Hepatitis (Viral)

Viral Hepatitis Overview:

Hepatitis refers to swelling of the liver. Though there are numerous causes for hepatitis, the most important to consider in the case of acute hepatitis is viral hepatitis. There are numerous virus' that can cause this condition, mainly Hepatitis A virus, Hepatitis B virus, and Hepatitis C virus. All are unrelated but cause a similar set of symptoms.

 

Aetiology:

Viral hepatitis first involves inflammation and acute infection of the liver (worse with Hep B abd C). The hepatic cells can become necrotic, resulting inflammation, fibrosis, in eventual scarring (cirrhosis).

If the acute infection is severe enough it may occlude the intrahepatic bile cannaliculi, causing jaundice. This happens because the death of hepatocytes lining the bile ductules, allowing conjugated bilirubin. Uncongegated bilirubin also increases as a result of a reduction in hepatocytes able to conjucate bilirubin.

Hepatitis A virus (HAV)

  • Transmitted via fecal-oral contact
  • Acute infection only (not chronic)
  • Detected via HAV IgM antibody (active) or HAV IgG antibody (Recovery or vaccination)

Hepatitis B virus (HBV)

  • Transmitted via the blood
  • Acute and chronic infection possible
  • Closely linked to liver cancer
  • Detected via HBV antigens (HBsAg, HBcAg, HBeAg)

Hepatitis C virus (HCV)

  • Transmitted via the blood and sexual contact
  • Acute and chronic infection possible
  • Detected via HCV RNA testing (PCR)

Hepatitis D virus (HDV)

  • Can only infect if the host has HBV
  • Detected via HDV IgG (active) and HDV IgM (active)

Hepatitis E Virus (HEV)

  • Transmitted via fecal oral contact
  • Acute infection only (not chronic)
  • Detected via HEV IgM antibody (active) or HEV IgG antibody (recovery)

Other Viruses

  • Epstein Barr virus (EBV)
  • Herpes simplex 6 virus (HSV-6)
  • Coxsackie virus
  • Human parvovirus (HPV) Cytomegalovirus
 

Special Considerations:

  1. Depending on the type of virus causing the condition, treatment will be different. All of these viruses except the hepatitis A virus are enveloped. Therefore herbal treatments including St John's wort will be of value for the enveloped, but less towards the non-enveloped strains of virus. These are important considerations to make in the treatment of this condition. Not all viral hepatitis is the same.
  2. Hepatits A can be effectively treated with herbal medicine, however, hepatitis B, and C, can generally only be maintained with herbal medicine. They will eventually lead to chronic hepatitis. 
  3. Higher doses will be required for acute stages of hepatitis than chronic. 
 

Symptoms:

Fever

Hepatomegaly

Fatigue

Malaise

Nausea

Pain In The URQ

Frequent Infection

Jaundice

Dark Colored Urine

 

Diagnostic Considerations:

Screenshot 2018-03-09 13.28.04.png

Clinical Phases:

  1. Prodrome phase
  2. Icteric phase
  3. Recovery phase
  4. Chronic phase

Findings

  • Atypical lymphocytosis
  • ALT will be higher than AST, but both will be elevated
  • Bilirubin will be increased
  • High urobilinogen in the urine (as a result of reabsorped UBG not able to to be processed effectively in the liver).
 

Therapeutic Aims:

1. Reduce Fever If Present With Diaphoretics

Diaphoretics are indicated in all cases of fever with acute hepatitis. Often combined with a diffuse stimulant like Zingiber officinalis.

  • Diaphoretics (Taraxicum officinale)

2. Reduce Viral Numbers

Consider whether the invading virus is enveloped or not.

  • Antivirals (Melissa officinalis, Hypericum perforatum)

3. Improve Immune Function

Improves the bodies ability to manage viral load.

  • Immunomodulators(Ganoderma lucidum, Eleutherococcus senticosus)

4. Improve Liver Function

  • Hepatotrophorestoratives (Silybum marianum)

5. For Chronic Hepatitis Use Smaller Doses For Longer

Also include antioxidant treatments and cytoprotectives to offer further protection to the hepatocytes.

  • Antioxidants (Curcuma longa)
 

Differential Diagnosis:

  • Alcoholic fatty liver disease
  • Non-alcoholic fatty liver disease
  • Liver cancer
 

Cautions:

Many viral causes of hepatitis are infectious diseases.

 

Herbs For Viral Hepatitis

  • Antivirals
    • Phyllanthus
    • thuja
    • hypericum
  • Diaphoretics (in the case of fever)
    • yarrow
    • tilia
    • sambucus
  • diffuse stimulants
    • ginger
  • Immune enhancers
    • echinacea
    • andropgraphis
  • Hepatoprotectives
    • silybum
    • bupleurum
    • taraxicum
    • cynara
    • andrographis
 

Author:

Justin Cooke

The Sunlight Experiment

Updated: May 2018


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