- What is cirrhosis?
- Effects of cirrhosis
- Hepatitis D
- Blood test, Liver Function Test (LFT) & liver biopsy
- Side effects of treatment
- Protect yourself
*Read Part 1 here.
What is cirrhosis?
Cirrhosis is a result of long-term liver damage. If the liver is damaged for a short time, some of the cell die and the liver regrows to its original size and shape.
When the liver is very inflamed for a long time, scar tissue, called fibrosis develops. Also, the liver does not regroup properly. Smooth liver tissue is replaced by tissue that is much harder than normal and if this affects the whole liver, this is called cirrhosis.
If the swelling in the liver can be reduced, the rate at which liver damage occurs can be slowed down or even stopped.
Once cirrhosis has developed, it cannot go back to normal, even if the liver is no longer inflamed. If cirrhosis is left unchecked, then the liver may fail. In cases where the liver fail due to cirrhosis, a liver transplant may be is necessary and can save lives.
Late effects of cirrhosis
Blood that comes from the intestine to feed the liver, before passing back into the general circulation, cannot get through the hardened liver.
This obstruction to the flow of blood causes backpressure down the system, leading to enlarge (varicose) veins in the lining of the gullet and stomach because the blood is trying to find a way round the scarred liver.
The varicose veins can burst, causing severe internal bleeding, which shows itself as vomited blood or altered in the stool (black, tarry bowel motions). Either or these symptoms must receive urgent medical treatment.
Effect on the brain
The liver normally breaks down the waste products that would otherwise affect the brain.
With severe liver disease the liver cannot remove these waste products and they are carried by the blood to the brain.
Symptoms can range from minor lapses in memory to slurred speech, confusion and unconsciousness. With the help of treatment these effects can be reversed.
Severe liver disease alters the way the body handles fluid so that excess water is retained in the body and may be obvious as swelling of the legs and/or swelling of the abdomen (due to fluid in the cavity which surrounds the bowel). The accumulation of fluids is called ascites.
In a few people liver cancer may develop as a late result of cirrhosis. Liver transplantation can be done when someone has developed primary liver cancer, so long as it has not progressed too far and beyond the liver to other sites in the body.
A few people with Hepatitis B also have another virus called the delta virus or Hepatitis D. This virus needs Hepatitis B virus to survive, which means that it is only possible to have Hepatitis D if you have Hepatitis B. Hepatitis D is passed on in blood and is most common in injecting drug users. Being infected with both viruses leads to more serious liver disease.
Blood test, Liver Function Test (LFT) & liver biopsy
Hepatitis B is detected by a blood test. The test that is freely available, looks for antibodies to Hepatitis B which are produced by the body’s immune system in response to the virus as well as various proteins produced by the virus. Hence, there are several different results which tell the doctor slightly different things.
Liver Function Test (LFTs)
LFTs are blood test that measure substances in the bloodstream that indicate the liver is damaged. However they are not always good indicators of liver damage and do not detect the presence of the virus.
LFT levels can fluctuate throughout the course of the disease. Sometimes they are normal, but this does not prove that liver damage is absent.
The only way to assess the amount of liver damage is through liver biopsy. The biopsy involves taking a small sample of liver tissue for examination under a microscope. The test is usually performed under a local anesthetic. A hollow fine needle is passed through skin into the liver and a small piece of tissue is withdrawn inside the needle.
In most people the procedure is uncomfortable but occasionally some people find it very uncomfortable. The result of biopsy are graded and staged according to the degree of inflammation and scarring.
Most people with acute Hepatitis B do not need treatment as they do not develop long-term liver damage. They may feel more tired than usual and need plenty of rest, but they eventually recover and may never be infected with Hepatitis B again; however this does not apply to everyone.
People who are infected for more than 6 months may benefit from treatment. They need to be regularly seen by a specialist in liver diseases (hepatologist) or a specialist in digestive (gaestroentrologist) to check whether they have liver damage and whether treatment is necessary.
If treatment is needed, an antiviral medication called interferon can be used. This is similar to interferon that the body’s immune system produces to fight infection.
Another antiviral medication called lamivudine may be used. Lamivudine aims to reduce the amount of virus in the body, although it doesn’t work for everybody. Some people become resistant to it. People must take one tablet a day. Adefon is another.
Other treatment are being investigated in clinical trials and may be used in combination with interferon or alone, many in tablet or capsule form and not requiring injections, oral medication that can be needed to treat Hepatitis B.
Side effects of treatment
Interferon produces side effects in many people, especially in the early stages of treatment.
The side effects vary from person to person. Some people get flu-like symptoms such as:
- muscle aches
This is not a full list of side effects. Often, taking paracetamol before the interferon can help the flu-like symptoms.
People who have very bad effects may not be able to take a full dose or a full course. Because of the different side effects, blood tests are needed during treatment.
It is important to go for regular check-ups so that side effects can be carefully monitored.
Lamivudine seems to have fewer side effects than interferon.
Protect yourself with vaccination
The vaccination is given by injection in the arm 3 doses. The first dose is followed by the second one a month later and the third dose 5 months after that.
It it important to have all 3 doses of the vaccine because you will not be fully protected until you have had the third injection.
A blood test is sometimes recommended up to 2 months after the final injection to find out whether the vaccine has worked.
A few people will not respond to the vaccine and they may have to take another course, though some people may not respond to the vaccine at all.
Anyone who has been exposed to the virus should be given an injection of antibodies called immunoglobulin immediately as well as the vaccine, as there is not enough time to wait for the vaccine to work. People who may be exposed to the virus during the course of their work include nurses, doctors, prison wardens and dentists. Thy may need an injection of antibodies as well as the vaccine if they accidentally injure themselves with a needle contaminated with blood.
New born babies of infected mothers
Babies born to infected mothers are given an immediate injection of immunoglobulin as soon as possible after they are born to help prevent the baby from being infected. At the same time a dose of the vaccine is given, followed by 2 doses with a month in between each, with a booster dose 5 months later.
Family and friends
Partners, children and other household members of an infected person should be vaccinated. There is no risk of infection from normal social contact. For example, you cannot catch Hepatitis B from a toilet seat or just by touching an infected person. The virus is thought to be killed by a hot wash in a washing machine and by using hot water and washing-up liquid on cutlery and plates.
Other people at risk
Doctors, dentists, nurses, prison officers and anyone else whose job may involve contact with infectious body fluids should be vaccinated.
To reduce the risk of infecting others:
- Carefully clean and cover cuts, scratches and open wounds with a water proof plaster
- Clean up blood from floors and work surfaces with undiluted household bleach
- Do not use anyone else’s toothbrush, razor, scissors or personal items
- Practice safe sex by using a condom in circumstances where you are likely to be infected
- Do not donate blood or semen, or register as an organ donor
If you are worried that you may have Hepatitis B, you must contact your doctor.
People with Hepatitis B often ask if they should follow a special diet. For most, particularly to those who are well, the answer is no. Just like anybody else, they should eat a balanced diet with everything in moderation and no excesses. This means eating regular meals, including plenty of fruit and vegetables and avoiding excessive fatty and sugary meals.
Eating a wide variety of different food will help to ensure that meals are enjoyable as well as providing an adequate supply of vitamins and minerals. Most people do not require vitamin supplements, but if you are concerned, ask your doctor for guidance.
Ideally, anybody with Hepatitis B should drink no or as minimal amount of alcohol as possible because alcohol can fasten liver damage.