people who have chronic hepatitis. About 10 per-
cent of people who develop chronic hepatitis sub-
sequently develop LIVER CANCER. People who have
chronic forms of hepatitis may show no signs or
symptoms of disease though are carriers who pass
the virus to others with whom they have close
contact (particularly sexual contact).
Alcoholic hepatitis Alcohol is highly toxic to
the liver. Chronic alcohol abuse results in repeated
inflammation of liver tissue, with resulting scar-
ring (fibrosis) that ultimately limits the liver’s abil-
ity to function (cirrhosis). Liver damage that
occurs is permanent and may lead to liver failure.
Hepatotoxic hepatitis The most common hepa-
totoxins resulting in hepatitis are acetaminophen
(Tylenol) and NONSTEROIDAL ANTI-INFLAMMATORY
DRUGS(NSAIDS) such as ibuprofen (Motrin). Other
hepatotoxins include cleaning solutions, industrial
pollutants, and carbon tetrachloride. Hepatotoxic
hepatitis can result in rapid liver failure or lead to
chronic hepatitis.
Symptoms and Diagnostic Path
The general symptoms of hepatitis are the same
regardless of the cause and occur in four distinct
stages:
- Infective asymptomatic, in which the virus has
invaded the liver and is replicating. During this
stage the person is most highly infective. - Prodromal, in which infection has not yet man-
ifested symptoms but the person begins to feel
generalized malaise, loss of APPETITE, and aver-
sions to certain foods (and often to cigarette
smoke). - Active disease response, with characteristic
symptoms that include JAUNDICE, dark urine,
pale stools, FEVER, fatigue, and abdominal ten-
derness. - Recovery, during which the person continues
to feel fatigue and malaise but liver functions
are returning to normal, or liver failure, indi-
cating the disease process has overwhelmed the
liver.
Viral hepatitis remains infectious for as long as
the virus is active in the body. With chronic forms
of viral hepatitis, symptoms recur periodically.
Alcoholic hepatitis and hepatotoxic hepatitis
remain in active disease state until the causative
substance clears the body.Treatment Options and Outlook
Treatment for hepatitis is largely supportive, con-
sisting of fluid consumption, adequate nutrition,
and rest. The course of acute disease may be mild
and flulike or life-threatening, depending on
numerous variables such as the cause and the
individual’s personal health status. People who
have IMMUNE SYSTEMimpairments, such as those
who have HIV/AIDS, are very young, or are very old
are at greatest risk for severe disease. ANTIVIRAL
MEDICATIONSsuch as adefovir, ribavirin, interferon,
amantadine, and lamivudine sometimes limit the
course of active disease in chronic hepatitis (HBV
and HDV). Liver damage due to hepatotoxic hepa-
titis may so overwhelming as to require immedi-
ate liver transplantation.
Chronic hepatitis remains a significant lifelong
threat to health. Those who have chronic infec-
tious hepatitis can pass the disease to others.
Regardless of cause, chronic hepatitis limits the
liver’s ability to function. Physiologic stress, such
as alcohol consumption or taking certain medica-
tions, can seriously strain the liver’s capacity. Peo-
ple who have chronic hepatitis may experience
frequent bouts of fatigue. Many people are able to
enjoy relatively normal lifestyles, though must
remain mindful of situations and substances that
could challenge the liver.Risk Factors and Preventive Measures
The primary risk factor for infectious hepatitis is
exposure to others who have hepatitis infections.
For hepatitis A, this includes consuming foods
handled in an unsafe manner by a person who
already has hepatitis A infection or handling con-
taminated fecal waste (such as diapers). Those at
risk for blood-borne hepatitis infections (HBV,
HCV, HDV) include- people who have unprotected sex with multi-
ple partners (hepatitis B is especially common
among men who have sex with men) - people who inject illicit drugs and share nee-
dles, paraphernalia, and drugs - people who undergo long-term hemodialysis to
treat renal (kidney) failure
56 The Gastrointestinal System