The liver is a complex organ that has several functions, including the metabolism of substances such as fats, alcohol and some medications, and is also responsible for the production of bile.

The inflamed liver is known by the medical term hepatitis. Its causes are multiple and the treatment depends on both the origin of the inflammation and the complications that arise.

What is defined as hepatitis?

It is the inflammation of liver cells (called hepatocytes), which causes an abnormal elevation of liver enzymes and an increase in liver volume (hepatomegaly).

The inflamed liver can be accompanied in some cases by injury or death of the hepatocytes (a process called necrosis), which leads to unwanted consequences such as chronic hepatitis, liver cirrhosis and liver failure in the so-called fulminant hepatitis.

Symptoms of an inflamed liver.

The main symptom of hepatitis is abdominal pain. The inflamed liver causes pain below the right side, specifically in the region called the right upper quadrant. When the doctor evaluates the abdomen, it is easy to feel an enlarged liver that is painful to the touch.

Another characteristic symptom of an inflamed liver is jaundice (which is the yellowing of the skin and mucous membranes), which appears due to the overproduction of bile; and when this is excreted in the urine, coluria (which is a dark color of the urine due to the deposit of bile pigments) occurs. Other associated symptoms are nausea, vomiting, in some cases fever and general weakness.

In the case of liver failure (due to fulminant hepatitis), hemorrhages, ascites (presence of fluid in the peritoneal cavity) may be evidenced and in severe cases, neurological alterations (such as drowsiness, incoherent speech and tremor in the hands) occur due to elevation of the levels of ammonia in the blood that are deposited in the brain.

How is an inflamed liver diagnosed?

If hepatitis is suspected it is important to consult a doctor. The diagnosis of hepatitis is based on a correct questioning of the patient, his physical examination and the request for complementary studies.

Among the laboratories that are requested are blood chemistry, which includes liver function tests such as aminotransferases or transaminases.

Total and fractionated bilirubin, clotting times, lipid profile, alkaline phosphatase, and total protein plus albumin are also requested. Also, in blood it is possible to detect the presence of some viruses and autoantibodies that cause liver inflammation.

Among the imaging studies requested is abdominal ultrasound, which will allow evaluating the liver volume and the characteristics of the blood flow of the hepatic veins and arteries.  A computed tomography scan may be necessary to rule out liver injury or necrosisIn some cases, a liver biopsy will be ordered to determine the cause.

Why is the liver inflamed?

There are many causes of hepatitis . Most are infectious causes, including viral hepatitis  caused by Hepatitis A, B, C, D or E viruses and also other viruses with a predilection for liver cells (Dengue Virus, Cytomegalovirus, Human Immunodeficiency Virus, Herpes, Epstein Barr Virus, etc.). These germs directly attack hepatocytes, causing a local inflammatory response.

In addition, there are other causes such as alcoholic hepatitis (which precedes alcoholic liver cirrhosis) and drug hepatitis, due to excess doses of drugs that are metabolized by the liver, for example, acetaminophen and slimming substances. The excess of these types of substances prevents liver cells from working properly and, therefore, they become inflamed.

Another cause of hepatitis is the use of substances called phytopharmaceuticals (which are those medicines extracted from plants, including some natural preparations, herbs and infusions), which are used as an alternative method for treating diseases.

Finally, there is an immune condition, called autoimmune hepatitis, caused by autoantibodies that are produced against hepatocytes. When the exact cause of the inflamed liver is not known after all the studies are done, it is called cryptogenic hepatitis.

How to treat an inflamed liver?

Treatment will depend on the cause of the liver inflammation. In most acute viral processes, where the symptoms are not so severe, the treatment is based on controlling the associated symptoms (fever, general malaise, abdominal pain, etc.) and avoiding drugs that are metabolized in the liver such as acetaminophen and penicillin, for example.

When chronic causes of an inflamed liver are detected, such as Hepatitis B or C, an antiviral treatment (such as interferon alpha, lamivudine and ribavirin) should be started by a hepatologist to control the infection and the liver enzymes should be monitored regularly.

If hepatitis is due to ingestion of any drug, it should be withdrawn immediately and depending on the severity, plasmapheresis (exchange of plasma in the patient) can be used.

Finally, if the cause is autoimmune, steroids and immunomodulatory drugs such as cyclophosphamide and mycophenolate mofetil should be indicated.

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