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Hepatitis

Hepatitis means inflammation of the liver. Your liver is an important organ located in the upper right corner of your abdomen, just under your rib cage. Your liver has a number of essential functions and plays a major role in metabolism. All of the blood leaving your intestines passes first through the liver. Excess sugar is taken up by the liver and stored as glycogen, and cholesterol is converted in the liver to bile. Bile is then stored in the gall bladder and released into the intestine to help digest fat. Other compounds, such as alcohol and some drugs, are removed from your blood by your liver and altered so they can be eliminated from the body. Your liver removes bilirubin from your blood, a by-product when red blood cells die. Your liver also synthesizes a number of proteins that it then releases into your blood. Some of these proteins allow your blood to clot and others are important in the defense against infection.

Hepatitis, or inflammation of the liver, will make it difficult for the liver to carry out its many functions, and over the long-term hepatitis can result in scarring and liver failure. Many things can cause hepatitis, a few of the common ones are mentioned here. One of the most common causes is viruses; particularly Hepatitis A, Hepatitis B, and Hepatitis C. Hepatitis A and B are usually transmitted in contaminated food, and Hepatitis C by sharing needles used to inject drugs. All three viruses though can also be transmitted during sex: Hepatitis A particularly by rimming; Hepatitis B by exposure to body fluids; and Hepatitis C by body fluids, but most importantly by exposure to blood. Some compounds and medications are toxic to the liver and can cause hepatitis. Chief among these is alcohol, but some herbal and naturopathic remedies, as well as anabolic steroids, can also cause hepatitis. Some medications, including acetaminophen (Tylenol), can be toxic to the liver if taken at too high a dose. For some people, excess fat builds up in the liver causing inflammation and organ damage. Rarely, the immune system, for unknown reasons, can attack the body’s liver causing autoimmune hepatitis.

Hepatitis can be mild with no symptoms, or severe resulting in liver failure. It can also be only temporary and resolve (acute), or become a permanent condition (chronic). Symptoms can include fatigue, nausea, vomiting, and loss of appetite. People can also become jaundiced, where the skin and whites of the eyes turn yellow. If the liver becomes swollen, individuals with hepatitis can feel pain or discomfort in the upper abdomen. Severe hepatitis is life threatening. People with severe hepatitis may also become disoriented and confused, and bleed easily due to loss of clotting factors in their blood.

Hepatitis is diagnosed based on symptoms and a few blood tests. If the liver is inflamed liver enzymes known as ALT and AST will be elevated in the blood. Bilirubin may also increase in the blood if it is not being removed by normal liver function. However, diagnosing the cause of the hepatitis may be more challenging. Your doctor will ask you about potential liver toxins including alcohol, drugs, medications, and herbal remedies. Blood tests will be done to detect the presence of the Hepatitis A, B, and C viruses, as well as a few other viruses, such as Epstein Barr virus and Cytomegalovirus. There are a few genetic causes of hepatitis that can be detected by blood tests. Your doctor may also request an ultrasound or CT scan to look for fat deposits in your liver. If necessary, a liver biopsy may also be required.

Treatment of hepatitis depends on the cause, and it is important to sort this out with your doctor. Any drugs, medications, herbal remedies, or supplements that are causing your liver to be inflamed should be stopped right away. If a particular medication is bothering your liver, your doctor may have to find an alternative. It is very important to avoid alcohol. Alcohol alone can cause hepatitis, but if the hepatitis is caused by something else alcohol will add to the injury and make things worse. There is no treatment for the hepatitis A virus, but almost everyone will recover from this infection on their own. Most people will also clear the Hepatitis B virus on their own, but in some Hepatitis B becomes a chronic infection. There are medications though that can suppress the hepatitis B virus to prevent it from damaging your liver. There are now very effective treatments to cure hepatitis C infection.

Preventing hepatitis is all about avoiding the things that can damage your liver. Drink alcohol in moderation, binge drinking or drinking every day can cause liver damage. If you are starting a new supplement or herbal remedy, consider having some blood tests done to be sure they are safe for your liver. Most importantly, be sure you are vaccinated for the Hepatitis A and Hepatitis B viruses. These viruses are easy to transmit and infection is totally preventable. There is no vaccine for the hepatitis C virus. If you use injection drugs or have multiple sexual partners, consider including hepatitis C testing with your other routine testing for HIV and other sexually transmitted infections.

Cirrhosis

Cirrhosis is a late stage of liver disease when scar tissue replaces normal, healthy liver cells. Anything that harms your liver can, over the long term, cause scarring and cirrhosis. The most common causes are chronic alcohol use; accumulation of fat in your liver; and untreated viral hepatitis, specifically Hepatitis B and Hepatitis C. When these things harm your liver,  your liver will try to repair itself, but in the process can develop scar tissue. The more injury your liver sustains, the more scar tissue develops. Eventually there can be more scar tissue than functioning liver. Generally the scarring cannot be reversed, so it is better to prevent damage to your liver in the first place.

