Chronic hepatitis is defined as inflammation of the liver lasting for more than six months. It can be caused by viruses, steatosis, alcohol, autoimmune diseases, hemochromatosis, alpha-1-antitrypsin deficiency and long-standing use of drugs like isoniazid, methyldopa, and nitrofurantoin). A majority of the patients have elevated liver enzymes without symptoms. A liver biopsy is a gold standard for diagnosis, prognosis, and management of the condition.
Chronic hepatitis is a condition characterized by inflammation of the liver parenchyma lasting for more than six months. It has variable clinical features ranging from no symptoms to fulminant liver failure irrespective of the cause of chronic hepatitis. Several viruses (hepatitis B, C, D, and E ) are known to cause chronic active hepatitis with progression to cirrhosis   as well as hepatocellular carcinoma. Chronic hepatitis develops over several years . Other causes of chronic hepatitis include autoimmune hepatitis, drugs like isoniazid, nitrofurantoin and methyldopa (long-standing use), alcohol, non-alcoholic steatohepatitis, deficiency of alpha -1-antitrypsin, Wilson's disease, and hemochromatosis.
Non-specific symptoms of anorexia, easy fatigability, malaise with low-grade fever and upper quadrant abdominal discomfort may be seen in cases of chronic hepatitis although, many patients are asymptomatic and diagnosed incidentally due to elevated liver enzymes. In advanced stages of chronic hepatitis, features of cirrhosis like hepatosplenomegaly, palmar erythema, parotid enlargement, spider nevi, gynecomastia and even ascites, portal hypertension and hepatic encephalopathy may be present. Cholestasis can produce symptoms of jaundice, acholic stools, pruritus, and steatorrhoea. In women with autoimmune chronic hepatitis, features of other organ involvement such as arthralgias, menstrual irregularities, ulcerative colitis, thyroiditis, pulmonary fibrosis, nephritis and hemolytic anemia are seen. Extra-hepatic manifestation like lichen planus, vasculitis, porphyria cutanea tarda, glomerulonephritis, cryoglobulinemia and even lymphomas are noted in chronic hepatitis secondary to hepatitis C while ataxia with other neurological manifestation has been reported in chronic hepatitis E  .
Entire Body System
OUTCOMES: Positive outcome by medication and operation demonstrates that his phosphorus and serum calcium levels were maintained within normal range and pain in the right thigh region was improved from visual analogue pain score (VAS) 7 before surgery [ncbi.nlm.nih.gov]
Symptoms & Causes Common symptoms of autoimmune hepatitis include feeling tired, pain in your joints, nausea, poor appetite, pain over your liver, and jaundice. [niddk.nih.gov]
Always discuss pain with your medical provider, particularly when pain is constant, severe or interferes with your quality of life. Call your medical provider if you have severe or chronic stomach pain. [hepmag.com]
Tell your health care provider right away if you have stomach area pain that may be a symptom of this type of blood clot New or worsened cataracts (a clouding of the lens in the eye). [us.promacta.com]
Except for reduced motivation other dimensions of fatigue were significantly higher among those with CHB compared to healthy controls (p CONCLUSIONS: Poor HRQOL and fatigue are widespread among patients with CHB. [ncbi.nlm.nih.gov]
Mental fatigue can manifest as somnolence, lethargy, or directed attention fatigue. Fatigue and 'feelings of fatigue' are sometimes confused. Unlike weakness, fatigue usually can be alleviated by periods of rest. [en.wikipedia.org]
Usually minimal if present at all and include nonspecific symptoms of weakness, fatigue, intermittent nausea and abdominal discomfort. Serum Enzyme Elevations. [livertox.nih.gov]
Fatigue: In the acute phase, bed rest and low physical exertion may be advised. [hepmag.com]
Symptoms can include: fatigue muscle aches loss of appetite Most symptoms of chronic hepatitis C don’t appear until cirrhosis develops and the liver begins to fail. [healthline.com]
- Chronic Fatigue Syndrome
