Hepatitis B (cont.)
Mary D. Nettleman, MD, MS, MACP
Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.
In this Article
- Hepatitis B facts
- What is hepatitis?
- How is the hepatitis B virus spread (transmitted)?
- What are the symptoms of acute hepatitis B?
- What are the symptoms of chronic hepatitis B?
- How is hepatitis B diagnosed?
- What is the role of a liver biopsy in chronic hepatitis B?
- What is the natural course of chronic hepatitis B?
- What medications are used to treat hepatitis B?
- What are the effects of alcohol on hepatitis B?
- What are the effects of immunosuppressive medications on hepatitis B?
- What is delta hepatitis?
- What about co-infection with hepatitis B virus and hepatitis C virus?
- What happens in co-infection with hepatitis B virus and HIV?
- What is the role of liver transplantation in hepatitis B?
- What can be done to prevent hepatitis B?
- What is new in the treatment of hepatitis B?
- Find a local Gastroenterologist in your town
What are the symptoms of chronic hepatitis B?
The liver is a vital organ that has many functions. These include a role in the immune system, production of clotting factors, producing bile for digestion; storing nutrients including sugars, fats and minerals for use by the body later; processing medications; and breaking down toxic substances. Patients with chronic hepatitis B develop symptoms in proportion to the degree of abnormalities in these functions. The signs and symptoms of chronic hepatitis B vary widely depending on the severity of the liver damage. They range from few and relatively mild signs and symptoms to signs and symptoms of severe liver disease (cirrhosis or liver failure).
Most individuals with chronic hepatitis B remain symptom free for many years or decades. During this time, the patient's liver function blood tests usually are normal or only mildly abnormal. Some patients may deteriorate and develop inflammation or symptoms, putting them at risk for developing cirrhosis.
Cirrhosis of the liver due to hepatitis B
Inflammation from chronic hepatitis B can progress to cirrhosis (severe scarring) of the liver. Significant amounts of scarring and cirrhosis lead to liver dysfunction.
Symptoms may include:
- loss of appetite,
- weight loss,
- breast enlargement in men,
- a rash on the palms,
- difficulty with blood clotting, and
- spider-like blood vessels on the skin.
Decreased absorption of vitamins A and D can cause impaired vision at night and thinning of bones (osteoporosis). Patients with liver cirrhosis also are at risk of infections because the liver plays an important role in the immune system.
Advanced cirrhosis of the liver due to hepatitis B
In patients with advanced cirrhosis, the liver begins to fail. This is life-threatening condition.
Several complications occur in advanced cirrhosis:
- Confusion and even coma (encephalopathy) results from the inability of the liver to detoxify certain toxic substances.
- Increased pressure in the blood vessels of the liver (portal hypertension) causes fluid to build up in the abdominal cavity (ascites) and may result in engorged veins in the swallowing tube (esophageal varices) that tear easily and may cause massive bleeding.
- Portal hypertension can also cause kidney failure or an enlarged spleen resulting in a decrease of blood cells and the development of anemia, increased risk of infection and bleeding.
- In advanced cirrhosis, liver failure also results in decreased production of clotting factors. This causes abnormalities in blood clotting and sometimes spontaneous bleeding.
- Patients with advanced cirrhosis often develop jaundice because the damaged liver is unable to eliminate a yellow compound, called bilirubin.
Hepatitis B virus and primary liver cancer (hepatocellular carcinoma)
Patients with chronic hepatitis B are at risk of developing liver cancer. The way in which the cancer develops is not fully understood. Symptoms of liver cancer are nonspecific. Patients may have no symptoms, or they may experience abdominal pain and swelling, an enlarged liver, weight loss, and fever. The most useful diagnostic screening tests for liver cancer are a blood test for a protein produced by the cancer called alpha-fetoprotein and an ultrasound imaging study of the liver. These two tests are used to screen patients with chronic hepatitis B, especially if they have cirrhosis or a family history of liver cancer.
Hepatitis B virus involvement of organs outside of the liver (extra-hepatic)
Rarely, chronic hepatitis B infection can lead to disorders that affect organs other than the liver. These conditions are caused when the normal immune response to hepatitis B mistakenly attacks uninfected organs.
Among these conditions are:
- Polyarteritis nodosa: a disease characterized by inflammation of the small blood vessels throughout the body. This condition can cause a wide range of symptoms, including muscle weakness, nerve damage, deep skin ulcers, kidney problems, high blood pressure, unexplained fevers, and abdominal pain.
- Glomerulonephritis: another rare condition, which is inflammation of the small filtering units of the kidney.
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