HEPATITIS is a disease most would have heard of, but how many understand the complexities of this condition?
Hepatitis means inflammation of the liver and this usually happens as a result of an injury. It can affect individuals with healthy liver, as well as those suffering from a disease.
Depending on the nature of hepatitis and also importantly, the baseline health of the liver, the organ may recover within weeks or months, or become chronically affected, leading to liver scarring or fibrosis.
In conjunction with World Hepatitis Day, which fell on July 28, University of Malaya Specialist Centre (UMSC) consultant gastroenterologist Dr Ruveena Bhavani Rajaram answers some important questions about this disease.
WHAT ARE THE CAUSES OF HEPATITIS?
It can be caused by viral or bacterial infection, fatty liver, drugs or medication, excessive alcohol intake, hyper-immune response and, in rare instances, genetic disorders.
In Malaysia, Hepatitis B and C infection and fatty liver are the most common causes, followed by drugs or medication, and alcohol-induced hepatitis.
Depending on the cause, the condition may be acute and recovery happens within weeks. Otherwise, it may last for months or years. In rare cases, it becomes severe until it ends in liver failure. Patients at this stage need a transplant or they may die.
WHAT IS FATTY LIVER?
Liver inflammation due to fatty liver is caused by excess fat accumulated around the liver cells (hepatocytes). This excess fat is harmful and leads to chronic inflammation (hepatitis).
Fatty liver is commonly associated with diabetes, obesity, rapid weight loss and taking certain medications.
The good news is that it can be alleviated with good blood glucose control, gradually losing weight or cessation of the medication that causes it.
WHY DO DRUGS OR MEDICATIONS CAUSE HEPATITIS?
This is rather common. Hepatitis occurs when the amount of drugs, herbal remedies or food supplements become harmful to the liver when taken in the long term.
Overdose of certain medications may lead to acute hepatitis. Stopping the drug almost always leads to improvement and recovery. In very rare cases, severe liver damage may occur.
With regard to alcohol-induced hepatitis, the amount of consumption, drinking habit and the body’s ability to metabolise alcohol are factors that determine disease severity.
Sustained abstinence from liquor will aid in recovery for a small number of individuals, but the majority will end up developing liver fibrosis. Chronic alcoholism will lead to late stage scarring (cirrhosis) and liver failure.
WHAT ARE THE COMMON SYMPTOMS OF HEPATITIS?
Hepatitis is a silent disease as most people do not have symptoms and may not even be aware of their condition.
It may be detected via a blood test, where liver enzymes and other indicators are below or elevated from their normal range.
Further examination like ultrasound or computed tomography may be needed to make a diagnosis.
Some may experience nausea, poor appetite or discomfort at the upper right abdomen.
Rarely, those with severe hepatitis may become anorexic, suffer from fever and jaundice (eye and skin turning yellow), pass dark coloured urine, and being easily bruised besides abdominal or leg swelling.
ARE SOME INDIVIDUALS PRONE TO DEVELOPING THIS DISEASE?
Hepatitis B and C spread through an infected person’s blood or body fluids. Mothers with Hepatitis B can infect their offspring during childbirth or while nursing them at young age.
Having unprotected sex, using non-sterile needles during tattooing, and a history of intravenous drug use will increase the risk of contracting the viruses.
Hepatitis A, meanwhile, is transmitted via contaminated water and food. Although this infection is not common in Malaysia, there have been limited outbreaks over the years.
Those suffering from diabetes, overweight problems or on certain medications will be prone to develop fatty liver, while those who consume excessive alcohol are at risk of developing alcoholic hepatitis.
HOW IS HEPATITIS BEST PREVENTED?
Vaccines are available to prevent Hepatitis A and B.
Hepatitis A and E are transmitted via the oral-faecal route. Hence, keeping clean and avoiding dirty eateries are vital in preventing infection.
Hepatitis B, C and D are spread via blood and body fluids. Hence, it is important to reduce the risk of transmission through the practice of safe sex, avoiding high-risk sexual behaviour and drug abuse, and using only sterile needles for tattooing.
Avoiding or minimising alcohol consumption and practising a healthy lifestyle will reduce the risk of alcohol-induced hepatitis and fatty liver, respectively. Also, avoid consuming unregulated traditional remedies as they may contain substances that are toxic to the liver.
HOW PREVALENT IS THIS CONDITION IN MALAYSIA?
The prevalence of fatty liver is about 25 per cent in Malaysia and it increases to about 70 per cent among patients with diabetes.
The prevalence of Hepatitis B is about five per cent, with a higher rate among the Chinese. Hepatitis C affects two per cent of the population.