Chronic fatigue may be either persistent or relapsing. Chronic fatigue is a symptom of many diseases and conditions. [en.wikipedia.org]
Chronic illnesses that have been reported in rare instances after hepatitis B vaccination include chronic fatigue syndrome ( 171 ), neurologic disorders (e.g., leukoencephalitis, optic neuritis, and transverse myelitis) ( 172--174 ), rheumatoid arthritis [cdc.gov]
- Abdominal Pain
Acute infection may occur with limited or no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain. [web.archive.org]
But over time, they can experience the following: tiredness weight loss nausea abdominal pain severe itching jaundice (yellow discoloration of the skin and eyes) Eventually, people can have complications such as fluid in the abdomen and difficulty thinking [hepc.liverfoundation.org]
Symptoms include an enlarged liver, fever, nausea, vomiting, abdominal pain, and dark urine Disease of the liver causing inflammation. Symptoms include an enlarged liver, fever, nausea, vomiting, abdominal pain, and dark urine Hepatitis. [icd9data.com]
Blood clots in the liver's main artery may cause abdominal pain. The following tests will be done: Blood tests to check liver function ( AST and ALT ). These readings can be very high with ischemia. Doppler ultrasound of the blood vessels of liver. [nlm.nih.gov]
- Palmar Erythema
In advanced stages of chronic hepatitis, features of cirrhosis like hepatosplenomegaly, palmar erythema, parotid enlargement, spider nevi, gynecomastia and even ascites, portal hypertension and hepatic encephalopathy may be present. [symptoma.com]
erythema Patients with advanced cirrhosis may develop ascites or esophageal varices Serum enzyme levels usually fluctuate but may be elevated 2x to 10x Many patients with mild chronic hepatitis C have persistently normal serum aminotransferase levels [pathologyoutlines.com]
Palmar erythema. Jaundice. Clubbing. Dupuytren's contracture (alcoholic cirrhosis). Xanthomas: palmar creases or above the eyes in primary biliary cirrhosis. Initial hepatomegaly may be followed by a small liver in well-established cirrhosis. [patient.info]
Often, the first findings are Signs of cirrhosis (eg, splenomegaly, spider nevi, palmar erythema) A few patients with chronic hepatitis develop manifestations of cholestasis (eg, jaundice, pruritus, pale stools, steatorrhea). [msdmanuals.com]
Hirsutism. Investigation of chronic hepatitis Urinalysis : bilirubin and urobilinogen. Blood tests: FBC (associated anaemia, thrombocytopenia, raised MCV with alcohol abuse), clotting studies (clotting impairment with hepatic dysfunction). [patient.info]
[…] vomiting, poor appetite, and joint pain. Jaundice can occur as well, but much later in the disease process and is typically a sign of advanced disease. Chronic hepatitis interferes with hormonal functions of the liver which can result in acne, hirsutism [en.wikipedia.org]
The workup in all cases should begin with a detailed history and physical examination. As the etiology of chronic hepatitis can be variable like congenital alpha-1-antitrypsin deficiency, viral, autoimmune or long-standing usage of drugs and alcohol, the workup should specifically note previous history of hepatitis, high risk behavior (drug /alcohol abuse, multiple sexual partners), tattoos /piercings, history of incarceration, blood/ blood product transfusion, surgery, autoimmune diseases etc). Needle tracks, features of icterus, cirrhosis, and cholestasis should be looked for during physical examination.
Routine laboratory tests like complete blood count, urinalysis, stool analysis, liver enzymes, serum proteins and, coagulation profile are obtained. If hepatitis is confirmed on laboratory tests then specific tests to detect etiology of the chronic hepatitis are performed. These include viral serology, autoantibodies, alpha-1-antitrypsin levels, immunoglobulins, ceruloplasmin levels (in children to rule out Wilson's disease). Serum iron, ferritin, and total iron-binding capacity levels can help detect hemochromatosis as the cause of chronic hepatitis.