Cirrhosis is divided into two stages, compensated and decompensated. People with compensated liver cirrhosis generally don’t have any symptoms. They still have enough functioning liver cells to carry out what the body needs them to do. In effect, they are able to compensate for the damage. If injury to the liver continues, causing more scarring, people will progress to decompensated cirrhosis. Decompensated cirrhosis can cause jaundice (yellowing of the skin and eyes) and fluid buildup in the abdomen known as ascites. People with decompensated cirrhosis will also bruise easily and are at increased risk of bleeding, especially bleeding from the esophagus (the tube that carries food from your mouth to your stomach). With decompensated cirrhosis the liver is not able to clear metabolic by-products from the blood, allowing them to accumulate in the system with toxic effects including confusion. Other symptoms include swelling of the legs, nausea, recurrent infections, and breast enlargement in men.

In order to diagnose cirrhosis it has to first be suspected. If a person has compensated cirrhosis with no symptoms it may go undetected. If your doctor suspects cirrhosis he or she may first request an ultrasound or a CT scan to see if there is scarring in your liver; a blood test can also help. If cirrhosis is diagnosed then two important questions need to be answered. How advanced is the scarring? And what is causing the damage to the liver? The extent of scarring can be determined with a biopsy, where a needle is inserted through the abdominal wall and into the liver. A small piece of liver is then taken for examination under the microscope. The extent of scarring can also be determined with a fibroscan. This is a type of ultrasound where a probe is placed on the abdomen and measures how stiff the liver is. The stiffer the liver the more scarring there is. Determining the cause of cirrhosis may be evident or may take some detective work. Your doctor will ask you about long term use of alcohol, drugs, medications, and herbal remedies. Blood tests will be done to look for the presence of the Hepatitis B and C viruses. A few blood tests may also be done to detect some genetic causes of liver disease.

 

Once the liver has developed scar tissue it generally can’t be reversed. The goals of treatment are (a) to prevent or minimize further damage to and scarring of the liver, and (b) to treat the symptoms and complications that come with cirrhosis. Preventing further damage of course means knowing what is causing the problem in the first place. Alcohol must be avoided. Whether this was the original cause of the cirrhosis or not, drinking will only further damage your liver. Any other liver toxins such as drugs, some medications, and herbal remedies must also be avoided. If you have Hepatitis B there are medications that can suppress the virus to prevent further damage to your liver. If you have hepatitis C there are now very effective treatments to cure this infection. People with cirrhosis may require water pills to reduce the buildup of fluid in the abdomen, and other medications to reduce the risk of bleeding in the esophagus. People with advanced cirrhosis may require a liver transplant.

The way to prevent cirrhosis is to avoid things that can hurt your liver. Minimize your alcohol use. If you think you may be drinking too much, talk to someone who can support you in your effort to cut down or eliminate alcohol. Make sure you are vaccinated for Hepatitis B. If you inject drugs, make sure to use clean needles and the works. Never share needles as this is an excellent way to transmit Hepatitis C. Unfortunately, there is no vaccine for Hepatitis C. If you have Hepatitis B or Hepatitis C, see your doctor. There are now effective ways to treat these liver infections.

Fatty Liver Disease

Fatty liver, also known as nonalcoholic steatohepatitis, or NASH for short, is a fairly common cause of liver disease. The main feature is accumulation of fat in the liver cells resulting in liver inflammation. The inflammation in turn can cause liver scarring and progression to cirrhosis. Fatty liver disease has become increasingly common in Western countries like Canada. The exact cause of fatty liver is not known, but it is found most often in people in their 40s and 50s; is associated with obesity, particularly increased abdominal fat; diabetes; and high blood levels of triglycerides, a type of dietary fat.

Fatty liver disease is usually silent with no symptoms until it has progressed to cirrhosis. Severe or decompensated cirrhosis can cause jaundice (yellowing of the skin and eyes) and fluid buildup in the abdomen, known as ascites. People with advanced cirrhosis will also bruise easily and are at increased risk of bleeding, especially from the esophagus (the tube that carries food from your mouth to your stomach). With severe cirrhosis the liver is not able to clear metabolic by-products from the blood, allowing them to accumulate in the system with toxic effects including confusion. Other symptoms include swelling of the legs, nausea, recurrent infections, and breast enlargement in men.

