How many types of hepatitis are there?
There are five main types of hepatitis that are caused by a virus, A, B, C, D, and E – plus types X and G.
- Hepatitis A
This is caused by eating infected food or water.
- Hepatitis B
This is an STD (sexually transmitted disease).
- Hepatitis C
Hepatitis C is usually spread through direct contact with the blood of a person who has the disease.
- Hepatitis D
Only a person who is already infected with Hepatitis B can become infected with Hepatitis D.
- Hepatitis E
A person can become infected by drinking water that contains HEV (Hepatitis E Virus).
- Hepatitis X
If hepatitis cannot be attributed to the viruses of hepatitis A, B, C, D, or E, it is called Hepatitis X.
- Hepatitis G:
This is a type of hepatitis caused by the Hepatitis G virus (HGV).

Acute Causes

1. Viral hepatitis:
- Hepatitis A, B, C, D, and E.
- Yellow fever
- Adenoviruses
- Parvovirus B19

2. Non-viral infection
- Toxoplasma
- Leptospira
- Q fever
- Rocky mountain spotted fever
- Alcohol
- Toxins: Amanita toxin in mushrooms, carbon tetrachloride, asafetida
- Drugs: Paracetamol, amoxycillin, antituberculosis medicines, minocycline and many others (see longer list below).
- Ischemic hepatitis (circulatory insufficiency)
- Pregnancy
- Auto immune conditions, e.g., systemic lupus erythematosus (SLE)
- Metabolic diseases, e.g., Wilson’s disease

Chronic Causes
Viral hepatitis:
- Hepatitis B with or without hepatitis D.
- Hepatitis C (neither hepatitis A nor hepatitis E causes chronic hepatitis).

Autoimmune Causes
- Alcohol
- Drugs
- Methyldopa
- Nitrofurantoin
- Isoniazid
- Ketoconazole

Heredity Causes
- Wilson’s disease.
- Alpha 1-antitrypsin deficiency.
- Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic hepatitis.

Alcoholic Hepatitis Causes
- Long term alcohol consumption.
- Patients with chronic alcoholic liver disease.
- Alcoholic cirrhosis.

A large number of drugs can cause hepatitis:
- Agomelatine (antidepressant).
- Allopurinol.
- Amitriptyline (antidepressant).
- Amiodarone (antiarrhythmic).
- Atomoxetine.
- Azathioprine.
- Halothane (a specific type of anesthetic gas).
- Hormonal contraceptives.
- Ibuprofen and indomethacin (NSAIDs).
- Isoniazid (INH), rifampicin, and pyrazinamide (tuberculosis-specific antibiotics).
- Ketoconazole (antifungal).
- Loratadine (antihistamine).
- Methotrexate (immune suppressant).
- Methyldopa (antihypertensive).
- Minocycline (tetracycline antibiotic).
- Nifedipine (antihypertensive).
- Nitrofurantoin (antibiotic).
- Paracetamol (acetaminophen in the United States) can cause hepatitis when taken in an overdose. The severity of liver damage may be limited by prompt administration of acetylcysteine.
- Phenytoin and valproic acid (antiepileptics).
- Troglitazone (antidiabetic, withdrawn in 2000 for causing hepatitis).
- Zidovudine (antiretroviral i.e., against HIV).
- Some herbs and nutritional supplements.

Other Toxins that can cause hepatitis:
- Amatoxin-containing mushrooms.
- White phosphorus, an industrial toxin and war chemical.
- Carbon tetrachloride.
- Cylindrospermopsin, a toxin from the cyanobacterium Cylindrospermopsis raciborskii and other cyanobacteria.

Metabolic disorders can cause hepatitis:
- Hemochromatosis (due to iron accumulation).
- Wilson’s disease(copper accumulation) can cause liver inflammation.
- Necrosis.
- Non-alcoholic steatohepatitis (NASH) is effectively a consequence of metabolic syndrome.

The common digestive disorders are:
- heartburn or Gastro Esophageal Reflux Disease (GERD)
- constipation
- diarrhea
- gastritis
- hemorrhoids
- irritable Bowel Disease (IBS)
- gallstones

The other types of digestive disorders are:
- celiac disease
- peptic ulcers
- crohn’s disease
- ulcerative colitis
- diverticular disease
- colon cancer, rectal cancer and stomach cancer are also a part of digestive disorders.

