Your angry, inflamed liver can’t be soothed with words

The liver is the second largest organ of the body weighing about 1.5 kgs. It performs various important functions of the body like regulating blood glucose levels by producing glucose and storing glucose in response to variation of blood glucose levels, helping in breaking down lipids in the diet by secreting bile and synthesis of clotting factors.

Hepatitis:Hepatitis is a condition characterised by inflammation of the liver tissue. It can be caused by a number of different causative conditions like chronic alcohol intake, drug toxicity and infections. Among them, a very common reason for the cause of hepatitis is viral in nature.

Hepatitis viruses are of different types like A, B, C, D and E and the corresponding diseases caused by them are named Hepatitis A, B, C, D, and E respectively.

Hepatitis B:
Hepatitis B is an infectious disease caused by Hepatitis B virus which is endemic in humans. It causes both an ‘Acute’ form of the disease and also a ‘Chronic’ long-term form of the disease. It is transmitted by exposure to infected blood and body fluids. Important routes of transmission include:
•Unprotected sexual intercourse with an infected individual.
•Transmission of infected blood/blood products.
•Use of infected syringes- among drug abusers.
•Infected tattoo piercing needles.
•During child birth from infected mother to child.

The hepatitis virus lodges and reproduces in the liver cells. The body of the infected individual responds with an immunological response to the virus. The response generated also attacks the liver cells causing the pathological changes characteristic of the disease. People with good immune status can overcome the viral load and end up eliminating the virus.

Symptoms:
Usually, the patient is asymptomatic in the beginning and has no/ fewer symptoms. With time he/she may experience viral flu-like features:
•Fever
•Bodyache
•Feeling lethargic
•Nausea
•Abdominal discomfort
•Yellowish discolouration of skin/eyes/nails

In the advanced stage of the disease, it can lead to cirrhosis (scarring of liver tissue) and liver failure, in which it may present additionally as:

•Loss of weight
•Prominent blood vessels on abdomen
•Bleeding tendency throughout the body
•Confusion
•Coma

Long standing infection can lead to a state of ‘chronic hepatitis’ and also lead to liver cancer (Hepato-cellular carcinoma).

Diagnosis and Treatment:

Usually, the presence of initial symptoms raises an alarm of a liver disease when a person presents to his/her general physician. The doctor then evaluates by doing a battery of blood tests which also includes liver function test which give an evaluation of liver enzymes. On finding elevated liver enzyme levels, the clinical suspicion of a liver disease is confirmed.

The next investigations carried out are imaging studies like ultrasonography and viral markers like markers for hepatitis viruses. A positive viral marker for hepatitis B clinches the diagnosis for Hepatitis B. There are many markers for Hepatitis B like HBsAg, Anti-HBsAg, IgM and IgG antibody markers, HBc Ag and Anti-HBc antibody, HBeAg and Anti-HBe antibody. Depending upon the type of markers positive, it can be determined whether the patient has acute or chronic hepatitis B. Acute hepatitis B usually responds to conservative management.

Serial viral markers are done to review the response to conservative management. In cases of non-decline of viral load/nonresponse to treatment or in cases of chronic Hepatitis B, the patient is then referred to a hepatologist. A hepatologist is a specialised doctor who has done specialization in the field of medicine and further fellowship in gastroenterology and liver diseases. The hepatologist can start the patient on anti viral medicines which are available both as oral and injectable drugs. A liver biopsy can also be done to assess the severity of chronic disease. In cases of end-stage cirrhosis, option for liver transplantation is also considered.

In early stages of hepatitis B, the patient does respond to conservative management if his/her immune status is good and on regular follow-up. Such a patient can be managed by a general physician if a regular follow-up and serial liver function tests and viral markers are carried out. However, a hepatologist is the apt consultant to approach, especially if a patient is in the chronic phase of the disease or has progressed to cirrhosis/liver failure.

To know more about your specific condition, please visit an Hepatologist in a a trusted hospital close to you.