Because fatty liver has no symptoms, it is usually discovered with routine blood tests or when you are having tests done for other reasons. Because fat accumulation in the liver can cause the liver to become inflamed (called hepatitis), liver enzymes known as ALT and AST will be elevated in the blood. Your doctor will also request an ultrasound or CT-scan (CAT scan) to look for fat accumulation in your liver. The diagnosis may be confirmed with a biopsy, where a needle is inserted through the abdominal wall and into the liver. A small piece of liver is then taken for examination under the microscope.

The primary treatment for fatty liver is weight loss through a combination of exercise and healthy diet. If you don’t normally exercise, start slowly and gradually increase to at least 30 minutes a day. Any exercise can be good including walking, running, cycling, swimming, and aerobics. Adopting a healthy diet means eating smaller portions and reducing saturated fats by eating less meat and dairy products. If you have fatty liver it is also important that you avoid other things that can harm your liver, such as alcohol and some herbal remedies and supplements. Also, be sure you are vaccinated against the Hepatitis A and Hepatitis B viruses.

Why some people develop fatty liver and some people do not is not entirely known. The best way to prevent fatty liver though is by adopting a healthy lifestyle that includes regular exercise and a healthy diet.

Gallstones

Gallstones are hard deposits that can form in your gallbladder. Your gallbladder is a small sac tucked under your liver that stores bile produced by the liver. After a large meal your gallbladder will release bile through a tube known as the bile duct into your intestines to help digest fat. Gallstones may be made up of cholesterol or of bilirubin, a chemical produced when red blood cells die, and can range in size from a grain of sand to a golf ball. It is not entirely clear why gallstones form, but risk factors include age over 40, obesity, lack of exercise, and diets high in fat and cholesterol.

Gallstones don’t cause symptoms as long as they stay in the gallbladder. Problems arise if one of the stones is carried by the flow of bile into the bile duct, the tube that delivers bile from the gallbladder to the intestine. A stone in this tube will cause sudden pain, usually in the upper abdomen. Sometimes, if the stone is small enough, it will pass through the tube on its own and the pain will subside. However, if the stone gets lodged in the tube and blocks the flow of bile serious complications can develop. If bile can no longer leave the gallbladder because of the blockage, the bile will back up causing the gallbladder to expand and become inflamed. This can cause increasing pain and fever. As bile continues to back up further into the liver it can cause jaundice (yellowing of the skin and eyes) and liver inflammation. Also, in the absence of normal bile flow, bacteria from the intestine can move up the bile duct and cause infection. Finally, if the stone is lodged lower down in the tube leading from the gallbladder it may also block the tube leading from the pancreas causing the pancreas to also become inflamed (pancreatitis).

When gallstones are lodged in the bile duct they can usually be detected with an ultrasound or a CT-scan (CAT scan). Blood tests may also show an increase in bilirubin in the blood caused by the backup of bile. The backup of bile will also irritate the liver causing an increase in liver enzymes (AST and ALT) in the blood.

Gallstones sitting quietly in the gallbladder minding their own business don’t need to be treated. If they become symptomatic though, surgery to remove the gallbladder, and the stones in it, is the usual solution. Since your gallbladder is simply a sack that stores bile produced in your liver, you can live a perfectly normal life without it. If your gallbladder is removed bile simply flows directly from your liver to your intestine. The usual procedure used to remove the gallbladder is called a laparoscopic cholecystectomy. During this procedure the surgeon makes 3 or 4 small cuts in your stomach wall, each only 1-2 cm in size. Through these small openings the surgeon then inserts a light, a camera, and a couple instruments. Using the camera to see inside the abdomen, the surgeon is able to remove the gallbladder. Because during this procedure the cuts made in your stomach wall are very small, it takes less time to recover from the surgery. Sometimes the laparoscopic procedure cannot be done, and an open incision is required. In this case, the surgeon makes a larger cut in the stomach wall, usually 10-15 cm, to allow him or her to see the gallbladder directly in order to remove it. With the larger incision the recovery time from this surgery is a bit longer.

If a gallstone is lodged in the bile duct, the tube that allows bile to flow from the gallbladder to the intestine, it can be removed by ERCP (endoscopic retrograde cholangio-pancreatography). During ERCP you will be partially sedated, the doctor will pass a long flexible tube with a camera at the end through your mouth, down your esophagus, through your stomach, and into your intestine. Once in your intestine the doctor will then guide the tube up into the bile duct to remove the stone. During this procedure the gallbladder is not removed. If the gallbladder contains more stones surgery may be recommended to prevent mores stones from getting lodged in the bile duct.

The best way to avoid gallstones is through a healthy diet and exercise. Being overweight is a risk factor for developing gallstones, so maintaining a healthy weight is important. Avoid overeating, enjoy normal sized portions of food, and limit the amount of saturated fats.