Dr Anna Sparaco
(Specialist Surgeon: Hepatopancreaticobilary and Transplant)
The liver is the largest internal organ of the human body and weighs about 1.3kg on average. It resides on the right side of the upper abdomen below the rib cage. It has multiple functions involving digestion of food; storage of energy; production of proteins and removal of poisons. It can be considered as the largest and most complex biochemical laboratory in the universe. Needless to say significant damage to this organ is incompatible with life.
The term hepatitis is a marriage between two civilisations: “hepar “meaning liver in Ancient Greek and “itis” meaning inflammation in Latin. Therefore hepatitis is inflammation of the liver as a result of an injury: infective, toxic, metabolic or immunological.
Most liver inflammation is caused by 3 viruses viz. Hepatitis A, B and C. However, viral infections are not the only cause. Alcohol, medicines, chemicals, genetic problems, metabolic disorders, autoimmune and obesity are all culprits.
There are several Hepatitis viruses that can cause inflammation of the liver viz. Hepatitis A,B,C,D and E. Hepatitis A and E are transmitted in a similar fashion and are usually transient in nature. They can however be fulminant and if untreated could be fatal. Transmission is usually through drinking infected food and water or ano-oral sexual contact. Infection can be prevented by hand hygiene; consuming freshly cooked foods; drinking bottled or boiled water if unsure of local sanitation and peeling fruit from dubious sanitary origins. Administration of a Hepatitis A vaccine prior to travelling to an area endemic to Hepatitis A, such as the Indian subcontinent, Africa, Central and South America, Far East and Eastern Europe, is encouraged.
Hepatitis B,C and D are transmitted via blood and body fluids. Infection with these viruses can be prevented by informing the partners and spouses if one is either a carrier or has active infection. Practice safe sex and avoiding previously used needles and syringes . Avoid sharing toothbrushes, razors and manicure instruments. Get Hepatitis B vaccinations.
Initial symptoms of hepatitis are flu-like, and may include diarrhoea, fatigue, loss of appetite, mild fever, body aching, abdominal pain, vomiting and weightloss. Worsening is indicated by the presence of circulatory problems, dark urine, dizziness, drowsiness, enlarged spleen, headache, itchy skin, light coloured stools, yellow skin, yellow whites of the eyes and yellow tongue.
Treatment can range from conservative watchful waiting to a liver transplant. If the hepatitis has progressed to cirrhosis and is complicated by a cancer then the merits of the tumour and the degree of the damage to the liver will determine whether it is possible to cut out the tumour or to offer a liver transplant. If neither of these are options then alternative treatments such as chemoembolisation, chemotherapy and radiation therapy could be considered. It is of the utmost importance to get assistance from the appropriate health professionals quickly. The best care is usually obtained from centres that deal with the problem most often.