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Hepatitis C is an infection of the liver caused by the hepatitis C virus (HCV). Hepatitis C is one of five (A, B, C, D and E) viruses that are able to infect the liver. A virus is a very small organism, invisible to all but the strongest microscopes. Unlike other living organisms, a virus cannot reproduce itself. It needs to take over the reproductive mechanism of other cells within the body, like liver cells. Once a virus has invaded a cell, it reproduces quickly, eventually bursting the cell and scattering new virus particles into the bloodstream. These new viruses can then search out and invade more liver cells, repeating the process over and over. Hepatitis C viral particles are circulated throughout the body via the blood, but primarily do damage within the liver.
Fortunately, your body’s immune system has a very efficient type of “radar tracking” mechanism which allows identification and destruction of virus particles before they can spread. Every time you get a virus, like a cold or flu, there is a fierce battle being waged between the rapid formation of new virus particles and your immune system’s ability to destroy them. Your immune system usually wins the battle and the infection is cured. In most cases, however, hepatitis C is a stealth infection that eludes the body’s immune defense. It does this by constantly changing its appearance and the immune response cannot keep up with it. The infection is not cleared and becomes chronic, or permanent, in three cases out of four. Most people with this chronic infection are completely asymptomatic. Over time, as the immune response repeatedly attempts to destroy the virus in the liver, inflammation of the liver occurs. This liver inflammation is called hepatitis. Once is has become chronic, the condition is called chronic hepatitis C. A byproduct of this inflammation in some cases is elevation of the liver enzymes (AST & ALT) detectable on blood tests.
Chronic hepatitis C has become a serious public health problem in the United States. If your doctor has told you that you have this illness, you are not alone. The U.S. Center for Disease Control (CDC) estimates that at least 4.5 million Americans are now infected with this virus and over 170,000 new cases are added each year. More than 4 times as many people are infected with Hepatitis C than HIV-AIDS. There are approximately 170 million hepatitis C cases worldwide where it is the most prevalent of all the forms of hepatitis.
The Hepatitis C virus (HCV) first surfaced in the 1970’s as a mysterious post-transfusion virus dubbed “non-A non-B hepatitis” since research did determine that it was neither the virus that causes hepatitis A nor hepatitis B. The virus was finally isolated and named “hepatitis C” in 1989. Since then scientists have been scrambling to find out how many people have it, how it is transmitted, and how to treat it. An antibody test to screen and protect the blood supply was developed in 1990.
Hepatitis C is usually transmitted asymptomatically. Acute infection with this virus rarely causes any symptoms at all. In a small percentage of cases, nonspecific flu type symptoms may be present. Most will not have any symptoms at all, and therefore not know anything is wrong until it after discovering abnormal liver tests during a physical exam. It can be present for decades before symptoms such as loss of appetite, fatigue, nausea, vague stomach pain, and jaundice (a yellowing of the skin and whites of the eyes) occur.
HCV is a potential time bomb with a fuse of unknown length. Many infected persons remain healthy indefinitely; but 75 percent will develop a chronic infection that they are unable to clear. This can lead to cirrhosis (scarring) of the liver and 20 percent of infected patients develop life-threatening liver failure 15 to 20 years after his or her initial infection. At 30 years the risk of liver cancer increases.
A blood-borne virus is spread primarily by exposure to human blood. HCV is most often transmitted by blood transfusions and IV drug user’s contaminated needles, but the source of many infections is unknown.
You are at risk for HCV if you:
• ever injected drugs or shared needles
• ever shared an apparatus to snort cocaine
• have a job that exposes you to human blood
• are a hemodialysis patient
• received a blood transfusion before 1990
You may be at risk if you:
• have had unprotected sex with multiple partners
• live with a person who has hepatitis C
• have had a tattoo or body piercing
HCV is not spread by food or water and there is no evidence that HCV is spread by sneezing, coughing, hugging, or other casual contact.
People who have HCV should remain aware that their blood, and possibly other body fluids, are potentially contagious for the rest of their life. Care should be taken to avoid blood exposure to others by sharing toothbrushes, razors, needles, etc. In addition, infected individuals can never donate blood and should inform medical and dental care providers so that proper precautions can be followed.
HCV has been transmitted between sex partners and among household members; however, the degree of this risk is unknown. Studies of HCV and sexual transmission offer conflicting results. A 1991 study from Stanford University showed no evidence of HCV in the urine, semen, or vaginal secretions of infected individuals with HCV. But similar studies have shown evidence of HCV in five to 27 percent of sexual partners.
Researchers seem to agree that if it is transmitted sexually, it isn’t very efficient. The risks of catching HCV from an infected partner are estimated at less than one percent per year of exposure. Each couple will have to decide what is best for them, but currently the CDC does not advise changing sexual habits or using condoms in long-term monogamous relationships. As always, all people with multiple sexual partners should use condoms to reduce the risk of acquiring or transmitting HCV as well as other sexually transmitted diseases.
