Factors Influencing The Number Of Patients In Child
At the 0, 3, and 6 months, the number of patients with excessive drinking in Child-Pugh C class was highest among the three groups . Similarly, the number of non-drinking patients in Child-Pugh A class was the highest among the three groups . After 3â6 months of treatment, the number of patients in Child-Pugh C was still high .
Table 6Figure 4
What Is The Treatment For Hepatitis
Each type of hepatitis is treated differently.
Hepatitis A often goes away on its own and home treatment is all that is needed to help the liver recover, such as:
- Avoiding alcohol
- Avoiding certain medicines that can be harmful to the liver
Hepatitis B often goes away on its own in about 6 months, and can also be treated at home with the above remedies. Other treatments for hepatitis B include:
- Antiviral medications
- Liver transplant in severe cases
Treatment for hepatitis C is effective on certain forms of the hepatitis C virus. The choice of medications depends on the type of hepatitis C you have, whether you have been treated for the illness before, how much liver damage has occurred, any other underlying medical issues, and other medicines you take. Treatment for hepatitis C usually involves 8 to 12 weeks of oral antiviral medications, such as:
Toxic Effects On Cell Membranes
Ethanol and its metabolite, acetaldehyde, have been shown to damage liver cell membranes. Ethanol can alter the fluidity of cell membranes, thereby altering the activity of membrane-bound enzymes and transport proteins. Ethanol damage to mitochondrial membranes may be responsible for the giant mitochondria observed in patients with alcoholic hepatitis. Acetaldehyde-modified proteins and lipids on the cell surface may behave as neoantigens and trigger immunologic injury.
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Can Alcoholic Hepatitis Be Fatal
Yes, it is estimated that 1 in 3 with this condition will die from it. Often, it isnt until the majority of the liver has been critically damaged that there is any outward indication that there is a problem. By the time pain or some other symptom makes itself known, the liver damage is extensive and the organ is likely in critical condition.
How Do You Get Hepatitis A And How Common Is It
Hepatitis A can affect anyone. The virus is passed out in the stools of infected people. In areas of poor sanitation, or where disposal of sewage is poor, hepatitis A can become common due to dirty water and food. This means you may become infected with hepatitis A by eating uncooked food prepared or washed in contaminated water, or by drinking contaminated water. Shellfish caught in contaminated water can also carry the hepatitis A virus. Someone who has hepatitis A infection may pass on the infection to others. This can occur through preparing food, or through close contact with another person, if they have not washed their hands properly after going to the toilet.
The highest-risk areas of the world for hepatitis A infection include: the Indian subcontinent , Africa, parts of the Far East , South and Central America and the Middle East.
Hepatitis A has become uncommon in parts of the world where sanitation is generally good, such as the UK and Western Europe. Most cases of hepatitis A infection in the UK are diagnosed in people returning home after travelling to a country where sanitation is poor and risk of hepatitis A infection is higher. Outbreaks in schools and families can sometimes occur in the UK, as the virus is quite easily passed on from person to person if personal hygiene is not good. For example, the virus may be passed on if infected people do not wash their hands after going to the toilet.
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Charles S Lieber Md Macp
Charles S. Lieber, M.D., M.A.C.P., is chief of the Section of Liver Disease & Nutrition, Alcohol Research Center, Bronx, NY Medical Center and professor of medicine and pathology at Mt. Sinai School of Medicine, New York, New York. The preparation of this article was supported in part by National Institute on Alcohol Abuse and Alcoholism grants AA11115 and AA12867, by the Department of Veterans Affairs, and by the Kingsbridge Research Foundation.
Hepatitis is an inflammation of the liver that is characterized by jaundice, liver enlargement, abdominal and gastric discomfort, abnormal liver function, and other symptoms. Although in many patients the diseased liver is able to regenerate its tissue and retain its function, severe hepatitis may progress to scarring of the liver tissue , cirrhosis, liver cancer , and chronic liver dysfunction. Hepatitis can have numerous causes, such as excessive alcohol consumption or infection by certain bacteria or viruses. One common cause of hepatitis is infection with one of several types of viruses . With the development of new diagnostic tools, infections with the hepatitis C virus have received increasing attention in recent years. In the United States, the number of deaths caused by HCV is increasing and may approach or even surpass the number of deaths from AIDS in the next few years .
EPIDEMIOLOGY AND NATURAL HISTORY OF HCV INFECTION
EFFECT OF ALCOHOLISM ON HCV INFECTION
Effects of Alcoholism on HCV Acquisition and Persistence
Enhancing Healthcare Team Outcomes
Alcoholic hepatitis has repercussions beyond the liver and is best managed by an interprofessional team that includes physicians, physician assistants, and nurse practitioners. The primary care provider and nurse practitioner should educate patients on the harms of alcohol and if alcoholic hepatitis is suspected, quickly refer them to a gastroenterologist for further workup. The disorder can affect the functioning of multiple organs, and early diagnosis is important.
