Hepatitis - Chronic

(Old terminology: chronic active hepatitis, chronic persistent hepatitis)

The term "hepatitis" means inflammation of the liver, from whatever cause. Chronic hepatitis means that inflammation of the liver lasts for a prolonged period of time. A period of 6 months is sometimes taken to mean chronic, although this is arbitrary. In contrast, acute hepatitis is an episode of liver inflammation, usually lasting a few weeks or months, which gets better.

Cause of Hepatitis - Chronic

There are many causes of chronic hepatitis. The cause may be a virus, a medication, a toxin (e.g. alcohol), autoimmune (an abnormality of the immune system which allows damage to occur to your own tissues), or other factors. Some of the more important ones are viral hepatitis B, viral hepatitis C, and autoimmune chronic hepatitis (previously known as lupoid chronic active hepatitis). Hepatitis A does not cause chronic hepatitis. Less common causes include some medications, Wilson's disease (due to excessive copper accumulation), alpha-1 antitrypsin deficiency, inflammatory bowel disease, and occasionally alcohol.

Symptoms

A person with chronic hepatitis may feel quite well, or may have symptoms such as tiredness, loss of appetite, nausea, easy bruising and fluid retention. Your doctor may notice clinical signs such as dilated blood vessels in the skin (spider angiomata), redness of the palms (palmar erythema), easy bruising, enlargement of the liver and spleen, and fluid retention (ankle swelling and fluid in the abdomen - ascites).

Diagnosis

Chronic hepatitis may be suspected on the basis of blood tests, but the diagnosis requires a liver biopsy that demonstrates a particular type and location of inflammation in the liver.

In chronic hepatitis, the liver function tests show higher levels of the transaminases (ALT and AST) than the other liver enzymes. Hepatitis B and C tests, autoantibodies, copper and caeruloplasmin levels, and other tests are also necessary. After blood tests confirm that there is no disturbance of blood coagulation, a liver biopsy will be done for examination by a pathologist. Once the diagnosis is confirmed, treatment will be commenced.

Medical Treatment

The treatment of autoimmune chronic hepatitis requires the use of anti-inflammatory medication such as corticosteroids (e.g. prednisolone) and immunomodulators (e.g. azathroprine). Regular blood tests will be required to confirm that the treatment is working and to look for side-effects of the medication. The duration of treatment is usually for several years, but this will depend on the response to treatment.