Hepatitis B

What is it?

Hepatitis B is virus that infects the liver and can be transmitted through any fluid contact between people. It affects 400 million people worldwide and is more common in some regions such as Asia, Africa and parts of Europe. In the United States, between 1 and 2 million are infected. Hepatitis B is a silent disease, but can lead to liver cancer or cirrhosis.

Who gets it?

Anyone exposed to hepatitis B can get it. Bodily fluids of any kind harbor the virus. The only way to know if one is infected is to be checked. This involves a simple blood test. If you are exposed to it, you need to be checked. If you have moved to the Canada from a country with high rates of hepatitis B, you should be checked.

How do I know if I have it?

There are 8 major strains or genotypes of hepatitis B, the most common being genotype A. Most Asians that are infected have genotypes B or C. A blood test is needed to determine which one a person has.

How is it evaluated?

The typical work up of hepatitis B involves blood tests, and sometimes an ultrasound or liver biopsy. The amount of virus in the blood, or viral load, is important in determining how severe the disease is. Likewise the liver enzymes do also indicate the severity of disease and are important to monitor.

All of these are outpatient procedures and are routine.

Can it be treated?

There is a vaccine for hepatitis B and all persons should be vaccinated. For those that are infected, there are very effective treatments that can control the virus and prevent spread to others.

Bottom Line!

Hepatitis B can be easily diagnosed and can be treated and controlled.

Hepatitis C

What is it?

Hepatitis C is a viral infection that affects the liver. It affects millions of Americans and is largely without any major symptoms. Patients do not know they are infected unless they are specifically checked for it.

Who gets it?

The virus is spread through any blood contact or contamination. All persons born between 1945 and 1965 are at higher risk and should be screened. Anyone who had a blood transfusion prior to 1992, ever used injection drugs or cocaine, was ever in prison, or has multiple tattoos should be screened.

How do I know if I have it?

There are 6 major strains or genotypes of hepatitis C, the most common being genotype 1. A blood test is needed to determine which one a person has. The amount of virus in the blood, or viral load, does not have any bearing on how sick a person’s liver is. Likewise the liver enzymes do not indicate the severity of disease.

How is it evaluated?

The typical work up of hepatitis C involves blood tests, and sometimes an ultrasound or liver biopsy. All of these are outpatient procedures and are routine.

Can it be treated?

There is no vaccine for hepatitis C but fortunately, there are treatments available.

The treatment of hepatitis C can be done through medications available through pharmacies or through research trials. Most of the cutting edge research medications no longer use interferon.

Bottom Line!

Finally, it is important to remember two things. If untreated, hepatitis C can lead to liver cirrhosis and failure or liver cancer in some patients. And, hepatitis C is curable!

Liver Cirrhosis

What is it?

Cirrhosis of the liver is a condition where healthy liver tissue is progressively scarred and eventually leads to a small, hard shrunken liver that does not work properly. It is the 12th leading cause of death in the Canada and affects over 250,000 people in the Canada.

Who gets it?

Cirrhosis is caused by many liver disorders including hepatitis C and B, fatty liver disease (NAFLD), alcohol abuse, autoimmune hepatitis and disorders involving the bile ducts.

How do I know if I have it?

Early cirrhosis is silent and patients can look and feel fine. However, many patients complain of fatigue, weight loss, easy bruising, dark urine and when severe, patients develop fluid retention, confusion (encephalopathy), intestinal bleeding, infections, liver cancer and can become jaundiced (yellowing skin).

How is it evaluated?

Blood tests are done to assess the cause of cirrhosis, but imaging with ultrasound, CT or MRI scans are done, and in some cases, liver biopsy is done.

Can it be treated?

The underlying cause of cirrhosis can often be treated, and so can the symptoms of cirrhosis. In some cases, a liver transplant is needed.

Bottom Line!

Cirrhosis of the liver is an important condition and needs to be diagnosed and treated early to prevent complications.

Liver Cancer

What is it?

Liver cancer (hepatocellular carcinoma) is the fastest growing solid tumor in the Canada and is the 3rd leading killer of all cancers worldwide. It is a solid tumor that starts in the liver but can spread throughout the body.

Who gets it?

The main cause of liver cancer is liver cirrhosis. There are many causes of cirrhosis, but the most common in the United States is hepatitis C. Any cause of liver cirrhosis can lead to cancer, and some patients with hepatitis B get cancer of the liver even without cirrhosis.

How do I know if I have it?

Liver cancer is silent and can only be found through imaging such as ultrasound, CT scan or MRI scans. People with advanced liver disease should be monitored for liver cancer every 6 months. It is important to find it early!

How is it evaluated?

Blood tests are done to assess the cause of liver disease or cirrhosis, but imaging with ultrasound, CT or MRI scans are done, and in some cases, liver biopsy is done to confirm cancers. All patients with cancer of the liver should be seen by a hepatologist (liver specialist) and by liver surgeons at a transplant center.

Can it be treated?

If caught early, liver cancer is treatable and even curable. There are many treatment options including destroying the cancer cells with heat, cutting the cancer out (surgery) or in some cases a liver transplant. There are also experimental treatments for advanced cases.

Bottom Line!

Patients with advanced liver disease have to have an ultrasound every 6 months! The best way to cure liver cancer is to find it early.

Fatty Liver (Non-alcoholic fatty liver disease)

What is it?

