How Hepatitis Impacts Your Health

As an adult, it is typical to have certain blood tests monitored from time to time. Liver tests are one of the types of tests that your primary care provider may check yearly or even more often. This is because injuries to the liver are common, but could be dangerous if not identified and addressed. So, your primary care provider has been checking your labs and notifies you that your liver tests are now abnormal. They call and say, “I’m concerned that you may have hepatitis,” and your mind starts racing: What is hepatitis? What does it mean for my health? What can we do about it?

What is Hepatitis?

Hepatitis is present when there is damage or inflammation of the working cells of the liver, called hepatocytes. These cells break down toxins, build proteins, and help reuse certain substances in the blood. When hepatitis is mild, as is the case most of the time, the liver is able to continue doing its many jobs without any interruption. Rarely, when hepatitis is severe, the liver may not be able to perform these various activities, which can make a person very sick. Since the majority of the jobs of the hepatocytes are necessary for life, severe hepatitis could even be life-threatening.

There are many reasons the hepatocytes might be damaged or inflamed. Examples include:

• Infections, especially viruses
• Medications or herbal supplements
• Immune system attacks on the liver
• Storage of metals or fats

Viral infections, such as hepatitis A, hepatitis B, and hepatitis C, are common in this country. There are many other viruses that can also infect the liver, as well, such as Epstein-Barr virus, the virus that causes Mono (infectious mononucleosis). Most of these are temporary and, while they can make a person feel very sick, they resolve with no long-term damage to the liver. Hepatitis B and C, on the other hand, can be life-long infections that may require medications to control or cure.

What does it mean for my health?

Storage of excess fat, iron, and (rarely) copper can damage someone’s hepatocytes. People who struggle with insulin resistance can have excess fat in the liver. Also, people who are overweight and have diabetes, high cholesterol, and high blood pressure.

Immune attacks on the liver, or autoimmune disease, are similar to the wide variety of immune attacks seen on other organs, such as skin, joints, and the thyroid gland. Like those other diseases, these can tend to be progressive, and medication to stop the attack is typically necessary.

Some medications can occasionally cause hepatitis, although it is rare for this to be severe. Examples are some antibiotics, anti-seizure medications, and some cancer treatments. Typically, the potential to help treat a person’s disease far outweighs the small risk of these drugs causing hepatitis. Tylenol can cause hepatitis, but this only occurs when a person takes too much at one time, typically more than 4 grams (8 extra strength Tylenol pills) in 24 hours. Cholesterol medications called “statins” have a reputation for causing hepatitis, but this typically occurred in other drugs in this class that are no longer on the market. Many people do not realize that many herbal products can cause hepatitis as well. This occurs by means similar to any medication, and, since the FDA can’t approve or disapprove of these products, most reach the market without safety testing. In fact, herbal products are currently the fastest growing cause of hepatitis. The vast majority of hepatitis caused by medications or herbal products will resolve without long-term damage, if the product is stopped.

What can we do about it?

Evaluation and treatment of hepatitis typically includes blood tests and some type of ultrasound, CT, or MRI of the liver. When you can provide history of all medications, including temporary ones like antibiotics, and herbal products, this can help your doctor make a diagnosis. Sometimes, a liver biopsy will be necessary. The majority of cases of hepatitis are not severe, may be temporary, and are not likely to cause long-term liver damage. However, evaluation by a Gastroenterologist can help identify the cause, determine if a person is in any danger, and provide treatment when it is needed.

Written by Dr. Isaac Gaines, Gastroenterologist