Home Remedies for Common Digestive Disorders
- Drink fresh Aloe Vera juice.
- This is very high in vitamins, minerals and other essential nutrients.
- This remedy is said to relieve diarrhea, constipation as well as other gastrointestinal problems.
- Probiotics, which are microbial organisms, are usually found in the digestive tracts of humans.
- They improve the digestive process in the body.
- Consume probiotic yogurt at regular intervals during the day.
- This alleviates the digestive disorders.
- Different types of tea can be very helpful.
- Ginger tea, chamomile tea, green tea and peppermint tea are the effective varieties of tea that alleviate digestive problems.

Use bitter digestive stimulants and herbs like:
- black cohosh,
- angelica,
- yarrow,
- skullcap,
- dandelion
- small quantities of wormwood
- mint,
- lavender,
- fennel,
- rosemary,
- juniper,
- valerian,
- lemon balm

Diet for Common Digestive Disorders
- Follow a healthy diet at all times.
- The BRAT diet is the ideal one which comprises of bananas, rice, applesauce, tea (or Toast).

Diet Aspects
- Eating a high amount of fresh fruits and vegetables can increase the amount of vitamins, minerals and other nutrients.
- Consumption of whole grains and cereals is also important.
- It adds fiber to your digestive tract.
- Fiber facilitates the movement of the waste matter in the digestive tract.
- High-fiber foods help alleviate constipation.
- Adequate intake of fluids, especially water.
- Make sure that you drink at least 8 to 10 glasses of water through the day.

Other Home Remedies
- Ginger garlic with honey juice
- Decoction of Coriander, cardamom, ginger and cloves
- Lemon with honey
- Chamomile tea
- Holy basil with ginger and jiggery
- Cumin seeds with pomegranate
- Cabbage juice
- Papaya juice

The common digestive disorders are:
- heartburn or Gastro Esophageal Reflux Disease (GERD)
- constipation
- diarrhea
- gastritis
- hemorrhoids
- irritable Bowel Disease (IBS)
- gallstones

The other types of digestive disorders are:
- celiac disease
- peptic ulcers
- crohn’s disease
- ulcerative colitis
- diverticular disease
- colon cancer, rectal cancer and stomach cancer are also a part of digestive disorders.

Symptoms for Common Digestive Disorders

1. Heartburn or GERD Symptoms
- Regurgitation of sour liquid or food.
- Dry cough.
- Chest pain.
- Sensation of a lump in the throat.
- Sore throat or hoarseness.
- Dysphagia, which is difficulty in swallowing.
- Burning sensation in the chest, which could spread to the throat.

2. Constipation
- Experiencing a feeling of rectal blockage.
- Passing stools that are very hard.
- Having less than three bowel movements in a week.
- Straining excessively during a bowel movement.
- Pain in the abdominal area.
- Feeling a sensation of incomplete evacuation after passing stools.

3. Diarrhea
- Bloating in the abdominal area.
- Fever.
- Pain and severe cramps in the abdomen.
- Presence of blood in the stool on rare occasions.
- Bloody or black stool in severe and serious cases of diarrhea.

4. Gastritis
- Sensation of fullness in the upper abdomen after eating.
- Nausea and vomiting.
- Pain or a burning ache in the upper abdomen.

5. Hemorrhoids
- Bleeding during the bowel movement.
- A lump near the anus, which is painful and sensitive.
- Pain or discomfort.
- Leakage of feces.
- Swelling around the anal area.
- Irritation and itchiness in the anal area.

6. Irritable Bowel Disease (IBS)
- Mucus in the stools.
- Alternate bouts of constipation and diarrhea.
- Flatulence or excess gas.
- Cramps and pain in the abdomen.
- Bloated feeling.

7. Gallstones
- Sudden and intense pain in the upper right portion of the abdomen.
- Pain in the right shoulder.
- Backache, which is worse between the shoulder blades.

Functions of Liver
More than 500 vital functions have been identified with the liver. The functions include:
- Detoxification.
- Protein synthesis.
- Production of biochemicals that are necessary for digestion.
- Glycogen storage.
- Decomposition of red blood cells.
- Plasma protein synthesis.
- Hormone production.
- Production of bile for digestion.
- Production of certain proteins for blood plasma.
- Production of cholesterol and special proteins that help to carry fats through the body.
- Conversion of excess glucose into glycogen for storage.
- Regulation of blood levels of amino acids.
- These amino acids form the building blocks of proteins.
- Processing of hemoglobin – the liver stores iron.
- Conversion of poisonous ammonia to urea.
- Clearing the blood of drugs and other poisonous substances.
- Regulating blood clotting.
- Resisting infections by producing immune factors.
- Removing bacteria from the bloodstream.
- Liver breaks down harmful substances which are excreted into the bile or blood.
- Bile by-products enter the intestine and ultimately leave the body in the feces.

