Liver inflammation, also known as hepatitis, can have various causes, such as contaminated food, alcohol abuse. There is also autoimmune hepatitis. Hepatitis cannot always be cured.
Here you can find out everything you need to know about inflammation of the liver and what the symptoms are. In this article we will tell you who is particularly at risk and why animals can also contract liver inflammation. After that you will eventually be able to solve your problem and know what to do.
the essentials in brief
- There are many different forms of hepatitis, including forms of hepatitis AE, of which hepatitis A is the least dangerous version. Also, there is autoimmune hepatitis and alcoholic hepatitis.
- Typical symptoms are tiredness and a feeling of tension in the upper part of the abdomen. However, the disease is often asymptomatic for a long time and symptoms only appear when the disease has progressed.
- You can be vaccinated against hepatitis B with a 6-fold vaccination. This also protects against hepatitis D, because hepatitis D only occurs in connection with hepatitis B. There is also a vaccination against hepatitis A. It is not (yet) possible to be vaccinated against the other forms of hepatitis. Dogs can also be vaccinated.
Definition: What is liver inflammation?
Inflammation of the liver is also known as hepatitis. Five different classic viruses can be responsible for hepatitis; A, B, C, D and E. Acute viral hepatitis is notifiable according to §6 IfSg. (2)
Depending on the form and course, liver inflammation can also be fatal. Acute hepatitis can end up becoming chronic, because liver inflammation is often asymptomatic and symptoms only appear later in the course of the disease. (Image source: Online Marketing / unsplash)
Inflammation of the liver can also have other triggers, including toxins such as alcohol, medication or fatty deposits. (3) Hepatitis causes more deaths than HIV and tuberculosis. (1)
Background: What you should know about liver inflammation
The number of people with undetected chronic hepatitis is estimated at 290 million. (1) To solve your problem, you should have some background information about liver inflammation.
For this purpose we have answered the most frequently asked questions about hepatitis in the following paragraphs to solve your problem.
What forms of hepatitis are there anyway?
Hepatitis can be triggered by various viruses, the most common being the classic AE virus. These differ significantly. Hepatitis B, C and D are considered the most dangerous.
Hepatitis A is also known as travel sickness and can be transmitted, for example, through contaminated water or food or through contact and smear infections. The incubation period is 14-28 days.
Most often, hepatitis A heals without consequences. The older you are, the more likely hepatitis A is fatal. Young men who have same-sex, unprotected sex are particularly affected. In China, more precisely Shanghai, there was an outbreak of hepatitis A through raw mussels. There is a vaccination against hepatitis A.
Hepatitis B is the most common infectious disease spread through body fluids.
Hepatitis B is transmitted through bodily fluids and is the most common infectious disease it causes. When children become infected, hepatitis B often becomes chronic and severely damages the liver. You can be vaccinated against it and although there is no cure, you can relieve the symptoms. Hepatitis B is commonly transmitted through unprotected sex, blood, unsterile instruments, or perinatally.
Hepatitis C is also transmitted through bodily fluids. Although it is not possible to be vaccinated, hepatitis C can usually be cured.
Hepatitis D is considered the most severe form. Hepatitis D only occurs together with hepatitis B, which is why vaccination against hepatitis B also protects against hepatitis D. There is a very high risk of liver cirrhosis and cancer.
The last variant, hepatitis E, is often spread through pork if it has been infected and not heated enough. There is no approved vaccination and the severe course can lead to death, especially in pregnant women and the elderly. There are also neurological symptoms. (1,5,20,21,22)
Acute and chronic hepatitis are thus decided. If symptoms persist for more than six months, the clinical diagnosis is chronic. Histopathologically, the criteria are the presence of predominantly round cell and inflammatory cell infiltration and hepatocellular cell deaths located in the parenchymatous border lamella. (7)
There is also autoimmune hepatitis. This is chronic liver inflammation. It is probably caused by a loss of tolerance of hepatocyte-specific autoantigens. A combination of immunogenetic susceptibility and environmental triggers seems to trigger the loss of tolerance. It is divided into types 1 and 2. The subdivision is based on the expression of autoantibodies.
