Inflammation of the liver of any cause is referred to as hepatitis. It may be caused by viruses, drugs, or alcohol, although the most common cause is viruses, termed viral hepatitis. There are several types of viral hepatitis, the most common of which being hepatitis A, B, and C. You may hear about an outbreak of hepatitis A due to contaminated food, for example.

Very frequently the onset of hepatitis, the acute phase, is not associated with symptoms or signs, but when they do occur, they are usually general and include fatigue, nausea, decreased appetite, mild fever, or mild abdominal pain. Later signs more specific for liver disease may occur, specifically, yellowing of the skin and eyes (jaundice) and darkening of the urine. If the infection becomes chronic as is the case with hepatitis B and C, that is, infection lasting longer than months, the symptoms and signs of chronic liver disease may begin. At this point, the liver often is badly damaged.

Like many other viral diseases, Hepatitis A is highly contagious. It usually is spread from person to person via a fecal-oral route, meaning via fecal contamination of food. It usually is a mild hepatitis, and many people do not know they are infected. The virus is eliminated by the body rapidly, and it does not cause long-term damage. Good hand washing hygiene helps prevent hepatitis A.

Do you know how people catch hepatitis A? Hepatitis A is spread from person to person via fecal contamination, because the virus is present in the stool. It is spread via contaminated food or water by an infected person who gets small amounts of stool on his or her hands, does not wash his or her hands, and passes the stool onto food that is eaten by others. An example of this is outbreaks of hepatitis A in daycare centers for young children when employees don’t wash their hands after changing diapers, and they then pass the viruses to the next child they feed. In addition, fecal contamination of water in which shellfish live can contaminate the shellfish, and the shellfish can pass the virus to people who eat the shellfish raw.

Travelers to countries with high infection rates and the inhabitants of those countries are at higher risk for developing hepatitis A. The Centers for Disease Control issues travel advisories that identify the countries with outbreaks or endemic hepatitis A. Eating raw or uncooked foods increases the risk for hepatitis A.

A majority of adults who contract hepatitis B have between mild symptoms and no symptoms at all, and then the virus resolves spontaneously; however, about 5% of people are not able to eliminate the hepatitis B virus and develop chronic infection. If a chronically infected mother gives birth, 90% of the time her infant will be infected and develop chronic hepatitis B, usually for life. This may give rise to serious complications of liver disease later in life such as liver damage, liver failure, and liver cancer.

Persons infected with hepatitis B can pass the virus to others through blood or body fluids. In the U.S., the most common way of becoming infected is through unprotected sex, although sharing an infected person’s needles to inject illicit drugs also is quite common. Less common ways are by contaminated razors or toothbrushes. As previously mentioned, hepatitis B is passed from infected mother to infant in over 90% of cases.

Are you at risk for hepatitis B? Although unprotected sex is the most common way of becoming infected with hepatitis B, infection is more likely for people who have multiple sex partners. Shared needles also are an important means of spreading hepatitis B. Other risk factors are being a health care worker, but infection usually is related to needle sticks. There also is a risk of becoming infected by living with someone who has chronic hepatitis B, in part, due to sexual transmission or utilization of contaminated items like razors.

Is hepatitis C a virus? Yes. With acute hepatitis C, the virus is eliminated in 25% of people. The rest of infected people become chronically infected and later may develop serious complications such as liver failure and liver cancer. But there is now treatment for hepatitis C that usually can prevent these complications.

Hepatitis C is transmitted primarily by infected blood, for example by sharing needles when injecting illicit drugs. The virus is spread much less commonly with tattoos or body piercing with a contaminated needle. Mothers pass the virus to their infants at birth, and the infant becomes chronically infected. The risk of spreading hepatitis C with unprotected sex is small, but having multiple sex partners, HIV, or rough sex increases the risk.

It only takes one exposure to hepatitis C to become chronically infected. Some people who have injected illegal drugs even one time or many years in the past could have chronic hepatitis C, and not know it; there are often no symptoms. People with blood transfusions prior to 1992 – when they started testing blood for transfusion for hepatitis C – also may have become chronically infected.

Chronic hepatitis slowly attacks the liver over many years without causing symptoms. If the infection is not diagnosed and treated, many people will develop damaged livers. If suspected, viral hepatitis of all types can be diagnosed easily by blood tests.

It is important to test people with symptoms or exposure to hepatitis, as well as people at high risk, such as illicit drug users and people with multiple sex partners. There is a high prevalence of chronic hepatitis individuals of Asian heritage, and they also should be tested. It is estimated the 10% of Asians living in the U.S. have chronic hepatitis that probably has been present from birth.

If testing discloses that you have viral hepatitis, there are steps to prevent your passing the viruses to family and friends. Washing your hands help prevent transmission of hepatitis A. Not sharing needles, razors, nail clippers, or toothbrushes also will reduce transmission of viral hepatitis. Everyone should be vaccinated against hepatitis B.

No treatment is needed for hepatitis A since the infection almost always resolves on its own. Nausea is common, though transient, and it is important to stay hydrated. It is recommended that strenuous exercise be avoided until the acute illness is over.

