Posts Tagged ‘Cells’

What is Hepatitis? What are causes of Hepatitis?

Hepatitis is a medical condition in which the liver cells are inflamed.
Overview
- The word hepatitis comes from the Ancient Greek word hepar (root word hepat) which means ‘liver’, and the suffix Latin itis meaning inflammation.
- Its plural is hepatitides.
- This condition is recognized by the presence of inflammatory cells in the tissue of the organ.
- This condition can progress to cirrhosis and fibrosis.
- Hepatitis may occur with limited or no symptoms.
- It often leads to jaundice, anorexia (poor appetite) and malaise.
- Hepatitis is acute when it lasts less than six months.
- It is chronic when it persists longer.
- A group of viruses known as the hepatitis viruses cause most cases of hepatitis worldwide.
- It can also be due to toxins (notably alcohol, certain medications, some industrial organic solvents and plants).
- It can also be due to other infections and autoimmune diseases.

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.

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What are symptoms of primary sclerosing cholangitis?

Primary sclerosing cholangitis (PSC) is a chronic (lasting years and decades), progressive (worsening over time) disease of the bile ducts.
- This disease channelizes bile from the liver into the intestines.
- Bile is a watery liquid made by the cells of the liver that is important for digesting food in the intestine, particularly fat.
- This liquid also helps to get rid of the body of toxins.
- Liver cells secrete the bile they make into small canals within the liver.
- The bile flows through the canals and into larger collecting canals (ducts).
- The bile then flows within the intrahepatic bile ducts out of the liver and into the extrahepatic bile ducts.
- From the extrahepatic bile ducts, the bile flows into the intestine where the bile mixes with food.

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.

How is primary sclerosing cholangitis treated?

Primary sclerosing cholangitis (PSC) is a chronic (lasting years and decades), progressive (worsening over time) disease of the bile ducts.
- This disease channelizes bile from the liver into the intestines.
- Bile is a watery liquid made by the cells of the liver that is important for digesting food in the intestine, particularly fat.
- This liquid also helps to get rid of the body of toxins.
- Liver cells secrete the bile they make into small canals within the liver.
- The bile flows through the canals and into larger collecting canals (ducts).
- The bile then flows within the intrahepatic bile ducts out of the liver and into the extrahepatic bile ducts.
- From the extrahepatic bile ducts, the bile flows into the intestine where the bile mixes with food.

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.