Autoimmune hepatitis occurs in childhood and also in adulthood. Women are affected more often. The diagnosis is made with the help of scoring systems that take into account clinical, biochemical, serological and histological characteristics. (12)
Alcoholic liver disease describes a variety of disorders including reversible fatty liver, alcoholic hepatitis and cirrhosis, and hepatocellular carcinoma. Alcoholic hepatitis is caused by chronic alcohol abuse. (15)
What causes liver inflammation?
The entities are etiologically differentiated from each other. Hepatitis can have various causes. It can be caused virally, by drugs and toxins, and by autoimmunity. There are other, but rare, causes.
| infection cause | Explanation |
|---|---|
| Virus infection | Viral infection is the most common cause, with hepatitis B being the most common. Other viruses, such as Epstein-Barr virus, can also cause hepatitis but are very rare. |
| medication | Medications can also cause chronic hepatitis as a side effect, including, for example, nitrofurantoin or sulfonamides. |
| autoimmunity | Autoimmunity can cause autoimmune hepatitis. |
| metabolic diseases | Metabolic diseases can cause chronic hepatitis. |
| ASH and NASH | Hepatitis can be caused by alcoholic or nonalcoholic steatohepatitis, chronic hepatitis. You should definitely pay attention to combination damage. |
These two polluters; alcoholic or non-alcoholic steatohepatitis, but were not included in the consensus finding. (7)
What are the symptoms of liver inflammation?
The virus can often stay in the body for a long time without the affected person noticing anything. (1) In people infected with hepatitis B, symptoms often include fatigue and/or a feeling of distension in the upper right abdomen. In an advanced course, the disease usually becomes symptomatic. (5) However, if you have kidney pain, you can look here for tips .
How is liver inflammation diagnosed?
The diagnosis is made by measuring and evaluating the antigens BHs and HBe and their antibodies, or by using a PCR test. This one is more accurate. (6)
A biopsy of the liver is performed as part of the clarification of chronic hepatitis. This clarifies the chronicity and grading (inflammatory activity) and staging (extent of fibrosis) and statements about the etiology are made. The tissue of the liver is assessed here. (7)
Hepatitis is only diagnosed if at least one inflammatory cell infiltration or hepatocellular cell damage is detectable. It is not enough to be infected with HBV or HCV to be diagnosed with chronic hepatitis. (7)
How long does liver inflammation last?
Acute hepatitis B disease does not require therapy, but chronic hepatitis B disease is essential.
Age is the most important factor determining the severity and chronification of the infection. Most people who become infected with hepatitis B make a full recovery, although the infection can last for several weeks to months and can be completely asymptomatic or with very severe symptoms. (8th)
How is hepatitis transmitted?
With regard to hepatitis B, it can be said that two billion people worldwide carry the serological marker and 350 million suffer from chronic hepatitis B infection. It is through these that hepatitis is mainly spread. (8) Hepatitis B, C and D are transmitted parentally and hepatitis A and E are transmitted enterally. (9)
In young adults, infection usually occurs through lifestyle. These include sexual contact and drug use with infected syringes. Nursing staff, for example, are also particularly at risk because they come into contact with blood a lot, and infected doctors can also transmit the virus to their patients during operations. Furthermore, people who receive transfusions or travel a lot belong to an increased risk group. Mothers can also pass hepatitis B on to their children. (8.10)
How dangerous is liver inflammation?
In the case of chronic hepatitis B disease, there is a significant excess mortality. The 5-year survival rate was 84% and the 10-year survival rate was 68% in one study. (6) It is estimated that around one million people worldwide die from chronic hepatitis B infection. (8th)
Hepatitis A is estimated to have caused 7,134 deaths in 2016. However, most survive hepatitis A infection and are then immune for life. (21)
In alcoholic hepatitis, the 28-day mortality is 30-50%. This prognosis is particularly poor, which is also due to the fact that although this form of hepatitis is acute, almost 50% already have cirrhosis when therapy begins. (15)
How are alcohol and liver inflammation related?
Hepatitis most often occurs after someone has been consuming alcohol for a long time. If a person is abstinent for more than three months and then presents clinically, the person is suspected to have cirrhosis or chronic liver disease.
Balloon-like hepatocyte degeneration, patchy necrosis, and fibrosis in the perivenular and perisinusoidal spaces of the Disse and Mallory hyaline inclusions occur in many patients with alcoholic but not advanced hepatitis.