At every opportunity, the key to treatment is patient education about the health risks of alcohol. Patients with severe alcoholic hepatitis with an MDF greater than 32 have 30-day mortality of 30% to 50%. Forty percent of the patients with severe alcoholic hepatitis die within 6 months after the onset of the clinical syndrome. Jaundice and hepatic encephalopathy at the time of presentation indicate a poorer outcome.
Nurse practitioners, pharmacists, and primary care providers should urge patients to enter AA and take their family members there is evidence that this program can help some patients with alcoholism become sober. Other patients may need mental health counseling and cognitive behavior therapy.
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Who Is At Risk For Hepatitis
Individuals who share needles and practice unprotected sex increase their likelihood of contracting hepatitis. The main risk factor for alcoholic hepatitis is protracted alcohol abuse. Gender, weight, ethnicity, and certain genetic factors may affect the extent to which acute or chronic hepatitis develops in some people. Furthermore, some forms of hepatitis are transmitted genetically, through contaminated food, sharing silverware, or injury. So, it is difficult to completely reduce the risk of all forms of hepatitis. However, living a purposeful life enhanced by exercise and a healthy diet can reduce the risk for illness.
Where And How Does Hepatitis A Virus Get Into Drinking Water
Hepatitis A can be found in every part of the United States and throughout the world. Wells, if properly installed and maintained, provide a safe source of water in the U.S. When any water source, including private wells, is contaminated with feces from infected humans, the water can potentially spread the Hepatitis A virus. The virus can enter the water through various ways, including sewage overflows, sewage systems that are not working properly, and polluted storm water runoff. Wells may be more vulnerable to such contamination after flooding, particularly if the wells are shallow, have been dug or bored, or have been submerged by floodwater for long periods of time.
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Alcohol Drinking Diary And Change Plan
To keep track of how much you drink, use a drinking diary. Record the number of drinks you have every day. At the end of the month, add up the total number of drinks you had during each week.
One way to make any kind of change in your behavior is to come up with a “change plan.” This exercise has you list the specific goals you would like to achieve, outline the steps and challenges you will meet in reaching those goals, and figure out ways to overcome those challenges.
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What Is Viral Hepatitis
Viral hepatitis is an inflammation of your liver that’s caused by a virus. There are five types, but the most common ones in the U.S. are hepatitis A, B, and C. All of them affect your liver. Some of the symptoms are similar, but they have different treatments.
Hepatitis A. This type won’t lead to long-term infection and usually doesn’t cause any complications. Your liver heals in about 2 months. You can prevent it with a vaccine.
Hepatitis B. Most people recover from this type in 6 months. Sometimes, though, it causes a long-term infection that could lead to liver damage. Once you’ve got the disease, you can spread the virus even if you don’t feel sick. You won’t catch it if you get a vaccine.
Hepatitis C. Many people with this type don’t have symptoms. About 80% of those with the disease get a long-term infection. It can sometimes lead to cirrhosis, a scarring of the liver. There’s no vaccine to prevent it.
Here Are Some More Symptoms To Be Aware Of:
- Loss of appetite
- Fatigue and weakness
- Weight loss
Malnourishment is par for the course in those suffering from this disease. Thats because drinking lots of alcohol can suppress the appetite. Heavy drinkers get most of their caloric intake from alcohol therefore, they feel no need for food. In severe cases, the victim can accumulate fluid in the abdomen, become confused, and act differently all due to a buildup of toxins that the liver is normally in charge of breaking down. Because the liver isnt working properly, those toxins build up to dangerous levels. As a result, kidney and liver failure are very real possibilities.
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Who Is At Risk For Alcoholic Hepatitis
Both women and men can have alcoholic hepatitis. Most people who are diagnosed with alcoholic hepatitis are between 40 and 60 years old. Patients at highest risk for alcoholic hepatitis typically drink more than 100 grams of alcohol a day for many years. Those who have a family history of alcoholism may also be at risk for the disease.
Increased Risk Of Cirrhosis
There is little doubt that people with chronic hepatitis C who drink alcohol have a higher chance of developing cirrhosis. From an epidemiological point of view, more than 90% of heavy drinkers will develop fatty liver disease, of which as many as 20% will develop liver cirrhosis within 10 to 20 years.
Hepatitis C infection runs a similar course, with 75% of infected persons developing chronic disease, while 15-20% will progress to advanced disease within 10 to 30 years.
The combination of these two factors speeds the process dramatically, as well as increasing the severity of liver damageby some estimates, by as much as 200-300%. Furthermore, heavy alcohol users with HCV have a nearly 11-fold greater risk of developing cirrhosis than non-drinkers with HCV.
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Are There Any Possible Complications
Serious illness is rare with hepatitis A infection. The illness can be unpleasant and make you feel quite ill however, most people make a full recovery. In a small number of cases, the infection can cause severe liver inflammation leading to liver failure. This is more common in older people who develop this infection. An extremely small number of people die from severe hepatitis A infection. A liver transplant can be life-saving if liver failure develops.
