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Introduction

I will here give an overview of the main things that cause hepatitis.

I provide the common denominators and also differences between the types of this general term, hepatitis – including physical exam similarities and differences, and lab test similarities and differences.

And the theme will be the importance of differentiating the different types of hepatitis because it will mean different prognoses and different care plans.

Disclaimer

 

What Causes Liver Inflammation and Hepatitis?

 

This is for learning purposes. It really applies to two types of confused patients, the ones that got regular annual screening labs back that said their liver functions showed mild inflammation; and the ones that are actually sick with liver problem symptoms like nausea, jaundice, or gall stones.

Sure your doc should reassure you with a good idea of what your hepatitis is and what’s in store for you in later years based on the the type of liver inflammation that you are. But sometimes they don’t.

So now you can know more about it than they know about it. Because The medical literature has really changed about this. Heavily in the past five years.

So my big disclaimer is: get ready to be an expert!

Discussion

There’s really five types of things produce a swollen liver:

viral (right, hepatitis A, B, and C are the big ones; there’s also D and E)

steatosis (the term for just fatty liver)

toxic (some drug you’re put on for years – Ty big Pharma – or poison)

metabolic (storage) disorders (iron and copper problems are the big ones)

and

autoimmune (something, often times a drug, makes the body start cranking out your own antibodies against your own liver; and thank you big Pharma again)

 

What is Asterixis?

 

Physical exam for any type of hepatitis from the above list includes something called asterixis. It’s a waving of the hand after hyperextending at the wrist. It implies hepatitis. Shifting dullness of fluid in your belly implies ascites, a liquid the liver oozes out when the liver’s been sick a while.

Something else that happens when the liver gets sick is its blood supply backs up because it has trouble flowing through a sick liver. Telangiectasias are spider like varicosities on the belly wall, one of the areas it backs up to. Another back up area from liver blood flow of is the esophagus and stomach, leading to varices there. Super dangerous because they can rupture if you vomit (remember liver dysfunction causes nausea), especially if you’re clotting ability is bad as well because, something else the liver does, is make clotting factors. So, a set up for disaster if you develop varices. And yet another back up of liver blood flow because of increasing liver blood pressure from liver disease is in your rectum which leads to hemorrhoids.

Gynecomastia (man boobs; sorry) can occur from excess estrogen. One of the liver’s functions is to break down circulating estrogen in men and women. So, if the liver isn’t working, estrogen will build up. Yeah. Like that. I’m telling you. Hepatitis, regardless of the cause, is not a good situation.

LAB

‘LFTS’ or liver function tests can help elucidate what type of liver dysfunction is going on. They can even give you a clue as to what the cause is for the hepatitis.

Hepatitis in general is the diagnosis if your ALT and AST are both up. In most causes of hepatitis, ALT is greater than your AST. Any offending agent is first going to increase ALT because ALT is secreted by the liver cells (hepatocytes) quite readily. When things get really bad, the toxic agent will even start destroying mitochondria. AST is in the mitochondria, so those levels go up more. So, ALT(hepatocytes)> AST(mitochondria) implies hepatitis. Type unknown.

If your AST is greater than your ALT, that implies alcoholic induced hepatitis. Booze just has a way of causing more damage to the liver, thus destroying the mitochondria more in comparison to just hepatocytes.

Cholestasis is the bile, the liver’s main secretion product, backing up. Alkaline phosphatase (Alk phos) and bili (bilirubin pigment in bile) going up means you have a drainage problem. You’re getting back up because the pressure in the bile ducts is going up secondary to clogging, i.e., cholestasis. Alk phos implies small ducts are backing up; bili =>large ducts are backing up.

Actual liver function in terms of the good things it does are shown in albumin (the liver makes albumin, a protein that has many functions); INR (PT), our clotting ability, because liver makes most of our clotting factors; and bili – the liver makes bilirubin.

Back to bad things we see in lab tests. The blood pressure going up in the blood vessels of the liver from cirrhosis (end stage scarring and fibrosis in the liver) is seen by bad platelet counts because the spleen, filled with platelets, backs up from liver blood back up to it, destroying platelets in the spleen.

Conclusion

There are some uncontrollable things that could happen to hurt your liver. And there are some controllable things that destroy the liver. Alcohol is obviously the big one. So, one conclusion would be: don’t drink. I mean, like, not at all. That’s if you want to do the right thing for your liver.

This is the overview, pointing out types, the similarities, the differences, and the various manifestations of liver disease.

I’ll provide a separate topic, one each for each type, next.

And one last comment. The only other thing all of these types of hepatitis have in common is that they should all be responsive to stem cell regeneration. No drug will be able to give patients that hope.

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