Alcohol is often consumed as a stimulant. However, when it is consumed on a regular basis and begins to affect one's potential and social life, then it is commonly referred to as alcohol abuse. This can end in alcoholic hepatitis, which can be very dangerous. (Image source: Andreas M / unsplash)
Alcohol has a high status in many societies, especially in European countries, and the per capita change in alcohol consumption and the mortality rate from cirrhosis are correlated. Alcohol consumption is usually considered harmful when it affects social life or daily functioning.
How much alcohol must be abused?
It is not known how much alcohol one needs to consume to develop alcoholic hepatitis. However, it can be said that most patients drink more than 100 grams of alcohol per day and it is often 150-200 grams. Most have had this very high alcohol consumption for more than 20 years, although there are exceptions. Anyone who drinks 30-50 grams of alcohol per day for 5-10 years should be classified as a risk patient.
When and by whom is alcoholic hepatitis developed?
Alcoholic hepatitis is usually developed before the age of 60, most commonly between the ages of 40 and 50. Although women are at higher risk of developing alcoholic hepatitis, most patients are male.
Obesity is another risk factor for alcoholic hepatitis and most patients with alcoholic hepatitis suffer from malnutrition. Actually, you should pay attention to a high-fiber diet . Some studies have found that drinking beer and spirits is more likely to develop liver disease than wine and drinking outside of meal times. Adopted children of alcohol dependent people and identical twins have an increased risk of developing alcohol dependence.
How are hepatitis C and alcohol related?
Hepatitis C and alcohol abuse are also linked. 14% of patients with hepatitis C abuse alcohol at the same time. Alcohol and HCV act synergistically and cause accelerated progression of fibrosis and cirrhosis. The clinical course worsens.
What is the prognosis with alcoholic hepatitis?
Excessive alcohol abuse is the third leading cause of death in the United States and accounts for approximately 3.8% of all deaths globally. 44% of deaths from liver failure or disease are due to alcohol and in the US 10-15% of all alcoholics have developed alcoholic hepatitis.
About 70% of those affected will sooner or later develop cirrhosis. The course of the disease depends on abstinence. When a person stops drinking alcohol completely, the liver recovers completely about 10% of the time. (15.19)
What can I do if my pet has liver inflammation?
The liver can also become inflamed in pets. For example, there is hepatitis contagiosa canis. This virus is distributed worldwide, but occurs only rarely. Animals become infected orally, primarily by ingesting urine or foods containing urine. The infection is also excreted in the urine, which also spreads the virus further.
The acute hepatitis has symptoms such as fever, refusal to eat, vomiting and so on. If the course is particularly acute, the liver inflammation is more dangerous. It can be fatal, increased when the animal is young and has not been vaccinated. It can also end in chronic liver inflammation.
You can have your dog vaccinated against canine hepatitis with attenuated heterologous vaccines. Vaccination is a combination of vaccines. In order to avoid hepatitis and curb its spread, you should have your dog vaccinated against it. (17)
In cats, liver inflammation can be prevented by feeding the cat species-appropriate so that it does not become overweight. If you have a liver infection, you should definitely see a doctor. They then examine the blood and use x-rays or ultrasound to examine the liver.
The inflammation of the cat's liver tissue can lead to cholangitis or cholangiohepatitis. Hepatitis means that the liver can no longer carry out its metabolic tasks properly. The symptoms are similar to the symptoms already listed.
Acute liver inflammation in cats can also turn into chronic. This is not curable, but can be contained with the help of cortisone, for example. Acute hepatitis can be treated in different ways, depending on the cause of the hepatitis. (18)
Treat liver inflammation: The best tips & tricks for hepatitis
If you think you might be suffering from hepatitis, you should definitely act quickly. Depending on the form, liver inflammation can be treated and prevented, for example by vaccination against hepatitis A and B.
Below is some information that deals with the treatment of liver inflammation.
When should I go to the doctor with liver inflammation?
If you have symptoms, you should definitely consult a doctor immediately so that he can clarify how serious your illness is. Unfortunately, the disease is often asymptomatic for a long time and goes undetected.
How is the treatment going?
There is currently no cure for chronic hepatitis B, but therapies help stop the disease process and can prevent cirrhosis or carcinoma from developing. This improves the prognosis.
With regard to hepatitis D, there are therapeutic approaches that are being developed. However, there is still no effective treatment for this particularly severe form of hepatitis.
