| Chronic hepatitis is a broad term for various types of liver inflammation that last a minimum of 6 months but can persist for years or even decades.
The condition is often caused by acute infection (hepatitis B, C, and D or other viruses), chronic exposure to toxins (alcohol, prescription drugs), or some birth defects related to inadequate metabolism (alpha-1 antitrypsin deficiency, Wilson's disease). Hepatitis A and E do not cause chronic hepatitis.
Although the reason is not known, the drugs methyldopa, isoniazid, nitrofurantoin, and possibly acetaminophen can cause chronic hepatitis, especially when taken for long periods of time. Diseases linked to immune disorders such as Epstein-Barr, systemic lupus erythematosus, or rheumatoid arthritis may also cause chronic hepatitis. This type of chronic hepatitis is called autoimmune hepatitis.
There are two forms of chronic hepatitis. The milder of the two forms is called chronic persistent hepatitis and generally does not progress to liver scarring (cirrhosis) and possible failure. The cause of this form of the disease is often difficult to determine.
The most common form of the disease is called chronic active hepatitis and develops over a long period of time, with great potential for progression to other types of hepatitis viruses, cirrhosis and liver failure, and sometimes liver cancer.Risk: Exposure to infected blood is the primary risk factor for hepatitis B and C. Intravenous drug users, healthcare workers, and those who practice high-risk sexual activities are at highest risk. Infection by blood transfusion, once prevalent, is now rare.
Women are more likely to develop autoimmune hepatitis (Beers). Incidence and Prevalence: About one-third of all cases of acute viral hepatitis develop into chronic cases (Beers). Approximately 5% of all cases of hepatitis B develop into chronic cases (Wolf). Hepatitis C is chronic in at least 75% of all cases ("Chronic"). An estimated 20% of all cases of hepatitis B and C will eventually develop into cirrhosis (Wolf).
Currently, about 800,000 people carry chronic hepatitis B in the US. Of these individuals, approximately 4,000 die from cirrhosis developed from hepatitis B, and 1,000 die from hepatitis C developed from hepatitis B. Hepatitis G co-infection is reported in 6% of chronic hepatitis B infections and in 10% of chronic hepatitis C infections (Wolf).
An estimated 20% of people with chronic hepatitis C and an estimated 50% of individuals with autoimmune hepatitis develop cirrhosis, with or without liver failure, over a period of years (Beers). |
Source: Medical Disability Advisor
| History: There are often no reported symptoms. Some individuals may report milder symptoms such as fatigue, loss of appetite, and nausea or vomiting. Individuals in the early stages of active or chronic persistent hepatitis may complain of these and other symptoms, such as a general sensation of poor health (malaise), joint pain, headaches, low-grade fever, chest pain, and abdominal tenderness. More severe symptoms of chronic active hepatitis may include fever and yellowing of the skin and whites of the eyes (jaundice).
Young women with autoimmune hepatitis may not have menstrual periods (amenorrhea) and may experience acne, joint pain, lung scarring, inflammation of the thyroid gland and kidneys, and anemia. Physical exam: Examination may reveal abdominal tenderness, dry eyes and mouth, skin rash, persistent or recurring yellowing (jaundice) of the skin and whites of the eye (sclera), enlarged liver (hepatomegaly), enlarged spleen (splenomegaly), painful joints, and an enlarged thyroid gland (goiter). Young women with chronic active hepatitis may have acne and increased hair growth in a pattern similar to men (hirsutism). Progressive liver disease may be indicated by visible branching capillaries on the skin (spider nevi) and redness of the palms of the hand (palmar erythema). Tests: Immunoassay blood tests (serology) may be performed to measure key liver enzymes (GGT, AST, ALT, EIA) and blood components, including bilirubin, red blood cells (hematocrit), mean corpuscle volume, and viral antibodies. Magnetic resonance imaging (MRI) and high frequency sound waves (ultrasonography) may aid in the diagnosis. Removal of liver tissue with a needle (liver biopsy) for microscopic examination may also be needed. |
Source: Medical Disability Advisor
| Chronic persistent hepatitis may initially be diagnosed as acute viral hepatitis with no treatment except bed rest generally required. If liver enzymes remain elevated and symptoms do not respond to rest, a diagnosis of chronic persistent hepatitis may be made. Since this condition tends to resolve on its own and symptoms are mild, no treatment other than rest is usually recommended.