Liver Location
- The liver is located in the upper right-hand portion of abdominal cavity.
- This is beneath the diaphragm.
- And on top of her stomach, right kidney and intestines.
- Weight: The liver weighs about 2 pounds.

Regulation Process of the Liver
- The liver regulates most chemical levels in the blood.
- It excretes a product called bile.
- This helps to break down fats.
- It also prepares them for further digestion and absorption.

Lobes of the liver
- The liver consists of two main lobes.
- Both of these lobes are made up of thousands of lobules.
- These lobules are connected to small ducts.
- These connect with larger ducts to ultimately form the hepatic duct.

Blood flow and liver
- All of the blood leaving the stomach and intestines pass through the liver.
- The liver processes this blood.
- It breaks down the nutrients.
- The drugs present in the blood are broken into forms that are easier to use for the rest of the body.

In primary sclerosing cholangitis :
- The intrahepatic and extrahepatic bile ducts become inflamed,
- scarred and thickened (sclerotic),
- narrowed,
- finally obstructed.

Obstruction of the ducts can lead to:
- abdominal pain,
- itching,
- jaundice,
- infection in the bile ducts (cholangitis),
- liver scarring that leads to liver cirrhosis,
- liver failure.

Symptoms of primary sclerosing cholangitis:
- Most patients with early primary sclerosing cholangitis have no symptoms.
- The presence of primary sclerosing cholangitis is recognized only because of abnormally elevated blood levels of liver enzymes (particularly alkaline phosphatase levels).
- This is often recognized along with a routine physical examination.
Early symptoms of primary sclerosing cholangitis include
- Fatigue
- bodily itching (pruritus)

With the progress of the disease:
- Patients may develop jaundice (yellowing of skin and darkening of urine).
- Jaundice is due to the accumulation of bilirubin in the body.
- The bilirubin accumulates because it is not able to be eliminated in the bile.
- This is due to prolonged obstruction of the bile ducts.
- The accumulation of bilirubin turns the skin and whites of the eye (sclera) yellow.
- It may be due to accumulation of bile salts in the body.
- It is as a result of obstruction of the bile ducts.

As primary sclerosing cholangitis progresses, patients typically develop:
- Right upper abdominal pain,
- Fever,
- Fatigue,
- Pruritus
- Jaundice
- These patients also are at risk of developing primary sclerosing cholangitis complications.
- The patients with the autoimmune form of primary sclerosing cholangitis have more rapid symptoms of abdominal pain, jaundice and fever.

In primary sclerosing cholangitis :
- The intrahepatic and extrahepatic bile ducts become inflamed,
- scarred and thickened (sclerotic),
- narrowed,
- finally obstructed.

Obstruction of the ducts can lead to:
- abdominal pain,
- itching,
- jaundice,
- infection in the bile ducts (cholangitis),
- liver scarring that leads to liver cirrhosis,
- liver failure.

Diagnosis of primary sclerosing cholangitis includes:
- Blood tests
- Radiologic tests
- Colonoscopy

The treatment of primary sclerosing cholangitis includes:
- Cholestyramine (Questran) or rifampin(Rifadin) to diminish itching.
- Antibiotics for infection, specifically cholangitis.
- Vitamin D and calcium to prevent bone loss (osteoporosis).
- Medications such as ursodiol (UDCA) to retard the progression of primary sclerosing cholangitis.
- ERCP with balloon dilatation.
- Stenting (a procedure in which the bile ducts are stretched open) for primary sclerosing cholangitis patients with dominant extra-hepatic duct strictures.
- Liver transplantation for patients with advanced cirrhosis.

Medications
- Ursodiol (UDCA),
- Prednisone,
- Methotrexate(Rheumatrex, Trexall),
- Colchicine,
- 6-mercaptopurine,
- Tacrolimus (Prograf),
- Cyclosporine (Neoral, Gengraf)

UDCA
- Ursodiol (UDCA) is a bile acid.
- This is given orally and replaces other bile acids in the body.
- UDCA is believed to protect against damaging effects of other bile acids on the liver cells.
- It also can induce formation of antioxidants.
- UDCA is the most extensively studied medication for primary sclerosing cholangitis.
- Its standard doses are15 mg/kg/day.
- It has been shown to improve fatigue, and improve blood levels of liver enzymes in these patients.
- Higher doses (20-30 mg/kg/day) UDCA has been shown to improve blood liver enzymes.
- It also decreases bile duct inflammation, and decrease liver scarring.
- UDCA is safe and well tolerated.
- It may improve bile duct disease and retard the development of liver cirrhosis.
- UDCA may decrease colon cancer risk in patients with both primary sclerosing cholangitis and chronic ulcerative colitis.

