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Non Viral Hepatitis

There are four types of non-viral hepatitis,

  • Alcoholic hepatitis

  • Toxic/drug-induced hepatitis

  • Autoimmune hepatitis

  • Granulomatous hepatitis

1. Alcoholic Hepatitis

Alcohol has long been associated with serious liver diseases such as hepatitis inflammation of the liver. But the relationship between drinking and alcoholic hepatitis is complex. Only a small percentage of heavy drinkers develop alcoholic hepatitis, yet the disease can occur in people who drink only moderately or binge just once. And though damage from alcoholic hepatitis often can be reversed in people who stop drinking, the disease is likely to progress to cirrhosis and liver failure in people who continue to drink. For them, alcoholic hepatitis may be fatal.

Researchers are learning more about how and why alcoholic hepatitis occurs, but less is known about how to treat alcoholic hepatitis effectively. Anyone with alcoholic hepatitis must avoid alcohol and other substances that harm the liver. When damage is so severe that the liver is unable to function, a liver transplant may be an option.

Signs and Symptoms

Mild forms of alcoholic hepatitis may not cause noticeable problems, but as the disease becomes more advanced and the liver more damaged, signs and symptoms are likely to develop. These may include:

  • Loss of appetite

  • Nausea and vomiting, sometimes with blood

  • Abdominal pain and tenderness

  • Yellowing of the skin and whites of the eyes (jaundice)

  • Fever

  • Abdominal swelling due to fluid accumulation (ascites)

  • Mental confusion

  • Fatigue

These symptoms may vary, depending on the severity of the disease, and are likely to become worse after a bout of binge drinking.

Diagnosis

How is alcoholic hepatitis diagnosed?

In addition to complete medical history and physical examination, diagnostic procedures for alcoholic hepatitis may include the following:

specific laboratory blood tests, such as the following:

  • liver function studies

  • cellular blood counts

  • bleeding times

  • electrolyte tests

  • tests for other chemicals in the body

  • ultrasound (Also called sonography) a diagnostic imaging technique which uses high-frequency sound waves to create an image of the internal organs. Ultrasounds are used to view internal organs of the abdomen such as the liver spleen, and kidneys and to assess blood flow through various vessels.

  • liver biopsy - a procedure in which tissue samples from the liver are removed (with a needle or during surgery) from the body for examination under a microscope.

2. Toxic/Drug Induced Hepatitis

Hepatitis is the inflammation of the liver, resulting in liver cell damage and destruction. Drug-induced hepatitis is rare and is caused by toxic exposure to certain medications, vitamins, herbal remedies, or food supplements. Usually, the toxicity occurs after taking the causative agent for several months, or from an overdose of a medication such as acetaminophen. Usually, the agent is discontinued once hepatitis is suspected and is rarely restarted unless it is absolutely essential for treatment.

Signs and Symptoms

The following are the most common symptoms of drug-induced hepatitis. However, each individual may experience symptoms differently. Symptoms may include:

  •  fever

  • rash or itchy red hives on skin

  • joint pain

  • sore muscles

  • flu-like symptoms

  • nausea

  • vomiting

  • decreased appetite

  • sore muscles

  • Jaundice - yellowing of the skin and eyes

The symptoms of drug-induced hepatitis may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

Diagnosis

How is drug-induced hepatitis diagnosed?

In addition to complete medical history and physical examination, diagnostic procedures for drug-induced hepatitis may include the following:

specific laboratory blood tests, such as the following:

    • liver function studies

    • cellular blood counts

    • bleeding times

    • electrolyte tests

    • tests for other chemicals in the body

    • drug screening tests

    • ultrasound (Also called sonography) a diagnostic imaging technique which uses high frequency sound waves to create an image of the internal organs. Ultrasounds are used to view internal organs of the abdomen such as the liver spleen, and kidneys and to assess blood flow through various vessels.

    • liver biopsy - a procedure in which tissue samples from the liver are removed (with a needle or during surgery) from the body for examination under a microscope.

3. Autoimmune Hepatitis

A number of factors can cause the serious liver disease hepatitis, including viral infections, alcohol and certain drugs. But in autoimmune hepatitis, the problem is different: Your body's own immune system attacks your liver. Although the reason for this isn't entirely clear, some diseases, toxins and drugs may trigger autoimmune hepatitis in susceptible people, especially women.