Treatment for chronic active hepatitis C consists of general supportive care, hospitalization, and, in some cases, administration of anti-inflammatory drugs such as alpha interferon and ribavirin. Treatment for hepatitis B usually consists of interferon and lamivudine. Nutritional supplementation is provided during first onset (acute) phase of the illness to prevent dehydration and because the liver is unable to break down proteins.
For those cases of chronic active hepatitis not caused by infection, corticosteroid therapy is generally the treatment of choice. Chronic hepatitis often recurs once treatment has stopped. Drugs may be required for up to a year following the disappearance of symptoms. In some severe cases when the individual fails to respond to treatment, a liver transplant may be considered. |
Source: Medical Disability Advisor
| The outcome is highly variable. Chronic persistent hepatitis generally has a favorable outcome since cirrhosis and liver failure are unlikely to occur.
However, in chronic active hepatitis, the disease may disappear completely or may progress to cirrhosis. Other individuals appear to recover with treatment and then suffer relapses. The outcome is highly dependent on the cause.
An estimated 15% to 25% of individuals with chronic hepatitis B die of liver disease. Chronic hepatitis C is most often a long, slow disease that, after years of few or no symptoms or laboratory abnormalities, may develop into cirrhosis or liver cancer. With the current recommended drug therapy for chronic hepatitis C, the cure rate is about 60% (Mukherjee). Hepatitis D may be associated with an increased incidence of liver failure. In cases of autoimmune hepatitis, prognosis depends on the severity of liver inflammation. Those infected with a severe case have a worse prognosis than those who experience a mild initial disease, and recurrence is common. Spontaneous remission of autoimmune hepatitis occurs in 13% to 20% of individuals (Raghuraman).
Hepatitis often recurs; the overall success rate is an estimated 30% to 40% (Beers). Individuals who undergo liver transplants have about a 90% chance of surviving past 1 year if they are living at home. If an individual is critically ill at the time of the transplant, chances surviving past 1 year are reduced to 60%. The survival rate at 5 years is approximately 80% (Guillen). Liver transplants for hepatitis B are very rare because of the rate of recurrence. In cases of hepatitis C, recurrence is also common, but the disease usually takes a much milder form. |
Source: Medical Disability Advisor
| Complications associated with chronic hepatitis include bleeding, liver failure, brain injury (hepatic encephalopathy), inflammation of the pancreas (pancreatitis), liver scarring (cirrhosis), liver cancer (hepatocellular carcinoma), delirium tremens associated with alcohol use, blocked bile ducts from scarring (primary sclerosing cholangitis), damage to bile ducts from inflammation (primary biliary cirrhosis), and fluid retention in the abdomen (ascites). Inflammation and pain in the joints (arthritis) may occur, along with itchy skin eruptions. Inflammation may also affect the arteries in widespread areas (polyarteritis nodosa), the capillaries in the kidney (membranous glomerulonephritis), and the heart muscles or tissue (myocarditis). Individuals older than 40 and drug addicts are more likely to develop a worsening of the disease (subacute hepatic necrosis). Older individuals may also develop muscle pain similar to rheumatism (polymyalgia rheumatica). Other complications associated with development of chronic hepatitis C in particular may include thyroiditis, vasculitis, and various immune disorders. Other complications are anorexia, arthralgia, glomerulonephritis, skin rashes, and amenorrhea. |
Source: Medical Disability Advisor
| Work restrictions are highly dependent on the cause and severity of chronic hepatitis as well as the effectiveness of treatment. Hospitalization may be needed. Individuals may need a leave of absence from work for complete recovery that could take months. If liver damage is severe, permanent disability may result. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual have any past history of congenital biliary abnormalities or exposure to viral hepatitis or hepatic toxins?