Treatment of dominant strictures
- Dominant strictures are major narrowing in the extrahepatic bile ducts.
- Dominant strictures of the extrahepatic bile ducts occur in 7%-20% of primary sclerosing cholangitis patients.
- ERCP and balloon dilatation (stretching) of the stricture can improve symptoms and abnormal blood levels of liver enzymes and bilirubin.
- Successful dilatation of dominant strictures decreases the risk of developing cholangitis.
- ERCP and dilatation of dominant strictures should be done in centers with highly experienced physicians.
- In ERCP, doctors often also perform brush cytology of the dominant strictures to exclude cholangiocarcinoma.
- Surgery is another treatment for dominant extrahepatic strictures.
- Surgical resection of the stricture followed by creation of a choledocho-jejunostomy which is an artificial passage for bile formed by attaching the bile duct from above the stricture directly into the small intestine.
- This can improve symptoms, delay liver transplantation, and lower the risk of cholangiocarcinoma.

Liver transplantation
The reasons for liver transplant in primary sclerosing cholangitis patients are similar to those in other forms of end-stage liver disease. They are:
- Internal bleeding due to rupture of esophageal varices.
- Severe ascites that are refractory to medical treatment.
- Frequent episodes of bacterial cholangitis.
- Hepatic encephalopathy.

- Asthma
When the symptoms of asthma like wheezing, chest tightness, coughing, breath shortness worsens until he / she is unable to speak more than four words, blueness around lips and reliever medication is ineffective, person should be admitted to the emergency room in which he would be put on a nebuliser in which oxygen is directly delivered to the lungs. Oxygen mask can also be used.

- Heart Attack
Symptoms of heart attack include pain across chest, arms, jaws or neck and it does not lessen with rest, nausea, vomiting, difficulty in breathing, rapid weak and irregular pulse. Move to an emergency room and on the way to hospital chew a 160mg aspirin to stop clumping of blood platelets. In an emergency room, ECG is done and blood studies are done. Intravenous nitroglycerine reduces heart’s oxygen need and improves coronary circulation. The chance of death is halved if you reach in first hour.

- Fractures
When a fracture is suspected, pain worsens with the movement, that particular area swells, a limb is crooked. Transport to an emergency room very carefully. In the emergency room, x-ray of the limb is done and broken bone ends are treated.To relieve pain, a muscle relaxant is given. The area is immobilized with plaster cast or splint.

- Internal Bleeding
Sometimes, there is internal bleeding after an injury. Symptoms are pale and clammy skin, rapid weak pulse, shallow and rugged breathing, fainting, swelling, pain and tenderness. While you are waiting for ambulance to go to an emergency room, raise the legs and cover with blanket and do not offer an food or water. In an emergency room, the person is diagnosed and then treated.

- Diabetes
Sometimes, the blood sugar falls below 50 because of delayed and missed meals, sudden vigorous activities, irregular medications. It results in blurred vision, numbness, paleness, headaches, unconsciousness, tingling in lips and and fingers. When a person is admitted to an emergency room, the IV fluids are administered.

- Poison
Induce vomiting if poison is not in the form of kerosene, gasoline, turpentine, cleaning fluid, insect sprays. In an emergency room, urine and blood tests are done to identify the poison and specific antidotes are suggested.

- Urinary Retention
Sometimes a person has a full bladder but they could not urinate. When you are admitted to an emergency room, a catheter is inserted to allow the person to empty the bladder.

- Heat Exhaustion
It can hit you in a hot, noisy, smoke filled disco or pub resulting in loss of electrolytes. In an emergency room, patient is pumped with IV fluids to revive the blood pressure.

A healthy digestive system is really important. There can be few problems related to small intestine. The disorders with small intestine are mainly due to infection by microbes or structural disorders. Some intestine disorders are:
- blockage
- infection
- tumor
- crohn’s disease
- celiac disease
- short bowel syndrome.

Blockage in small intestine can be due to any kind of pressure that is applied externally, tumor or some foreign bodies. This blockage prevents fluids and waste products from passing through the digestive tract. Feeling of nausea, vomiting, inflammation in abdomen is observed.

Infection in small intestine is because of some bacteria or virus. This is because of eating spoiled food and having spoiled drinks. Feeling of constipation, diarrhea, cramps and loss of appetite is observed.

Celiac disease of small intestine causes inflammation and damage of intestine lining when it is exposed to specific forms of glycoprotein and gluten protein. It is an auto-immune disease.

Short bowel syndrome is the condition in which about two third of the small intestine is not working properly. It is also known as short gut. The nutrients are not absorbed properly as a result a feeling of fatigue, pain in the abdomen, diarrhea and malnutrition can occur.