Untreated autoimmune hepatitis can lead to scarring of the liver (cirrhosis) and eventually to liver failure. When diagnosed and treated early, however, autoimmune hepatitis often can be controlled with drugs that suppress the immune system. Yet these medications, which often must be taken long term, carry a number of risks and aren't always effective. A liver transplant may be an option when autoimmune hepatitis doesn't respond to drug treatments or in cases of advanced liver disease.

Causes of Autoimmune Hepatitis

The cause is not clear. It is thought to be an autoimmune disease. Our immune system normally defends us against infection from bacteria, viruses, and other foreign 'germs'. In people with autoimmune diseases the immune system attacks part or parts of the body as if it was 'foreign'. This causes inflammation, and may damage the affected part or parts of the body.

The immune system includes white blood cells and antibodies (special proteins) which attack and destroy foreign germs and materials. There are various different autoimmune diseases. The symptoms of each disease depend on which part or parts of the body are attacked by the immune system. In some autoimmune diseases it is antibodies which do the damage. In autoimmune hepatitis, it is white blood cells called lymphocytes which are mainly involved. The lymphocytes attack the liver cells (hepatocytes) which causes inflammation and damage.

It is not known why autoimmune hepatitis or other autoimmune diseases occur. Some factor may trigger the immune system to attack the body's own tissues. There are various theories as to possible triggers. For example, a virus, a chemical, or some other factor may trigger the disease. There is also an inherited factor which makes some people more prone to autoimmune diseases. (That is, you may need to be 'genetically susceptible' for a 'trigger' to set off the disease.)

Signs and Symptoms

Signs and symptoms of autoimmune hepatitis can range from minor to severe and may come on suddenly or develop over time. Some people have few, if any, problems in the early stages of the disease, whereas others experience signs and symptoms that may include:

  • Anemia

  • Fatigue

  • Abdominal discomfort

  • Joint aches (arthralgias)

  • Itching (pruritus)

  • Yellowing of the skin and whites of the eyes (jaundice)

  • An enlarged liver

  • Abnormal blood vessels on the skin (spider angiomas)

  • Nausea and vomiting

  • Liver scarring (cirrhosis)

  • Fluid in the abdomen (ascites) or mental confusion, in advanced cases

It's common for people with autoimmune hepatitis to have other autoimmune disorders such as:

  • Hemolytic anemia, a type of anemia that occurs when red blood cells are destroyed faster than the bone marrow can replace them

  • Chronic inflammation of the thyroid gland (thyroiditis)

  • Inflammation of the colon (ulcerative colitis)

  • Diabetes

  • Dry eyes and mouth (Sjogren's syndrome)

Diagnosis

Your doctor will make a diagnosis based on your symptoms, blood tests and liver biopsy.

  • Blood tests. A routine blood test for liver enzymes can help reveal a pattern typical of hepatitis, but further tests, especially for autoantibodies, are needed to diagnose autoimmune hepatitis. Antibodies are proteins made by the immune system to fight off bacteria and viruses. In autoimmune hepatitis, the immune system makes antinuclear antibodies (ANA), antibodies against smooth muscle cells (SMA), or liver and kidney microsomes (anti-LKM). The pattern and level of these antibodies help define the type of autoimmune hepatitis (type I or type II).

  • Blood tests also help distinguish autoimmune hepatitis from viral hepatitis (such as hepatitis B or C) or a metabolic disease (such as Wilson disease).

  • Liver biopsy. A tiny sample of your liver tissue, examined under a microscope, can help your doctor accurately diagnose autoimmune hepatitis and tell how serious it is. You will go to a hospital or outpatient surgical facility for this procedure.

4. Granulomatous Hepatitis

Granulomatous hepatitis is a condition in which abnormal collections of white blood cells collect in the liver.

Fortunately, most people recover completely from hepatitis A, E and nonviral hepatitis. Mild flare-ups may occur over a period of several months with viral hepatitis. Each flare-up is usually less severe than the initial attack, and a relapse does not necessarily indicate that complete recovery will not take place.

Unfortunately, hepatitis B, C and D can linger in the body, producing chronic, perhaps lifelong, infection. Additionally, carriers of the hepatitis virus can infect others, even though they feel perfectly well. They may face risks of liver disease (cirrhosis and liver cancer) in the future.

Treatment

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