inflammation of the liver, inflammation of liver parenchyma, viral hepatitis, autoimmune hepatitis, toxic hepatitis
By hepatitis the physician understands an inflammation of the liver, which can be caused by a variety of liver cell damaging influences such as viruses, toxins, autoimmune processes, drugs and physical causes. The various hepatitides cause liver cell destruction and immigration of inflammatory cells into the liver. Characteristic symptoms can be an enlargement of the liver with liver capsule pain and the development of jaundice (icterus). The severity of the symptoms varies from mild, almost symptom-free conditions to fulminant liver failure.
Classification of hepatitis
Hepatitis can be subdivided in different ways:
- At first, you can split them according to their progression: Acute hepatitis shows a short course (< 6 months). Chronic hepatitis has a long course (> 6 months) and, by definition, has a connective tissue (fibrous) scarring of the liver tissue in the histological examination.
- Classification by cause (aetiology, pathogenesis): Infectious hepatitis: viral (hepatitis A, B, C, etc.) Toxic hepatitis: alcohol-toxic, drug-induced hepatitis, drug-induced hepatitis and hepatitis in poisoning Autoimmune hepatitis: AIH (autoimmune hepatitis), PSC (primary sclerosing cholangitis), PBC (primary cheap cirrhosis) Hereditary, congenital hepatitis Hemochromatosis, Wilson’s disease, α1-trypsin deficiency, granulomatous inflammation (sarcoidosis) Physical hepatitis: Hepatitis after radiation, hepatitis after liver injury Extrahepatic diseases: Congestive hepatitis in heart failure, hepatitis in fatty liver (steatohepatitis), inflammation of the bile ducts (cholangitis)
- Classification according to histological criteria: Acute hepatitis is characterized by an increase in Kupffer cells, single cell necrosis, inflated hepatocytes and infiltration of inflammatory cells. Chronic hepatitis is characterized by fibrous scarring and loss of the typical liver structure. In fulminant hepatitis, so-called bridging (confluent) necroses (dead liver tissue) are found.
The Hepatitis Virus
Virology, the science of viruses, distinguishes several pathogens of hepatitis. These are named after the alphabet from A to E and have different characteristics:
- Hepatitis A (HAV): Transmission faecal-oral through contaminated food/water, mainly in developing countries, Mediterranean regions and tropics; no chronification
- Hepaititis B (HBV): Transmission through sexual intercourse, needle-stick injuries, from mother to newborn during birth; chronic course possible in 5% of infections
- Hepatitis C (HCV): transmission route unknown in 40% of cases, transmission through needle-stick injuries, split needles in drug addicts, during birth, during sexual intercourse; chronicity in 50-85% of cases; course of infection often without symptoms
- Hepatitis D (HDV): Transmission through sexual intercourse, needlestick injury, during birth; infection only possible in connection with hepatitis B infection
- Hepatitis E (HEV): transmission faecal-oral, through contaminated food/water; in pregnant women, serious courses can occur significantly more frequently and become life-threatening for mother and child; chronification after organ transplantation possible
The incubation period is defined as the time between the entry of a pathogen into the body and the onset of a corresponding disease with its first symptoms. The incubation period of a hepatitis A infection is between 14 and 50 days depending on the source.
The incubation period of a hepatitis E infection is comparably long and is between 14 and 70 days. These two liver inflammations show a similar transmission path as well as also same virus characteristics as mentioned above, which finally leads to the comparable incubation period. Hepatitis B can have an incubation period of 1 to 6 months, as can hepatitis D, which is related to it.
The hepatitis C has an incubation period of about 8 weeks. Hepatitis A is an inflammation of the liver caused by the hepatitis A virus.It is the most common form of “acute hepatitis” – acute means that in all those affected it heals after a few weeks, in a few cases after a few months, and does not become chronic. Mostly holidaymakers in southern countries with poor hygienic conditions fall ill with hepatitis A after they have ingested the virus via contaminated water or contaminated food.
Before a planned journey holiday-makers should therefore ask a family doctor whether a hepatitis A vaccination is recommended for the destination country. Hepatitis A typically begins during or shortly after the stay abroad with symptoms reminiscent of flu and/or gastrointestinal problems. Symptoms of hepatitis A include fatigue, aching limbs, often in combination with loss of appetite, nausea or pain in the liver.
These symptoms usually last for about 1 week and can be misinterpreted by doctor and patient as a simple cold, flu or gastrointestinal infection. In the course of the disease, the typical yellow coloration of the eyes or skin may occur, whereby a discoloration of the eyes is usually the first to be noticed. In addition, the urine often turns darker and the skin itches all over.
