Archive for the Patient Category

What is Ascites?

The most common major complication of cirrhosis is ascites (pronounced “a-sigh-tees”). When pressure in the portal vein gets too high (called portal hypertension), fluid leaks out and builds up. This can make your abdomen enlarge like a balloon filled with water. Ascites might be diagnosed with a physical exam. You may need other tests like an ultrasound (to look for fluid) or paracentesis (to take a sample of the fluid for testing).

Ascites can be very uncomfortable. Eating can be a problem because you have less room for food. Even breathing can be a problem, especially when you’re lying down. It can also lead to fluid buildup in the space around your lungs (called pleural effusion or hepatic hydrothorax), or abdominal hernias – especially umbilical hernias (when tissue from inside the abdomen bulges out through a weak spot in the navel or belly button).

The most dangerous problem associated with ascites is an infection called spontaneous bacterial peritonitis (SBP), which can be life-threatening. Some symptoms of SBP are fever, abdominal pain, nausea and vomiting, or confusion. If you get spontaneous bacterial peritonitis (SBP), you will need antibiotics to treat it. After you recover, you will probably be prescribed another antibiotic to reduce your risk of getting SBP again.

Treatment

Treatment for ascites caused by cirrhosis can include more than one of the options listed below.

Low Sodium (Salt) Diet

Restricting sodium is an important part of ascites treatment. Too much sodium can make your body hold on to extra fluid. This fluid can pool in your belly, chest and legs. Eating foods with less sodium can help control ascites.

• Aim to eat less than 2000 mg of sodium a day.
• One teaspoon of salt has about 2300 mg of sodium.
• All types of salt contain the same amount of sodium, including table salt, sea salt, and Himalayan salt.

Tips to reduce sodium:

• At first, foods may taste bland. Over time, your taste buds get used to less salt.
• Don’t add salt to your food while cooking or at the table.
• Choose fresh, unprocessed, and homemade foods.
• Eat less processed, packaged, or restaurant foods.
• Limit condiments and sauces (ketchup, mustard, soy sauce, gravies, salad dressings).
• Limit pickled foods, olives, chutneys, and dips.
• To boost flavours, try adding spices, seasoning mixes with no salt added, lemon, lime, vinegar, fresh or dry herbs, garlic, or onions

To access liver-friendly recipes and cooking videos, click here

Read food labels

Diuretic Medicine

Diuretic medicines such as furosemide and spironolactone can also help to get rid of the fluid that has built up in the abdomen (belly) and other parts of the body. If you have ascites, your doctor may prescribe a diuretic for you to take.

If you are taking diuretics, it is important to weigh yourself daily to monitor the effect of diuretics. One litre of ascites weighs about 2.2 pounds (1 kg). Gradual weight loss is a sign of decreasing ascites – this is expected and desired when diuretics are first started. Losing weight too quickly can be dangerous.

You should also have your blood work checked as recommended by your healthcare team because diuretics can effect your kidneys and electrolyte levels. Your dose of diuretics can be adjusted by your healthcare team if you are losing weight too quickly, having side effects, or they don’t seem to be working.

Let your healthcare team know if you are experiencing:

• dizziness
• a decrease in urination
• confusion or sleepiness
• have ongoing or worsening swelling in your abdomen (belly)
• are losing weight too quickly: 2 pounds (0.9 kg) or more in a day, for 2 days in a row, OR more than 7 pounds (3.2 kg) in a week

Paracentesis

Paracentesis is a procedure used to remove ascites fluid.

Sometimes paracentesis is used to take a sample of the fluid for determining why it’s building up. Paracentesis might also be used if you have cirrhosis and the following circumstances:

• You have severe ascites. It’s causing extreme discomfort, abdominal pain, and difficulty breathing. A paracentesis treatment may relieve the discomfort before you begin treatment with one or more diuretics.
• You haven’t responded to the standard ascites treatment of a low-salt diet and diuretic medicines, or your body is unable to tolerate diuretic medications. This is the case in less than 10% of people with ascites. In this situation, you may require paracentesis repeatedly.
• Your doctor suspects the fluid is infected.