While there are vaccines for other forms of hepatitis such as hepatitis A and hepatitis B, there currently is no effective vaccine for hepatitis C. Billions of healthcare dollars are being spent treating hepatitis C related liver disease complications worldwide and as a result, much research is being done to find treatments and preventative measures. HCV patients should be vaccinated against hepatitis A and B. Infection with either could speed the liver damage done by hepatitis C.
Learn more at liverfoundation.org
Almost all the organs of the body contain some fat. Fat cells provide insulation, protection, and are an efficient way to store extra energy. After a typical meal, dietary fat is absorbed by the intestines and enters the blood stream which carries the fat directly to the liver. Normally, this fat is metabolized in the liver and converted to energy. If the amount of fat delivered is excessive, it is stored in the liver and other tissues. The normal liver contains about five percent fat. The rest of the liver is made up of liver cells called hepatocytes which do all the work of the liver. When the amount of fat in the liver exceeds 10 percent, healthy liver cells are replaced by fat cells. This condition is termed a fatty liver disease, or steatosis.
Recent surveys have shown fatty liver to be much more common than previously recognized. It now affects about 23 percent of adult Americans and has become the most common cause of abnormal liver blood tests in the US population.
The typical patient is an older, obese woman who may be diabetic, but fatty liver affects both sexes and may occur in those of normal weight. It is also quite common in those who consume excessive amounts of alcohol.
There are two types of fatty liver – that seen in alcoholics and that which occurs in non-drinkers.
It has been recognized for centuries that chronic alcoholism can cause progressive liver failure. The first stage of alcoholic liver disease is a fatty liver. At this stage, the damage is often reversible if the individual becomes totally abstinent. But with continued drinking, liver disease progresses leading to cirrhosis. Liver cells die and are replaced by scar tissue. When excessive scar tissue develops (cirrhosis), the liver fails. So, an alcoholic with a fatty liver who continues to drink may be causing irreversible liver disease.
Until recently, it was believed that in non-drinkers a fatty liver was just a curiosity – a consequence of being overweight or a diabetic. New scientific studies have identified non-alcoholic fatty liver as a separate disease entity also with potentially serious consequences. It is now believed that 10-20 percent of non-drinkers who have a fatty liver will also go on to develop liver cirrhosis. Why this happens is not known. Fatty liver has become the most common cause of cirrhosis in non-drinkers.
In 1980, scientists noted changes on liver biopsies in non-alcoholics that looked very much like the liver damage seen in chronic alcoholics who continue to drink. In addition to excess fat, there were signs of dying liver cells (necrosis), and inflammation. They termed this condition non-alcoholic steatohepatitis, commonly referred to as NASH. (The phrase “steato” simply means fat and “hepatitis” means liver inflammation.) The presence of dying liver cells and inflammation makes NASH a more severe form of fatty liver. Patients with NASH are at risk of progression to cirrhosis.
As mentioned above, the main cause is deposition of excessive fat within the liver. There are many reasons why this might happen including:
• Non-Alcoholic Fatty Liver
• Type II diabetes, non-insulin dependent o obesity – more than 10 percent over ideal weight
• High blood fats, especially high triglyceride levels
• Certain drugs like prednisone, estrogen, amiodarone, tamoxifen
• Intestinal bypass for obesity
• Extensive surgical removal of small intestine
• Total parenteral nutrition (TPN)
So far, there is no evidence that heredity plays a role in acquiring the disease.
Most patients with fatty liver are asymptomatic. If the liver becomes enlarged, one may experience vague right-upper quadrant (RUQ) abdominal pain or nausea.
Typically, a patient is diagnosed with a fatty liver after routine blood tests are performed for another reason and abnormally elevated liver enzymes are discovered. Perhaps they tried to donate blood and were rejected. It may have been an insurance physical or just a routine checkup. The most common abnormality in the blood tests is two to three-fold elevation in liver enzymes called AST and ALT.
In non-alcoholic fatty liver other liver tests are usually normal. In any case, these individuals are usually referred to a specialist to investigate the underlying cause. If there is a history of chronic alcohol abuse, the underlying cause is usually obvious. In non-drinkers, investigation usually focuses on searching for other potential causes of hepatitis (inflammation of the liver); viral infection, hemochromatosis (iron oveload), Wilson’s disease (copper overload), alpha-one antitrypsin deficiency, gallstones, cancer or fatty liver.
Non-alcoholic fatty liver is suspected in any adult who has unexplained elevated liver blood tests and drinks no more than two alcoholic drinks daily. To investigate further, more blood tests are usually required. Imaging studies such as a sonogram or CT scan are helpful in ruling out cancer and gallstones. They can also help determine if the liver contains excessive fat. If NASH is suspected or the diagnosis unclear, a needle liver biopsy is often performed. This is the only way to differentiate simple benign fatty liver from NASH.
At present, there is no proven therapy to reverse a fatty liver directly. Therefore, treatment is usually directed at the underlying cause. Alcohol must be stopped completely. Potentially offending medications may need to be changed, if possible. Uncontrolled diabetes must be better controlled. High serum cholesterol and triglycerides need to be reduced. Excessive weight must be lost through a diet and exercise program. Several reports suggest that the use of ursodeoxycholic acid (URSO), a natural bile salt, may be helpful.
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