Toxic Hepatitis

1 What is Toxic Hepatitis?

Toxic hepatitis is a condtion that arises when the liver is inflamed due to exposure to certain substances. Toxic hepatitis can be caused by alcohol, chemicals, drugs or nutritional supplements. In some cases, it can develop within an hour or days after the initial exposure to a toxic substance. In other settings, it takes months of regular use for the signs and symptoms to show up.

The symptoms of toxic hepatitis often disappear when the intoxication ceases. However, toxic hepatitis can permanently damage the liver, leading to irreversible scarring of liver tissue also known as cirrhosis and in other cases can lead to liver failure.

2 Symptoms

 Mild forms of toxic hepatitis can be detected only by blood tests and may not cause any symptoms whatsoever. When the signs and symptoms of toxic hepatitis occur, they may include the following:

  • Yellowing of the skin and eyes (jaundice)
  • itching
  • abdominal pain in the right upper portion of the abdomen
  • fatigue
  • loss of appetite, nausea, vomiting, rash
  • weight loss and dark or tea-coloured urine.

3 Causes

There are several causes of toxic hepatitis.

Toxic hepatitis occurs when the liver is inflamed due to the exposure to toxic substances. It can also develop when too much prescription or over-the-counter medication are taken. One of the liver's many role involves removing and breaking down of most drugs and chemicals from the bloodstream.

Breaking down these toxins creates by products that can be damaging to the liver. Although the liver has a great capacity for regeneration, constant exposure to a toxic substance can cause serious and in some cases, irriversible harm.

Toxic hepatitis can be caused by:

  • Heavy drinking over many years which can lead to alcoholic hepatitis.
  • Over-the-counter medications which include nonprescription pain relievers such as acetaminophen, aspirin, ibuprofen and naproxen can damage the liver, especially if taken frequently or combined with alcohol.
  • Common chemicals that can cause liver damage include:
    • the dry cleaning solvent carbon tetrachloride,
    • a substance used to make plastics called vinyl chloride,
    • the herbicide paraquat,
    • a group of industrial chemicals called polychlorinated biphenyls.

4 Making a Diagnosis

Making a diagnosis of toxic hepatitis is done by performing several tests and procedures.

One must make a medical appointment with their family  doctor or a general practitioner if they have any worrying symptoms. If one has a liver problem such as toxic hepatitis, they are likely to be referred to a liver specialist or a Hepatologist. Because appointments can be brief, and because there is often a lot to cover, it is a good idea to be well prepared before the appointment.

Here is some informaton that can get one ready for their appointment:

  • A the time of the appointment, it is very important to be sure to ask if there is anything needed to be done in advance, such as making diet restrictions.
  • Writing down the symptoms experienced, including any that may seem unrelated to the reason to which the appointment has being scheduled.
  • It is also advisable to write own key personal information, including any major stresses or recent life changes.
  • Making a list of all medications, vitamins or supplements taken.
  • Taking a family member or a friend is also advisable in case certain information is overlooked or forgotten.
  • Write down questions to ask the doctor.

For toxic hepatitis, some basic questions to ask your doctor include:

  • What is likely causing my symptoms or condition?
  • Are there other possible causes for my symptoms or condition?
  • Is my liver damaged?
  • What kind of tests do I need?
  • Is my condition likely temporary or chronic?
  • What is the best course of action?
  • What are the alternatives to the primary approach that you're suggesting?
  • I have these other health conditions. How can I best manage them together?
  • Are there any restrictions that I need to follow?
  • Should I see a specialist?
  • What will that cost, and will my insurance cover it?
  • Is there a generic alternative to the medicine you're prescribing me?
  • Are there brochures or other printed material that I can take with me?
  • What websites do you recommend?
  • What will determine whether I should plan for a follow-up visit?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time. The doctor is also likely to pose a number of questions. Being ready to answer them may allow more time to cover points that need to be adressed. The doctor may ask:

  • When did you begin experiencing symptoms?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms? What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • What prescription and over-the-counter medications are you taking, and have you started any new medications recently?
  • Do you take herbal or nutritional supplements?
  • How much alcohol do you drink and how often?
  • Have you noticed yellowing in the whites of your eyes?
  • Has your urine color appeared darker?
  • Does anyone in your family have a history of liver disease?