Small Intestine Cancer is one of most dangerous disorder of small intestine as the symptoms of this cancer are not observed at early stages, they are noticed at later stages. Symptoms of small intestine cancer includes very acute pain in abdomen and intestine, too much weakness and excessive weight loss.

Crohn’s disease is an auto immune disorder. It causes inflammation and swelling of the digestive tract. The symptoms and complications of crohn disease can vary depending on the location of the inflammation. Common symptoms that can be observed are diarrhea, weight loss, weakness, vomiting, skin problems.

Small bowel bacterial overgrowth syndrome (SBBOS), or small intestinal bacterial overgrowth (SIBO) is an excessive bacterial growth in small intestine. Various symptoms include nausea, bloating, vomiting and diarrhea, which is caused by a number of mechanisms.

- Ulcerative Colitis
If a person is suffering from bloody diarrhea, abdominal pain, fever and anemia then it could be ulcerative colitis which is an inflammation and ulceration of the colon and rectal lining. Drugs are needed to cure it.

- Liver disease
If a person is suffering from loss of taste, then it could be a possibility that he or she is affected by a liver disease.

- Diverculitis
If a person is suffering from severe stomach pain that does not abate within an hour and is not relieved by antacids, coupled with pain, recurrent diarrhea, fever, chills, nausea and vomiting then it could be diverculitis which is an infection of pouches on the wall of the colon that requires antibiotics, antispasmodics and a high fiber diet.

- Peptic Ulcer
If a person is suffering from persistent ache in the gut that lasts for more than a few days between meals and at rest together with flu like symptoms, weight loss or rectal bleeding, then it could be peptic ulcer which can be treated with antibiotics and antiulcerants.

- O-esophagus Cancer
If a person is suffering from difficulty in swallowing, weight loss, chest discomfort, heartburn then it could be the cancer of oesophagus and it can be diagnosed by a barium meal and endoscopy.

- Hiatal Hernia
If the food is regurgitated from the stomach into the mouth then there is a possibility that the person is facing from hiatal hernia in which the upper part of the stomach slide up through the opening in the diaphragm and is diagnosed with barium meal and is treated with surgery.

- Irritable Bowel Syndrome (IBS)
If a person is suffering from fluctuation between diarrhea and constipation with stomach cramps which rarely hit you while you are asleep then it could be irritable bowel syndrome which can be treated with antispasmodic drugs, frequent small meals and fiber diet.

- Acidity or Heart Burn
If a person is suffering from a burning pain in the chest then it could be because of acidity which is often confused with a heart attack. When stomach’s excess acid is forced back up from the wind pipe, acidity bursts. Eating a rich spicy meal just before bed time is the main cause for acidity. Take an antacid and raise the head of your bed and sleep on your left side.

- Round Worms
If a person is suffering from anal itching then it could be because of round worms and you need a de-worming session.

Sitting affects the back more than standing. Standing demands five times more on the spine and muscles lying down. To keep the spinal curves aligned, the muscles are needed to be strong and flexible.

- Poor posture can narrow the space between vertebrae and hence increasing the risk of compressed nerves.
- Poor posture increases wear on joints and can contribute to osteoarthritis.
- Bad posture can cause your pectorals contract and shorten if you sit bent over a desk all day. The back muscles lengthens and gets weakened making it difficult to lift the chest which is important for good posture.
- Contracted chest muscles contribute to shoulder injury, sore neck, back pain and fatigue.

Poor posture includes rounded shoulders, protruding buttocks and abdomen, arched lower back, head pushed in forward position. To improve poor posture and maintain a good posture,one thing that is most important is to maintain a healthy weight. Keep in mind the following points:

- The footwear that you wear while standing or walking plays an important part for maintaining a good posture.
- You should imagine as if a wire is attached to the top of your head pulling it upwards.
- Avoid standing or walking with an extreme curve in lower back.
- Tighten the abdominal muscles and flattening your stomach and hold for few seconds.
- Stand evenly balanced on both feet.
- While sitting, sit firmly back with shoulders against chair, chest lifted and upper back straight.
- Equal weight should be put on both buttocks.
- Thighs should be horizontal while sitting.
- Feet should be flat on floor while sitting.
- While working at desk, do not loo directly down at your work.
- While driving, seat should be positioned so that the wheel could be reached easily as well as brake, accelerator and clutch.
- Take a break if you are sitting for a long time.
- The mattress should be comfortable, not too hard but it should not sag. Early morning back pain is a sign of a poor posture.
- Lifting or carrying too heavy objects can cause poor posture.