In many people, especially in children, hepatitis A does not cause any symptoms and can therefore go completely unnoticed. Only very rarely does hepatitis A progress severely. Mostly it is harmless and heals after a short period of illness without consequences.
It leaves behind a lifelong immunity. Hepatitis B is caused by the hepatitis B virus. It mainly manifests itself through symptoms caused by damage to the liver, but can also affect other organs such as the skin or joints.
Hepatitis B is usually transmitted through sexual contacts in countries with a high prevalence of infection, but it can also be transmitted by direct absorption of the virus into the blood. Drug addicts in particular are at risk here by using contaminated needles. Transmission from mother to child before or during birth is also possible.
and transmission of hepatitis B The virus is most widespread in Central Africa and China. Hepatitis B is the most common hepatitis worldwide. After infection with the virus, the disease usually breaks out within a few weeks – in exceptional cases, however, it can take six months before the first symptoms appear.
However, in 2/3 of those infected, the hepatitis B virus causes no symptoms and goes completely unnoticed. The virus is eliminated from the body and can no longer cause the disease. If symptoms of hepatitis B disease occur, the disease usually begins like any hepatitis caused by viruses with flu-like symptoms such as fatigue and tiredness or symptoms similar to a gastrointestinal infection, such as nausea, diarrhea and loss of appetite.
Subsequently, as is typical for many liver diseases, the skin and eyes can turn yellowish. This yellowing is often accompanied by itching of the entire skin and darkening of the urine. In a small proportion of those affected who show symptoms, the immune system is unable to eliminate the virus in the body.
This is called virus persistence. Virus persistence can go unnoticed and without symptoms. The affected persons are outwardly healthy.
In about 1/3 of the cases, however, it triggers and maintains a permanent inflammation of the liver, which varies from person to person. The latter is known as chronic hepatitis B. After years, this leads to cirrhosis of the liver.
Liver tissue is destroyed, replaced by connective tissue and the liver loses its function. On average, cirrhosis of the liver can be detected in one in five patients after 10 years. In addition, liver cancer can develop in the diseased liver after years.
A causal therapy attacking the virus is usually only used when the virus causes chronic hepatitis B. On the one hand, drugs are used to activate the patient’s own immune system, on the other hand, drugs are used to suppress and fight the virus itself. They are usually administered for at least half a year, in some patients longer.
In most cases, chronic hepatitis cannot be completely cured with the drugs available today. However, the virus can be suppressed permanently to such an extent that secondary diseases – liver cirrhosis and liver cancer – can be prevented.A hepatitis B vaccination is recommended for every child in Germany today. It protects very reliably against an infection when responding.
Hepatitis C is the inflammation of the liver after transmission and infection with the hepatitis C virus. In western countries the virus usually enters the body through “needle-sharing”. This is the repeated use and sharing of a needle to inject drugs into a vein.
Significantly less often the virus is passed on sexually through the mucous membranes. Transmission from mother to child before or during birth also plays a role. The virus is most widespread in parts of Africa.
In Europe, up to 2% of all people are hepatitis C virus carriers. An infection with the hepatitis D virus can only occur simultaneously with a hepatitis B infection (simultaneous infection) or in people who already carry the hepatitis B virus. The hepatitis D virus cannot reproduce without parts of the hepatitis B virus.
This means that a successful vaccination against hepatitis B also protects against hepatitis D. Similar to the hepatitis C virus, the virus is usually transmitted via venous injections of drugs with contaminated needles. If a person is infected with both viruses at the same time, the resulting hepatitis often has a severe course. Those affected feel very flabby, and the liver is severely inflamed.
Yellowing of the eyes and skin often occurs. In 95% of cases, however, the disease only progresses briefly and then heals completely. If hepatitis B patients are additionally infected with the hepatitis D virus, the liver is often damaged more quickly.
After a few years, this can lead to cirrhosis of the liver without proper therapy. Like hepatitis A, hepatitis E is an inflammation of the liver that lasts only a few weeks. It is transmitted by the hepatitis E virus.
The pathogens are usually ingested by vacationers in Asia, the Middle East or Central and North Africa via contaminated drinking water. However, in these countries the virus can also enter the body after contact with animals such as pigs and sheep or by eating the raw meat of these animals. Like hepatitis A, the disease typically begins with symptoms such as flu-like and/or gastrointestinal distress.
Followed by severe fatigue and yellowing of the eyes and skin. Normally it heals without consequences. A special case is pregnant women suffering from hepatitis E. In up to 20% of cases, the disease progresses severely here and can be life-threatening despite good treatment in hospital. Therefore pregnant vacationers are encouraged to consult a doctor as soon as possible in case of the above mentioned symptoms.
All articles in this series: