangerous?
With prolonged inflammation, dead liver cells are replaced by connective tissue - fibrosis develops, which goes through several stages and ends with cirrhosis. At the stage of cirrhosis, blood flow through the liver is disrupted, pressure in the portal vein increases, dilated veins of the esophagus, fluid in the abdomen, coagulation disorders and brain function appear. People with chronic hepatitis B and cirrhosis of any nature have an increased risk of liver cancer, so they undergo regular monitoring with ultrasound. Early treatment can stop and partially reverse fibrosis.
- Fibrosis and cirrhosis of the liver
- Portal hypertension
- Bleeding from the veins of the esophagus
- Ascites and edema
- Hepatic encephalopathy
- Increased risk of liver cancer
Treatment and lifestyle
The tactic depends on the reason. Chronic hepatitis C is now treated with direct-acting antiviral drugs: the course lasts several weeks and leads to recovery in the vast majority of patients. For hepatitis B, drugs are used that suppress the replication of the virus; They are taken for a long time, and the decision to start treatment is made by the doctor based on the viral load and the degree of fibrosis. For fatty liver disease, the main treatment is weight loss and physical activity. Alcohol is excluded in any form. Hepatoprotectors and herbal remedies are not a replacement for therapy.
- Direct acting antivirals for hepatitis C
- Suppressive therapy for hepatitis B
- Weight loss and activity in fat disease
- Complete abstinence from alcohol
- Vaccination against hepatitis A and B as recommended by a doctor
- Regular monitoring and ultrasound of the liver