There is a standard therapy for autoimmune hepatitis. This consists of either one drug (prednisone or budesonide) or a combination of two drugs (azathioprine). It is a long-term therapy that stops the progression of the disease. (3.6)
The aim of hepatitis C infection is to completely eliminate the virus. The therapy does not necessarily have to be started immediately because the development of liver cirrhosis is unlikely. Therefore, a decision must be made on the basis of various criteria as to whether therapy is to take place. Patients must not consume alcohol or other drugs and be abstinent for at least one year. Children are not treated.
Standard therapy for hepatitis C is a combination of interferon-alpha and ribavirin. The therapy lasts either 24 or 48 weeks. If after 24 weeks the PCR test is positive, the therapy should be terminated as unsuccessful.
The side effects of the treatment are sometimes very severe and sometimes lead to the therapy being discontinued.
The treatment can cause side effects, which must be clarified with the patient in any case, so that they do not stop their therapy because of this. Side effects include flu-like symptoms and induced anemia. Psychiatric side effects can also occur and patients must be closely monitored. Sometimes the therapy has to be stopped. (11)
In autoimmune hepatitis, immunosuppression occurs with prednisone or prednisolone and azathioprine. In the case of acute liver failure, severe cirrhosis or hepatocellular carcinoma, only a liver transplant can help. Transplantation can result in recurrent autoimmune hepatitis, or new disease can occur. (12)
Which antibiotics or drugs help with liver inflammation?
If the antibiotics no longer help, for example in the case of a very advanced hepatitis B disease, often only a liver transplant can help. However, not all those affected suffer from such severe courses. (5) Antibiotics often disrupt the gut flora, so you should clean up your gut flora after taking antibiotics .
Interferons help with chronic hepatitis B disease. These improve survival. However, the optimal dose and duration remain unclear. Lamivudine can also help and ensure that the histology is improved. Here, too, the details are unclear. There are also other antivirals, including famiciclovir and adefovir dipivoxil, which is a nucleoside analogue, and other nucleoside analogues, but their effects have hardly been studied. (6)
Which fruits and vegetables for liver inflammation?
Other things also help against liver inflammation, because the liver is very important when it comes to processing food and small children in particular are at risk of malnutrition in chronic liver diseases. One should therefore pay attention to a healthy diet . (13)
How can I prevent liver inflammation?
Transmission is almost exclusively sexual and parenteral, so risk-taking behavior needs to be watched. One should not have unprotected sexual intercourse for the presentation and, when consuming drugs, make sure that one does not use contaminated injection equipment.
Pregnant women should be tested for HBs antigen so that the child is immediately immunized. Passive and active. In the case of cuts and stings in the medical field, care should be taken to ensure adequate hygiene. Piercings and tattoos should also be avoided in order not to expose oneself to an additional risk of infection with a virus. (6)
Can I get vaccinated against liver inflammation?
You can get vaccinated against hepatitis B. This is a 6-fold vaccination. You can be in the 3rd, 5th and 12-14. Month of life and should then be vaccinated again at the age of 6-15 years for a booster shot. Hepatitis B vaccination also helps against hepatitis D. (5)
Over 600 million people have been vaccinated worldwide and over 100 million are added each year. Prevention is better than cure, one should be vaccinated before the first sexual contact. (6) You can also be vaccinated therapeutically, but this is not currently taking place. (6)
Conclusion
Vaccination can at least prevent hepatitis A, B and D. Even if many hepatitis diseases run smoothly, hepatitis can be quite dangerous and you should in any case, regardless of whether it is a pet, because animals can also get hepatitis, or humans, consult a doctor and get advice from him. So if you suspect that you have hepatitis, you should see a doctor.
You should also pay attention to your alcohol consumption and not abuse alcohol, because alcohol abuse can also lead to liver inflammation and alcoholic liver inflammation is often fatal. Acute inflammation of the liver can progress to chronic. Antibiotics or medications in general help with acute hepatitis. If the hepatitis is already very advanced, however, often only a liver transplant can help.