Other Treatments

Your healthcare team may recommend other treatment options. Options available to you will depend on lots of different factors like your age, other medical conditions and how sick your liver is. Some other treatment options might include:

• Transjugular intrahepatic portosystemic shunt (TIPS). This procedure that involves inserting a shunt to decrease portal hypertension by redirecting blood flow around the liver.
• Liver transplant. This is a major surgery where your liver is removed and replaced with a donor liver.
• Indwelling abdominal catheter. This is a special type of catheter that’s left in place for ongoing fluid drainage.

Hepatitis C is a contagious virus that can cause liver disease liver disease. it is sometimes called HCV for short.

Hepatitis means inflammation of the liver. When the liver’s inflamed (swollen and irritated), it has a harder time functioning properly. When this happens for a prolonged time, the liver starts to lose its ability to function, and a person may get sick.

Some people who get infected with hepatitis C never feel sick and recover completely. Others develop acute or chronic hepatitis C.

Risk Factors

Symptoms

The symptoms of hepatitis C are often mild. Most people carry the virus for years and don’t notice any symptoms. When they do notice symptoms, the most common ones are:

• “brain fog” (the sense that you’re not thinking and concentrating normally)
• fatigue
• joint pain
• loss of appetite
• weight loss

Diagnosis

You don’t need a liver biopsy to determine if you have hepatitis C. Usually, two lab tests are used to diagnose it: hepatitis C antibody (Anti-HCV) and hepatitis C RNA (HCV RNA).

Hepatitis C Antibody (Anti-HCV)

This is the first hepatitis C test your healthcare providers will perform. It will find out if your body has antibodies against hepatitis C. A positive result means that at some point in your life, you were exposed to the hepatitis C virus, and you developed antibodies to it. But it doesn’t tell us if you’re still infected. So, if this test is positive, your healthcare providers will perform the hepatitis C RNA (HCV RNA) test to find out if you’re still infected.

Hepatitis C RNA (HCV RNA)

The hepatitis C RNA (HCV RNA) test will be used to find out if you still have the virus in your body. If the HCV RNA test is positive, you have chronic hepatitis C and should be considered for treatment to clear it.

Genotypes

Hepatitis C genotypes are different strains of the hepatitis C virus. There are six genotypes around the world. In Canada, the more common genotypes are 1, 2, and 3. Genotypes matter very little now, because the newer treatments are effective against all genotypes. In many jurisdictions, genotypes are no longer tested or reported.

Treatment

Since 2010, the medical community has made enormous progress in treating chronic hepatitis C. New medications called direct-acting antivirals (DAAs) act on the virus itself to rid it from the body. This is different than older medications like interferon, which works by stimulating an immune response.

These newer treatments are very effective and have cure rates of over 95%. Interferon is no longer used for hepatitis C treatment.

The newer treatments take less time (between 8 to 12 weeks), have fewer side effects, and appear to be effective at all stages of the disease.

Because these treatments are newer, they’re still expensive. But the cost is generally covered by provincial drug benefit programs or private insurance companies. Virtually all patients in Canada can now access these life-saving treatments that cure hepatitis C.

Alternative Therapies

If you’re trying alternative therapies such as herbal remedies, homeopathic medicines, and minerals, tell your healthcare providers. Please note: no alternative therapies have been proven safe and effective for clearing (curing) hepatitis C.

Q&A

Hepatitis means inflammation of the liver. When the liver’s inflamed (swollen and irritated), it has a harder time functioning properly.

Hepatitis viruses cause inflammation. There are different types of hepatitis viruses such as hepatitis B and C. Other hepatitis viruses such as hepatitis A and E may cause serious inflammation of the liver, but they resolve on their own in most cases and don’t lead to cirrhosis.