For hepatitis B, treatment is aimed at controlling the virus and preventing damage to the liver. Antiviral medications are available that will benefit most people, but the medications need to be chosen carefully, and the treatment needs to be monitored in order to assure successful treatment and to prevent or treat medication-related side effects. For some individuals, the risks of treatment may not be justified.

The treatment for chronic hepatitis C has changed for the better in recent years. Patients can expect better outcomes, shorter treatment times and fewer side effects thanks to changes in treatment.

“Direct acting” antiviral drugs have changed the way hepatitis C is treated. Treatment of chronic hepatitis C has evolved, rendering many earlier drugs obsolete. The drugs currently used include pegylated interferon, ribavirin, elbasvir, grazoprevir, ledipasvir, sofosbuvir, paritaprevir, ritonavir, ombitasvir, dasabuvir, simeprevir, and daclatasvir. These are always used in various combinations, never alone. Interferon is given by injection while the other medications are pills. Studies have shown that combinations of these drugs can cure all but a small proportion of patients; however, serious side effects of treatment can occur.

Treatment options need to be discussed with a knowledgeable physician, as the appropriate combination is dependent upon multiple factors. These include genotype (there are 6), prior treatment and results, drug intolerances, presence of compensated liver disease or uncompensated cirrhosis, presence of HIV co-infection, other complicating conditions and liver transplantation.

Monitoring the progression of liver disease and its treatment are the cornerstones of managing hepatitis B and C. Doctors regularly follow blood tests to determine how well your liver is functioning. Ultrasound examinations and CT scans can determine if there are complications such as cirrhosis or liver cancer that can be treated more effectively if found early. Some people will not need treatment.

Liver function tests and imaging can also help identify problems like hepatic steatosis (hepatic lipidosis), hepatic encephalopathy (hepatic coma), hepatic cysts, hepatic adenoma, hepatic hemangioma, diffuse hepatic steatosis, hepatic lesions, hepatic fibrosis, and fulminant hepatic failure.

Imaging helps doctors see the hepatic portal vein, hepatic portal system, hepatic vein, hepatic artery (common hepatic artery), hepatic duct (common hepatic duct), and hepatic lobes.

Cirrhosis is the most common complication of chronic hepatitis. Cirrhosis can be detected with simple tests, but the liver biopsy is the best way to diagnose it. Cirrhosis occurs as the liver is destroyed and it is associated with liver failure, a life-threatening condition. The signs of cirrhosis include retention of fluid (swelling of the abdomen or lower extremities), fatigue, nausea, and weight loss. Later, confusion and jaundice occur due to the accumulation of chemicals normally removed by a healthy liver.

The major cause of liver cancer is hepatitis B and C, and can develop silently as the liver becomes cirrhotic. Blood tests, ultrasound examinations, CT and MRI scans can identify the cancers (seen here in green). Biopsy of the liver is needed to definitely make a diagnosis of cancer. If the cancers are found early, a small proportion of patients can be cured.

The liver serves many functions including the manufacture and removal of chemicals that allow cells to function normally, digestion of food, elimination of toxic chemicals, and the production of many proteins that the body needs. Thus, if a large portion of the liver is damaged, the liver cannot perform these critical functions; it is impossible to live without a liver. If the liver fails, a liver transplant may be the only hope, but it is not easy to find a healthy liver to transplant.

Vaccines can protect against hepatitis A and B. The Centers for Disease Control recommends hepatitis A vaccination for children 12 to 23 months of age and for adults who travel or work in locations with a higher prevalence of hepatitis A infection. Vaccination for hepatitis A also should be given to people with hepatitis B and C. If the mother has chronic hepatitis B, the infant should receive the hepatitis B vaccine as well as hepatitis B immune globulin to prevent the development of chronic hepatitis B. There is no vaccine for hepatitis C (there are at least 7 genotypes and about 60 subtypes; a vaccine would need to be effective against most of them).

If you have chronic hepatitis, you should prevent further damage to your liver, for example, by not drinking alcohol. Since some medications and supplements can damage the liver, before taking them you should discuss them with your doctor. Regular appointments for follow-up are important. Early progression of the disease or complications are likely to change treatment.

When excess fat is stored in the liver, it may lead to fatty liver disease. This condition impairs the liver’s ability to function. It is reversible in the early stages. However, if it progresses to cirrhosis, which is scarring of the liver, it is not reversible.

Fatty liver disease is very common and it affects approximately 1 out of 4 people. Many people who have fatty liver disease do not know they have the condition. There are two kinds of fatty liver disease: nonalcoholic fatty liver disease and alcoholic fatty liver disease.

Fatty liver disease is an abnormal accumulation of fat in the liver that may compromise the liver’s ability to function. There are two types of fatty liver disease. One is associated with alcohol use (alcoholic fatty liver disease) and one is not (nonalcoholic fatty liver disease). Another name for alcoholic fatty liver disease is alcoholic steatohepatitis. Accumulation of excess fat in the liver may hinder the liver’s ability to filter out toxins. This, in turn, may make people feel sick.