Fatty liver (steatosis, non-alcoholic fatty liver disease) is a condition where the liver becomes infiltrated with fat. The fat is called steatosis, but when there is inflammation or scarring, it is called steatohepatitis or NASH. This condition can lead to fibrosis, or even cirrhosis of the liver. Up to 20% of the US population has fatty liver, and perhaps as many as 5% have NASH.

Who gets it?

Most people with fatty liver are overweight or have diabetes or pre-diabetes (insulin resistance). Occasionally, medications can lead to fatty liver. Excessive alcohol use can also lead to steatosis.

How do I know if I have it?

Fatty liver is a silent condition. Although liver enzymes (AST and ALT) can be elevated, patients generally feel fine. Some complain of a dull pain under their right rib cage, and this is due to swelling of the liver. Usually blood tests lead to the diagnosis.

How is it evaluated?

Blood tests indicating elevated liver enzymes usually lead to further evaluation. An ultrasound usually shows fat in the liver, but so will a CT scan or MRI scan. The only way to diagnosis steatohepatitis (NASH) is to biopsy the liver.

Can it be treated?

There is no  approved treatment for NASH, but general therapies include weight loss, control of diabetes, a healthy diet, and abstinence from alcohol. There are some new experimental therapies for fatty liver.

Bottom Line!

Fatty liver is the most common liver condition in the Canada. The aggressive variant is called NASH and should not be ignored. It can lead to cirrhosis!

Autoimmune Hepatitis

What is it?

Autoimmmune hepatitis is a condition where the body’s immune system attacks the liver. It is not known why this occurs, but is much more common in women than men. If not treated, it usually leads to cirrhosis of the liver and liver failure.

Who gets it?

Autoimmune hepatitis usually occurs in women, and presents in either young women or women in their 50s or 60s. People who get it have a genetic predisposition and often have other autoimmune conditions or family members with those conditions, particularly hypothyroidism.

How do I know if I have it?

Autoimmune hepatitis can be silent, but during flares of the disease, many symptoms may emerge, including fatigue, abdominal pain, joint pains, fever, nausea, loss of appetite, jaundice and dark urine.

How is it evaluated?

Blood tests are needed to help make the diagnosis, and liver biopsy is almost always required. The disease has periods of flaring up and periods of remission. The diagnosis is often missed or delayed because of this.

Can it be treated?

Autoimmune hepatitis has a treatment and it involves suppressing part of the immune system using medications. Most people need lifelong therapy, but this allows them to lead normal lives.

Bottom Line!

Patients with autoimmune hepatitis have to be diagnosed before they can be treated. Without treatment, the disease can progress to cirrhosis in 10 years.

Hemochromatosis

What is it?

Hemochromatosis or HHC is a condition of excessive body iron. The gut absorbs too much iron and this iron is stored in the liver, leading to liver damage including cirrhosis and liver cancer. Other organs including the pancreas and heart can be damaged as well.

Who gets it?

HHC is an inherited disorder and is more common in men. It is much more commonly found in Caucasians than Asians or those of African descent. Having the gene that predisposes to the condition is much more common than having the actual disorder.

How do I know if I have it?

HHC is silent early in the disease, but later can lead to joint pain, fatigue, diabetes, loss of sex drive and erectile dysfunction and even heart arrhythmias or heart failure.

How is it evaluated?

HHC is first suspected when iron stores are found to be elevated by blood tests.

A liver biopsy is usually needed to determine if the liver has too much iron it.

Can it be treated?

The treatment for HHC is to lower the body’s iron stores with phlebotomy (removing blood). In some patients, a chelating agent is given to bind the iron.

Bottom Line!

Hereditary hemochromatosis is treatable but if missed, leads to cirrhosis and increased risk of liver cancer.

Primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC)

What is it?

These conditions are disease of the bile ducts of the liver. Bile ducts normally are smooth and tapered and drain bile acids out of the liver into the small bowel. When these bile ducts become scarred and irregular in shape, bile acids do not drain normally and lead to liver damage. Primary biliary cirrhosis involves the smaller bile ducts while primary sclerosing cholangitis involves larger bile ducts.

Who gets it?

Primary biliary cirrhosis (PBC) is more common in women than men. It is thought to be an immune mediated injury of the liver, but the exact cause is not known. Primary sclerosing cholangitis (PSC) is a disease involving larger bile ducts, and leads to cirrhosis in many people. It is often associated with ulcerative colitis and can occur in both men and women.

How do I know if I have it?

In early disease, neither condition has symptoms. PBC often leads to fatigue, itchy skin, dry eyes, dry mouth, fatty deposits of the skin around the eyes, and darkening of the skin. PSC is often associated with recurrent infections, itchy skin, and is often associated with inflammatory bowel disease. If not treated, both conditions lead to cirrhosis and liver failure. PSC is also associated with bile duct cancer.

How is it evaluated?

Blood tests and liver biopsy are usually needed to diagnose PBC, while imaging is needed to diagnose PSC. Elevated alkaline phosphatase is the typical liver enzyme elevation noted on blood tests and this should lead to imaging. This can be done with ERCP or MRI scans for PSC. A high index of suspicion is needed to make the diagnosis in early disease.

Can it be treated?

It is important to diagnose biliary conditions early to prevent long-term liver damage. Once diagnosed, PBC is usually treated with a bile acid called ursodeoxycholic acid. PSC does not have an accepted therapy but requires close monitory. Both conditions sometimes require liver transplantation if they progress to cirrhosis.

Bottom Line!

Biliary conditions such as PSC or PBC are not common, but important to diagnose and monitor to prevent complications.