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Does individual report fatigue, loss of appetite, and nausea or vomiting? Does individual have a general sensation of poor health (malaise), joint pain, headache, absence of menstrual periods (amenorrhea), chest pain, and abdominal tenderness? Fever and yellowing of the skin and whites of the eyes (jaundice)?
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Does exam reveal abdominal tenderness, dry eyes and mouth, skin rash, persistent or recurring yellowing (jaundice) of the skin and whites of the eye (sclera), enlarged liver (hepatomegaly), enlarged spleen (splenomegaly), painful joints, and an enlarged thyroid gland (goiter)?
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If a young woman, does individual have acne and increased hair growth in a pattern similar to a man (hirsutism)?
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Are visible branching capillaries on the skin (spider nevi) and redness of the palms of the hand (palmar erythema) present?
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Was the diagnosis confirmed with liver enzyme and viral antibody tests?
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If the diagnosis was uncertain, were additional tests done to rule out other conditions with similar symptoms?
Regarding treatment:
- Was treatment appropriate for the type and severity of the hepatitis?
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Did treatment include physical rest, good nutrition or nutritional support, and avoidance of any medications or toxins metabolized by the liver (e.g., alcohol, Tylenol)?
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Was individual compliant with treatment recommendations? If not, would counseling or support groups be beneficial?
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For advanced stages of chronic active hepatitis, did aggressive treatment include administration of corticosteroids or interferon?
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If facing liver failure, is individual a candidate for liver transplant?
Regarding prognosis:
- If diagnosis is chronic persistent hepatitis, what is expected outcome?
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In chronic active hepatitis, has the disease progressed to cirrhosis?
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Does individual have a coexisting condition such as substance abuse, alcohol use, immune suppression, cancer, or clotting abnormalities that may complicate treatment or affect recovery?
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Have any complications developed that may impact recovery?
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Did individual require liver transplantation? If so, has adequate time elapsed for complete recovery?
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Source: Medical Disability Advisor
| Beers, Mark H., ed. "Chronic Hepatitis." The Merck Manual of Medical Information. 2nd Home ed. Whitehouse Station, N.J.: Merck Research Laboratories, 2003. Merck. Merck & Co., Inc. 22 Dec. 2004 <http://www.merck.com/mrkshared/mmanual_home2/sec10/ch137/ch137c.jsp>. "Chronic Hepatitis C: Current Disease Management." National Digestive Diseases Information Clearinghouse. National Institute of Diabetes and Digestive and Kidney Diseases. 22 Dec. 2004 <http://digestive.niddk.nih.gov/ddiseases/pubs/chronichepc/#A>. Guillen, Steve, et al. "Liver Transplant." eMedicine Consumer Health. Eds. Michael D. Burg, Francisco Talavera, and James Ungar. 22 Dec. 2004. Medscape. 22 Dec. 2004 <http://www.emedicinehealth.com/articles/13891-7.asp>. Mukherjee, Sandeep, and Vinod K. Dhawan. "Hepatitis C." eMedicine. Eds. George Y. Wu, et al. 4 Nov. 2004. Medscape. 22 Dec. 2004 <http://emedicine.com/med/topic993.htm#section~follow-up>. Raghuraman, Unnithan V., and David C. Wolf. "Autoimmune Hepatitis." eMedicine. Eds. Mounzer Al Samman, et al. 2 Sep. 2004. Medscape. 22 Dec. 2004 <http://emedicine.com/med/topic366.htm#section~follow-up>. Wolf, David C. "Hepatitis, Viral." eMedicine. Eds. Rajeev Vasudeva, et al. 2 Sep. 2004. Medscape. 22 Dec. 2004 <http://emedicine.com/med/topic3180.htm>. |
Source: Medical Disability Advisor
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