Nonalcoholic fatty liver disease (NAFLD) usually does not cause any symptoms. Most people do not know that they have it. But if the condition worsens it damages the liver from inflammation and may lead to scarring (cirrhosis). This is known as nonalcoholic steatohepatitis (NASH). People who suffer from diabetes or who are overweight or obese are more likely to suffer from NASH.

Certain conditions increase the risk of NAFLD. People who are overweight or obese are more likely to get it than those who are normal weight. In one study, 90 percent of those undergoing bariatric surgery had NAFLD. High blood pressure and type 2 diabetes increase the risk of NAFLD. Even children can develop NAFLD. Approximately 10 percent of kids in the U.S. have the condition.

Ethnicity is related to risk as well. NAFLD is more common in people who are Hispanic and Caucasian and it is less common in people who are African American. People who are Asian American are more likely to develop NAFLD compared to those of other ethnicities when they are at a normal weight.

Alcoholic fatty liver disease occurs in long-term heavy drinkers. People who are obese, female, and those who have certain gene mutations are more likely to get it, too. The disease may be silent and not cause any symptoms. Others may experience fatigue or abdominal discomfort in the area of the liver. People who have the condition and continue drinking increase their risk of future cirrhosis, alcoholic hepatitis, liver failure and liver cancer.

Many people who suffer from fatty liver do not know they have it because they don’t experience any symptoms. When people do experience symptoms, they may include loss of appetite, weight loss, abdominal fullness, abdominal pain, fatigue, confusion, weakness, and nausea. Signs of fatty liver that may be apparent to others include a yellowing of the skin and eyes (jaundice) and swelling of the legs and abdomen (edema).

Fatty liver disease may be hard to diagnose because many people do not have any symptoms. Tests the doctor may order if they suspect a patient has fatty liver include blood tests to monitor for elevated liver enzymes, ultrasound, and computed tomography (CT) scan. Elastography is a test that helps assess the level of fat and scarring in the liver. In some cases, the doctor may want to take a sample of liver tissue (liver biopsy) to diagnose fatty liver disease.

There’s a lot patients can do with diet and lifestyle changes to treat a fatty liver. Losing weight if they are overweight or obese may help the liver. Losing as little as 1 to 2 pounds can help. The doctor can also prescribe certain medications to treat inflammation and help keep blood sugar under control, if patients need them.

Fatty liver that is not related to alcohol use is mainly caused by obesity. The doctor will recommend weight loss for patients with fatty liver who are overweight or obese. Even losing as little as 1 to 2 pounds can help. Depending on a patient’s weight, weight loss of approximately 10 percent is desirable. The doctor or nutritionist can recommend the best fatty liver disease diet. Those who are very obese may need weight loss surgery, which can help fatty liver as well.

Patients may be able to treat and reverse fatty liver with the help of diet and lifestyle changes, including weight loss. Exercising for at least 30 minutes for five days a week can help people lose weight. Even moderate activities like walking at a brisk pace count towards this goal. People who have not exercised in a while or who are starting to exercise for the first time should get their doctor’s okay first.

People who suffer from fatty liver disease from alcohol should not drink alcohol. This may be easier said than done. In 2018, almost 15 million people in the U.S. suffered from an alcohol use disorder. They may drink to excess and feel as if they have no control over how much they drink. And this excess alcohol consumption may lead to fatty liver disease.

Can fatty liver be reversed? The answer is yes, especially if the disease process is diagnosed early. Avoiding alcohol is part of the recovery process. Patients with fatty liver who suspect they have an alcohol abuse problem should talk to their doctors. There are treatments that can help. .

Fatty liver may increase the risk of type 2 diabetes. Having both conditions can make fatty liver worse if type 2 diabetes is not well controlled. Patients who have type 2 diabetes should make sure it is well controlled. People with fatty liver should keep blood lipids, like triglycerides and so-called “bad” LDL cholesterol, in check. Controlling high blood pressure and losing weight also helps take strain off of the liver. They should also avoid drinking alcohol.

People with fatty liver should attend regular doctor checkups to stay on top of their health. The doctor may order an ultrasound to monitor a patient’s liver along with regular blood tests to monitor liver function.

People who suffer from fatty liver disease can potentially develop a more serious condition if they become ill with hepatitis A, hepatitis B, pneumonia, or the flu. That’s why it is important to receive vaccinations against these diseases to decrease the risk of other potential complications.

The liver filters everything we eat, drink, and take; this includes herbs, vitamins, supplements, and medications (over-the-counter and prescription drugs). Patients who suffer from fatty liver or other condition that compromises liver function should talk to their doctors about everything they take. Patients may need to stop taking certain substances or switch to different medications that do not harm the liver.

Prevention is the name of the game when it comes to fatty liver disease. Ask the doctor about the best diets for fatty liver disease prevention. Keep weight down by eating a sensible diet and exercising regularly, with the doctor’s knowledge and permission, of course. Avoid or limit alcohol intake. Review all over-the-counter medications, prescription medications, supplements, vitamins, and herbs with the doctor to make sure they aren’t harming the liver. Living a healthy lifestyle keeps weight, blood pressure, blood lipids, stress, diabetes, and heart disease risk low. It’s also good for the liver.