Journal of Tropical Diseases & Public Health

Hepatic Inflammation

Hepatic inflammation is the medical term for the inflammation of liver cells (hepatocytes). It occurs when the liver responds to injury or infection by swelling, becoming tender, and experiencing impaired function. Inflammation can range from mild to severe and may be a sign of both acute or chronic liver disease.

Causes of Hepatic Inflammation

1. Viral Infections:
   • Hepatitis Viruses (A, B, C, D, E):
     The most common causes of liver inflammation, hepatitis viruses lead to both acute and chronic liver disease. Chronic inflammation can eventually lead to scarring (cirrhosis) or liver cancer.
2. Alcohol Use:
   • Alcoholic Hepatitis:
     Excessive alcohol consumption can irritate and inflame liver cells. This can progress from simple fatty liver disease to alcoholic hepatitis and eventually cirrhosis if the drinking continues.
3. Non-Alcoholic Fatty Liver Disease (NAFLD):
   This condition involves fat accumulation in the liver in individuals who consume little or no alcohol. It can progress to non-alcoholic steatohepatitis (NASH), a more severe form that includes inflammation, liver cell damage, and scarring.
4. Autoimmune Diseases:
   • Autoimmune Hepatitis:
     This occurs when the body's immune system mistakenly attacks healthy liver cells, leading to chronic inflammation and damage.
5. Medications and Toxins:
   Certain drugs (e.g., acetaminophen, statins), toxic substances, and herbal supplements can cause liver inflammation if used improperly or in high doses.
6. Metabolic Disorders:
   • Hemochromatosis:
     Excessive iron buildup in the liver can lead to inflammation and damage.
   • Wilson’s Disease:
     Accumulation of copper in the liver due to a genetic disorder can cause inflammation and liver failure.
7. Bacterial and Parasitic Infections:
   Certain bacterial infections, such as leptospirosis, or parasites, like the Plasmodium species that cause malaria, can result in liver inflammation.

Symptoms of Hepatic Inflammation

• Jaundice:
  Yellowing of the skin and eyes due to the buildup of bilirubin.
• Fatigue:
  Chronic tiredness and weakness, often associated with liver inflammation.
• Abdominal Pain:
  Discomfort or pain, particularly in the upper right side of the abdomen where the liver is located.
• Loss of Appetite:
  Reduced desire to eat, sometimes accompanied by weight loss.
• Nausea and Vomiting:
  Digestive issues are common, particularly with inflammation.
• Dark Urine and Pale Stool:
  Changes in bile flow due to liver dysfunction.
• Itchy Skin (Pruritus):
  Accumulation of bile salts can cause persistent itching.

Diagnosis of Hepatic Inflammation

To diagnose hepatic inflammation, healthcare professionals may use:

1. Blood Tests:
   • Liver Function Tests (LFTs): Measures enzymes (ALT, AST) and bilirubin levels to assess liver function and damage.
   • Viral Serology Tests: Check for specific viruses like hepatitis B or C.
   • Autoantibody Tests: If autoimmune hepatitis is suspected.
2. Imaging Studies:
   • Ultrasound, CT Scan, or MRI: These tests help visualize liver inflammation, fat accumulation, or scarring.
   • FibroScan: Measures liver stiffness to assess the degree of inflammation and fibrosis.
3. Liver Biopsy:
   A small sample of liver tissue is taken to confirm the severity of inflammation and to identify its underlying cause, such as hepatitis or fatty liver disease.

Treatment of Hepatic Inflammation

The treatment for hepatic inflammation depends on its underlying cause:

1. Viral Hepatitis:
   • Antiviral Medications: For hepatitis B or C, antivirals like entecavir or sofosbuvir can control the viral infection and reduce inflammation.
   • Vaccination: Hepatitis A and B can be prevented through vaccination.
2. Alcoholic Hepatitis:
   • Abstinence from Alcohol: Completely stopping alcohol consumption is crucial for recovery.
   • Steroids or Pentoxifylline: In severe cases, medications may be prescribed to reduce liver inflammation.
3. Non-Alcoholic Fatty Liver Disease (NAFLD):
   • Lifestyle Changes: Weight loss, a healthy diet, and regular physical activity can reduce fat in the liver and help lower inflammation.
   • Medications for Diabetes and Lipids: For patients with metabolic syndrome, medications to control blood sugar or cholesterol may be required.
4. Autoimmune Hepatitis:
   • Immunosuppressive Therapy: Medications like corticosteroids (prednisone) or azathioprine help reduce immune system activity and inflammation.
5. Liver Detoxification and Cessation of Harmful Medications:
   • Drug-Induced Hepatitis: Stopping the medication or toxin causing the inflammation and, in some cases, administering antidotes (e.g., acetylcysteine for acetaminophen overdose).
6. Liver Transplant:
   For end-stage liver disease or severe inflammation that does not respond to treatment, a liver transplant may be necessary.

Prevention of Hepatic Inflammation

• Vaccination: Get vaccinated against hepatitis A and B to prevent infection.
• Limit Alcohol Intake: Avoid excessive drinking to prevent alcoholic hepatitis.
• Healthy Lifestyle: Maintain a healthy weight, eat a balanced diet, and exercise regularly to prevent fatty liver disease.
• Safe Practices: Practice safe sex and avoid sharing needles to reduce the risk of viral hepatitis.
• Medication Safety: Use medications and supplements as directed, and avoid excessive use of over-the-counter painkillers like acetaminophen, which can harm the liver.