Chronic Hepatitis and Cirrhosis

Chronic hepatitis refers to the presence of inflammation and necrosis in the liver for more than six months, although pathologists admit this is a somewhat arbitrary designation. Rather than defining hepatitis as chronic, the medical emphasis is to note the specific etiological and pathological factors involved in the disease, e.g. chronic HCV with periportal inflammation, autoimmune hepatitis with cirrhosis, etc.

HBV and HCV are the major causes of chronic hepatitis, mediated through the host response to infection, rather than the virus itself. Iatrogenic causes of chronic hepatitis include drugs such as isoniazid, methyldopa, nitrofurantoin, and acetaminophen, although many more can be added to this list. The role of alcohol in chronic liver disease has already been discussed in detail.

The clinical features of chronic hepatitis includes lethargy, anorexia, and fatigue, sometimes with low-grade fever and epigastric discomfort. In many cases there will be no noticeable evidence an overt pathology, and characteristic signs of liver injury such as jaundice, as splenomegaly, spider nevi, ascites may only evolve over a period of several years. In the autoimmune variant of hepatitis that tends to be more common in women, there can be systemic complications including acne, amenorrhea, joint pain, ulcerative colitis, fibrosis of the lungs, thyroiditis, nephritis, and hemolytic anemia. The overall prognosis for chronic hepatitis is highly variable, depending upon the removal of etiological factors (e.g. drugs or alcohol). In cases of HBV or HCV liver inflammation and damage progresses slowly, and are difficult to treat with standard medical therapies, although the many hepatoprotective herbs such as Turmeric (Curcuma longum), Milk Thistle (Silybum marianum), and Amalaki (Phyllanthus emblica) would seem to be indicated. Autoimmune forms of chronic hepatitis are generally treated with immunosuppressive drugs such as corticosteroids, and although they can be effective in limiting the acute manifestation of disease, the side-effects can promote immunodeficiency. (Berkow 1992; Rubin and Farber 1990, 402-10)

Cirrhosis is the end stage of any chronic liver disease, in which the functional liver essentially devolves into a shrunken, fibrotic cord of tissue that surrounds small nodules functional hepatocyes. Fibrosis can occur as the result of chronic infection (e.g. viral hepatitis), chronic exposure to toxins (e.g. drugs, alcohol), autoimmune mechanisms, biliary obstruction, vascular impairments, or some combination of these factors.

The clinical manifestations of cirrhosis can range from an asymptomatic state that can exist for years, to more generalized symptoms such as asthenia, poor appetite, lethargy, and fatigue. If the fibrosis has progressed such that bile flow is obstructed jaundice is its natural evolute, with accompanying indications of poor appetite, poor fat digestion, and eventually, essential fatty acid and fat-soluble vitamin deficiencies. Upon palpation the liver is often firm and displays a blunt edge, but in other cases the liver may be too small to palpate. Ascites is a potential presentation and may be present with splenomegaly. With portal hypertension cirrhosis can present as a life-threatening esophageal or gastric bleeding secondary. (Berkow 1992; Rubin and Farber 1990, 418-20)

Holistic treatment

The holistic treatment of chronic hepatitis is essentially the same as that for viral hepatitis, without necessarily using herbs that have antiviral activities. In end-stage conditions, the treatment is more or less symptomatic.