References
-
Federal Ministry of Education and Research: Hepatitis: an underestimated disease with a high number of unreported cases, October 2019 Source
Federal Ministry of Justice and Consumer Protection: Law on the Prevention and Control of Infectious Diseases in Humans (Infection Protection Act - IfSG)
§ 6 Notifiable diseases Source
Manns, MP Chronic inflammatory liver disease. Internist 59, 517-518 (2018). https://doi.org/10.1007/s00108-018-0433-2 source
Federal Ministry of Education and Research: New therapy against hepatitis delta - combination of two active ingredients heals every fourth patient, 2011 Source
AGES: Viral Hepatitis and the Public Health Service in Austria Source
Institute for Clinical Pharmacology: Hepatitis B viral infection: diagnosis, clinical consequences, therapy and prophylaxis, J. Reichen, PJ Grob on behalf of SEVHEP*, 2002 Source
Schirmacher, P., Fleig, WE, Tannapfel, A. et al. Biopsy diagnosis of chronic hepatitis. Pathologist 25, 337-348 (2004). https://doi.org/10.1007/s00292-004-0692-7 source
Kane, MA World Epidemiology of Hepatitis B. Soz Preventive Med 43, S24–S26 (1998). https://doi.org/10.1007/BF02042169 Source
Viral Hepatitis: Therapeutic Review (2011), 68, pp. 175-181., 2013 https://doi.org/10.1024/0040-5930/a000147., Darius Moradpoud, Hubert E. Blum, 2013 Source
Bundesgesundheitsbl - Gesundheitsforsch -Gesundheitsschutz: Hepatitis B und C., 369-378 Gerlich, WH, 2004 https://doi.org/10.1007/s00103-004-0811-x Source
Bundesgesundheitsbl - Health research - Health protection: Therapy of hepatitis C infection, H. Wedemeyer, M. Cornberg, MP Manns, 2001 Source
autoimmune hepatitis
REVIEW
Farhad Sahebjam, John M. Vierling (✉)
Departments of Medicine and Surgery, Baylor College of Medicine, Baylor-St. Luke's Medical Center, Houston, TX 77030, USA © Higher Education Press and Springer-Verlag Berlin Heidelberg 2015
Front. Med. 2015, 9(2): 187-219 DOI 10.1007/s11684-015-0386-y Source
Springer Link: Chapter: Pediatric Gastroenterology, Hepatology and Nutrition, Burkhard Rodeck Klaus-Peter Zimmer, 2008 Source
Thieme: DGEM guideline: "Clinical nutrition in intensive care medicine", unnar Elke, Wolfgang H. Hartl, K. Georg Kreymann, Michael Adolph, Thomas W. Felbinger, Tobias Graf, Geraldine de Heer, Axel R. Heller, Ulrich Kampa, Konstantin Mayer, Elke Muhl, Bernd Niemann, Andreas Rümelin, Stephan Steiner, Christian Stoppe, Arved Weimann, Stephan C. Bischoff Source
Basra S, Anand BS. Definition, epidemiology and magnitude of alcoholic hepatitis. World J Hepatol. 2011;3(5):108-113. doi:10.4254/ wjh.v3.i5.108Source
Bell BP. Hepatitis A vaccine. Pediatr Infect Dis J. 2000 Dec;19(12):1187-8. doi: 10.1097/00006454-200012000-00015. PMID: 11144382. Source
MSD Animal Health: Hepatitis Contagiosa Canis Source
Veterinary medicine portal: Hepatitis in cats (inflammation of the liver): Dipl.-Biol. Ulrike Ibold, Pascale Huber (vet), February 2018 Source
Bellentani S, Saccoccio G, Costa G, et al. Drinking habits as factors of risk for alcohol induced liver damage. The Dionysus Study Group. Good. 1997;41(6):845-850. doi:10.1136/gut.41.6.845 source
Halliday ML, Kang LY, Zhou TK, Hu MD, Pan QC, Fu TY, Huang YS, Hu SL. An epidemic of hepatitis A attributable to the ingestion of raw clams in Shanghai, China. J Infect Dis. 1991 Nov;164(5):852-9. doi: 10.1093/infdis/164.5.852. PMID: 1658157. Source
World Health Organization: Hepatitis A, 27 July 2020 Source
Cuthbert YES. Hepatitis A: old and new [published correction appears in Clin Microbiol Rev 2001 Jul;14(3):642]. Clin Microbiol Rev. 2001;14(1):38-58. doi:10.1128/CMR.14.1.38-58.2001 Source