If an asymptomatic patient is detected with elevated liver enzymes and if they were born between 1945 and 1965, they should be evaluated for hepatitis C. Cryoglobulin and rheumatoid factor levels are assessed in patients with chronic hepatitis secondary to hepatitis C.
Liver biopsy is the gold standard for the diagnosis of chronic hepatitis and provides information about the extent of cellular necrosis, parenchymal fibrosis and inflammation  . Histopathology can also detect steatohepatitis and iron deposition and helps to plan further disease management and prognosis . Fibroscan, an ultrasound-based procedure can detect liver fibrosis in advanced cases while blood tests like FIBROSpect II, HepaScore, and HCV FIBROSURE are used to detect mild and severe stages of liver fibrosis.
During the 3-year study, NA treatment history including the incidence, the type of treatment modification, reasons for the modification, and overall complete virologic response (CVR) rate were retrospectively evaluated using the patients' medical records [ncbi.nlm.nih.gov]
Six medications are now approved for the treatment of chronic hepatitis B, but there is still significant uncertainty with regards to treatment outcomes, cost impact, and benefits in view of the absence of long-term outcomes data. [doi.org]
care and treatment of infection due to the hepatitis C virus (HCV). [web.archive.org]
For a transitional period and to facilitate relearning, the terms CAH, CPH, and CLH can be reported in parentheses behind the etiologic diagnosis. [ncbi.nlm.nih.gov]
If hepatitis is confirmed on laboratory tests then specific tests to detect etiology of the chronic hepatitis are performed. [symptoma.com]
The most common etiologies are acute viral hepatitis A and B, medication overdose (e.g., acetaminophen), idiosyncratic drug reactions, ingestion of other toxins (e.g., amanita mushroom poisoning), and metabolic disorders (e.g., Reye's syndrome). [doi.org]
Unless these tests indicate viral etiology, further testing is required. [msdmanuals.com]
Improvements in socioeconomic and hygienic conditions have led to a change in its epidemiology worldwide. [doi.org]
Changes of estimated glomerular filtration rate (eGFR), which was computed with both the Chronic Kidney Disease Epidemiology Collaboration and the Modification of Diet in Renal Disease formulas, were tested by repeated measures One-way analysis of variance [ncbi.nlm.nih.gov]
Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 79. Updated by: Michael M. [nlm.nih.gov]
The pathophysiology may be mitochondrial toxicity, for the NAs inhibit not only hepatitis B virus (HBV) polymerase, but also the host mitochondrial DNA polymerase γ. [ncbi.nlm.nih.gov]
Hepatic Disorders, Jaundice, and Hepatic Failure Sections: Hepatic Disorders, Jaundice, and Hepatic Failure: Introduction, Epidemiology, Pathophysiology, Clinical Features, Diagnosis of Specific Entities, Laboratory Evaluation, Imaging, Treatment, Disposition [web.archive.org]
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test Hepatitis B virus (HBV) is a DNA virus that is endemic throughout the world. [mayomedicallaboratories.com]
$326,000-686,000) and cost per HCC prevented (range: US$654,000-1,380,000) over 10-year horizon using data from REVEAL study, cost per end point complication prevented in cirrhotics (US$9,630/year), and cost per HCC prevented in cirrhotics (US$ 27,600 [ncbi.nlm.nih.gov]
Authors : WHO Overview These are the first World Health Organization (WHO) guidelines for the prevention, care and treatment of persons living with chronic hepatitis B (CHB) infection, and complement similar recently published guidance by WHO on the prevention [web.archive.org]
[…] the perinatal hepatitis B prevention program. [cdc.gov]
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- Bedossa P, Moucari R, Chelbi E, et al. Evidence for a role of nonalcoholic steatohepatitis in hepatitis C: a prospective study. Hepatology. 2007;46:380–387.