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Hepatitis (Liver Inflammation) in the Elderly

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Hepatitis is condition where the liver is inflamed. It is most often caused by viral infections but in the elderly, hepatitis is more likely to be seen with chronic alcoholism, overuse of prescription medication and as a result of other chronic diseases. The liver is one of the most versatile and resilient organs in the body. Therefore many of the disease processes that ultimately impact on the liver may only be noticed later in life. Seniors may suddenly discover that they have hepatitis and it has even progressed to severe liver damage (cirrhosis) yet had no significant prior signs of symptoms.

What is hepatitis?

Hepatitis is swelling and inflammation of the liver characterized by presence of inflammatory cells in the liver. Hepatitis can be self-limiting and heal on its own or can progress to scarring of the liver (cirrhosis) resulting in poor liver function. This may also progress further to liver failure. Hepatitis may be asymptomatic or may lead to jaundice, loss of appetite, and bodily discomfort. It can be acute (lasting for less than six months) or chronic (persisting for long). Hepatitis may result in liver damage, liver failure, or liver cancer in some cases.

Causes of Hepatitis

The causes of hepatitis may include:

  • Viral (from hepatitis A, B, or C viruses), bacterial, or parasitic infections.
  • Body’s immune cells attacking the liver (autoimmune).
  • Liver damage resulting from prolonged alcoholism, ingestion of poisonous mushrooms, or other toxics
  • Certain medications – long term use and overdose.
  • Inherited disorders like cystic fibrosis or hemochromatosis (iron accumulation in the liver).
  • Metabolic diseases like Wilson’s disease.

Risk factors

  • One of the greatest risk factors for seniors is the presence of chronic diseases and chronic pain, which may lead to overuse of anti-inflammatory drugs and analgesics. Pain medication addiction is a serious problem among seniors.
  • Ingestion of contaminated water or food spreads hepatitis A infection. International travel to Asia, Central or South America, intravenous drug use and working in a food, health care, or sewage industry increases the risks of catching hepatitis A infection.
  • Hepatitis B infection is spread through contact with body fluids (blood, semen, and vaginal fluids) of hepatitis B patients. Presence of HIV infection and unsafe sex increase the risk of hepatitis B infection.
  • Prolonged kidney dialysis, unprotected sex, or contact with body fluids of patients of hepatitis C causes hepatitis C infection.
  • Malnutrition worsens alcoholic hepatitis.

Hepatitis Symptoms

Symptoms of hepatitis depend on factors like the cause of the liver damage and presence of other illnesses. Symptoms of hepatitis may include:

  • Stomach pain or abdominal distention
  • Loss of appetite
  • Fatigue
  • Nausea and vomiting
  • Weight loss
  • Jaundice (yellowing of the eyes or skin)
  • Dark urine and pale stools
  • Breast development in males (gynecomastia)
  • Low fever
  • General itching

Some forms of hepatitis (like hepatitis B or C) are asymptomatic during the first infection.

Treatment of Hepatitis

Treatment depends on the type of hepatitis. Liver transplant is recommended for acute liver failure and end-stage liver disease.

  • Hepatitis A: No specific treatment exists for hepatitis A. Hepatitis A vaccine offers protection from hepatitis A.
  • Hepatitis B: Hepatitis B immunoglobulin injections offers protection from hepatitis B. Anti-viral medications and liver transplant are suggested to suitable cases of hepatitis B.
  • Hepatitis C: Anti-viral medications, liver transplant, and vaccines against the hepatitis A and B viruses are recommended to patients of hepatitis C.
  • Autoimmune hepatitis: Immunosuppressants (prednisone, azathioprine, mycophenolate, cyclosporine or tacrolimus) and liver transplant are recommended to patients suffering from autoimmune hepatitis.
  • Toxic hepatitis: Avoiding exposure to toxins, administration of acetylcysteine in the case of acetaminophen overdose, and liver transplants are suggested to patients of toxic hepatitis.
  • Alcoholic hepatitis: Abstinence from alcohol, administration of corticosteroids or pentoxifylline to reduce liver inflammation, and liver transplant are recommended to patients suffering from alcoholic hepatitis. Treating malnutrition with vitamins (specially B-complex) and folic acid helps in reversing malnutrition.

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