Tests and procedures used to diagnose toxic hepatitis include:

  • The doctor will likely perform a physical exam and take a medical history.
  • It is very important to go to the appointment with all medications being taken, including over-the-counter drugs and herbs, in their original containers.
  • Tell your doctor if you work with industrial chemicals or may have been exposed to pesticides, herbicides or other environmental toxins.
  • The doctor may also order blood tests that look for high levels of certain liver enzymes. These enzyme levels can show how well the liver is functioning.
  • Imaging tests can also be carried out  to create a picture of the  liver using ultrasound, computerized tomography (CT) or magnetic resonance imaging (MRI). 
  • A liver biopsy can help confirm the diagnosis of toxic hepatitis. During a liver biopsy, a needle is used to extract a small sample of tissue from the liver. The sample is examined under a microscope.

5 Treatment

Treatments for toxic hepatitis include:

  • Stopping exposure to the toxin. Doctors can work to determine what is the cause  of the liver damage. Sometimes it is clear what is cusing the symptoms, but sometimes it takes more detective work to determine a cause.
  • Medication to reverse the liver damage caused by acetaminophen. If liver damage was caused by an overdose of acetaminophen, a chemical called acetylcysteine can be given right away.
  • People with severe symptoms are likely to receive supportive therapy in the hospital, this includes intravenous fluids and other medication to relieve nausea and vomiting. when liver function is severely impaired, a liver transplant may be the only option.
  • A liver transplant is an operation to remove a diseased liver and replace it with a healthy liver from a donor. Most livers used in liver transplants come from deceased donors. In some cases, livers can come from living donors who donate a portion of their livers.

6 Prevention

Because it is not possible to know in advance how one will react to a particular medication, toxic hepatitis cant always be prevented. However, the risks of liver problems may be reduced in the following ways:

  • Limiting medications by taking prescription and nonprescription drugs only when absolutely necessary. It is also avantageous to investigate on nondrug options for common problems like high blood pressure, high cholesterol and arthritis pain.
  • One must always take medication as directed. Because the effects of over-the-counter pain relievers sometimes wear off quickly, it is easy to take too much.
  • One must also be cautious with herbs and supplements. It is not advisable to assume that a natural product is harmless. It is not advisable to mix alcohol and drugs.
  • If one works work with or uses hazardous chemicals, they are advised to take all necessary precautions to protect themself from exposure. 

Keep all medications and vitamin supplements away from children and in childproof containers so that children can't accidentally swallow them.

7 Risks and Complications

Factors that increase the risk of toxic hepatitis include:

  • Taking over-the-counter pain relievers that carries a risk of liver damage, thus, increasing the risk of toxic hepatitis.
  • Having a serious liver disease such as cirrhosis  or fatty liver disease make one more susceptible to  the effects of toxins.
  • Having viral heptitis caused by hepatitis B or C viruses increases the vulnerability of the liver.

Another risk is aging. Drinking alcohol while taking medication increases the toxic effect of most drugs. Because women seem to metabolize certain toxins slower than men do, their livers are exposed to more blood concentrations of harmful substances for longer periods of time. This increases the risk of toxic hepatitis. Inheriting certain genetic mutations that affect the production and action of liver enzymes that break down toxins may make one more susceptible to toxic hepatitis. 

Working with certain industrial chemicals can put one at risk of toxic hepatitis.The inflammation associated with toxic hepatitis can lead to liver damage and scarring. Over time, this scarring, called cirrhosis, makes it difficult for your liver to do its job. Eventually cirrhosis leads to liver failure. The only treatment for chronic liver failure is to replace the liver with a healthy one from a donor (liver transplant).

8 Related Clinical Trials