Somewhere between 1 to 2 in 10 people who get hepatitis A infection will seem to recover but will then have a return of their symptoms between about one and three months after their original illness. This is because the infection hadn’t cleared completely. This relapse will have similar symptoms to the initial illness. Some people can have a relapse of their symptoms more than once.
Who Is More Likely To Get Hepatitis A
People more likely to get hepatitis A are those who
- travel to developing countries
- have sex with an infected person
- are men who have sex with men
- use illegal drugs, including drugs that are not injected
- experience unstable housing or homelessness
- live with or care for someone who has hepatitis A
- live with or care for a child recently adopted from a country where hepatitis A is common
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What Are The Symptoms Of Hepatitis A
Not all people infected with hepatitis A virus will have symptoms. Pre-school children often have no symptoms, and, in general, children will have milder symptoms than adults. Symptoms may occur 15 to 50 days from the time you first come in contact with the hepatitis A virus.
When you first become infected with the hepatitis A virus it is called acute infection. Typical symptoms of an acute hepatitis A infection include fatigue, nausea and vomiting, abdominal discomfort, jaundice , dark urine, low-grade fever and loss of appetite.
The older you are when you get hepatitis A, the more likely that you will experience more severe symptoms. Some people feel sick for one to two weeks, while in others the symptoms may last several months. Hepatitis A rarely causes death. However, persons with pre-existing chronic liver disease, including chronic hepatitis B and C, are at increased risk of serious complications from this infection.
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Are Men Or Women More Likely To Get Alcoholic Hepatitis
Women appear to be more likely to suffer liver damage from alcohol.
Even when a man and woman have the same weight and drink the same amount, the woman generally has a higher concentration of alcohol in the blood because she has relatively more body fat and less water than the man, and her body handles alcohol differently.
How Can Prevent Alcoholic Hepatitis
The best treatment is to stop drinking.
Treatment also may include:
- Hereditary defects in iron or copper metabolism
- Prolonged exposure to toxins
In children, the most frequent causes are biliary atresia â a disease that damages the bile ducts â and neonatal hepatitis. Children with these diseases often receive liver transplants.
Many adult patients who require liver transplants suffer from primary biliary cirrhosis. We do not yet know what causes this illness, but it is not in any way related to alcohol consumption.
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Liver Disease After Menopause
The lack of estrogen following menopause can also have a negative effect on the liver.
If youve gone through menopause, youre more likely to develop a fatty liver, Dr. Wakim-Fleming notes. Fatty liver disease in women can progress into cirrhisis more rapidly after menopause.
After menopause, women in general are at risk of gaining more weight because of hormonal changes, and they may not exercise as much as they used to. There are also genetic factors that contribute to cirrhosis she says.
When women gain weight, fat accumulates in the liver cells. This creates a toxic environment for the liver that leads to fibrosis, then cirrhosis and eventually cancer. Fatty liver is fast becoming the number one reason for liver transplants, Dr. Wakim-Fleming says.
How Is Alcoholic Hepatitis Treated
The goal of treatment is to restore some or all normal functioning to the liver.
You will need to stop drinking alcohol. To do thi, you may need to be in an alcohol treatment program. Sometimes you may also need to change your diet. Scarring of the liver is permanent. But the liver is often able to repair some of the damage caused by alcohol so you can live a normal life.
You may be admitted to the hospital or treated on an outpatient basis. There is no medicine to cure alcoholic hepatitis. Treatment involves easing the symptoms and keeping the disease from getting worse.
Be sure to ask your healthcare provider about recommended vaccines. These include vaccines for viruses that can cause liver disease.
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Protecting Yourself From Cirrhosis
Cirrhosis is a silent killer, Dr. Wakim-Fleming warns. You may not know you have it until it is too late to reverse it. So its better to take a proactive approach and be aware of this silent killer so that preventive measures can be taken early on
Once cirrhosis develops, the only cure is a liver transplant. According to some studies, women are more likely to die on the waiting list for a liver transplant than men, and are more likely to have acute liver failure.
Women tend to have smaller muscle mass, and this affects their kidney scores. That means their medical severity score may be lower than it truly is. Cirrhosis is associated with weakness of bones and can hamper the ability of women to become pregnant.
While some risk factors for cirrhosis are beyond your control, adopting a healthy lifestyle at any age can help to reduce your risk.
As for non-prescribed herbal supplements, Dr. Wakim-Fleming says women can save their money and skip them.
The problem with supplements or complementary medicines is that theyre not usually regulated, so you dont really know whats in them, or their real benefits, she says. You dont need herbal supplements to stay healthy. Your doctor may give a supplement if your body in is low in it. Recent studies have shown that three to four cups of dark coffee daily may have some protective effects on the liver as well. But discuss this first with your doctor, as you will need to balance the negative risks of too much caffeine.