Hepatitis B is a contagious liver disease that results from infection with the hepatitis B virus. It’s common worldwide. In regions where hepatitis B is most common, such as countries in Asia and Africa, at least one in five people may be infected with the virus.

Hepatitis B ranges in severity and can be either acute or chronic.

Acute Hepatitis B	Chronic Hepatitis B
A mild, short-term illness lasting a few weeks.	A serious, long-term, lifelong illness.
Happens within the first 6 months after someone is exposed to the virus.	Occurs when the virus stays in a person’s body.
Acute infection can—but doesn’t always—lead to chronic infection (chronic hepatitis B).	The younger people are when they’re infected with the hepatitis B virus, the greater their chance of developing chronic hepatitis B.

Causes

The hepatitis B virus is not in food or water. It’s in blood and other body fluids, and it’s contagious. It passes from person to person when blood, semen, or other body fluid infected with the virus enters the body of a person who’s not infected.

In North America, the vast majority of people with chronic hepatitis B have immigrated from an area where it’s common, such as Asia and Africa, and they were infected at birth.

Adults who get hepatitis B, usually through sex, will clear the infection themselves in about 99% of cases. Therefore, they will have only acute hepatitis B—not chronic—and will not have long-term health problems.

Hepatitis B is Not Passed By	Hepatitis B Can Be Passed By
Coughing or sneezing	Birth (spread from an infected mother to her baby during birth)
Hugging and kissing or other casual contact	Direct contact with the blood or open sores of an infected person
Sharing food, drinks, or eating utensils	Improperly sterilized equipment used during manicures and pedicures; medical or dental procedures; and tattoos and body piercing
Touching or shaking hands	Sex with an infected partner
Using toilet seats	Sharing needles, syringes, or other drug-injection equipment
	Sharing personal hygiene items with an infected person such as nail clippers, razors, or toothbrushes

Symptoms

What happens when you get hepatitis B depends largely on the age when you’re infected and how well your immune system copes with the virus.

You may have hepatitis B for years and never have any symptoms. You can still spread the virus to others even if you don’t have symptoms.

Acute Hepatitis B Symptoms and Complications

If you’re infected as an adult, you may have a brief illness with mild or moderate symptoms such as:

• abdominal discomfort
• dark urine
• fatigue (feeling tired all the time)
• jaundice (yellowing of the eyes and skin)
• loss of appetite (not feeling hungry)

If you’re infected as an adult, you have a 99% chance of clearing the infection and developing lifelong protection against the virus. The acute infection rarely leads to severe illness that requires a liver transplant (less than 1% of cases).

Chronic Hepatitis B Symptoms and Complications

Most babies and children exposed to the hepatitis B virus never have signs or symptoms. Unfortunately, they’re more likely to become carriers of hepatitis B for life because their immune system is unable to clear the virus from their body. In these cases, their chronic infection is often not detected until much later in life when:

• they’re screened because they come from an area where the virus is common or
• they become seriously ill with liver disease as adults.

Chronic hepatitis B goes through different phases that show how well your body’s coping with the virus. Most people have an inactive disease and stay healthy, but one in four will have an active disease. If untreated, this may lead to cirrhosis and/or liver failure. Liver cancer is also a risk for all patients with chronic hepatitis B. Therefore, screening for hepatitis B is important.

People who are healthy with an inactive disease are still at risk of the virus becoming active again. This can happen spontaneously, or when their immune system is weakened by other viral infections or medicines such as chemotherapy, especially corticosteroids.

Diagnosis

To confirm if you have hepatitis B, you’ll need lab tests such as the following:

Lab Test	If This Test is Positive, it Means:
Hepatitis B Surface Antibody (Anti-HBs or HBsAb)	You have antibodies against hepatitis B and are protected from getting the disease. You were either vaccinated against hepatitis B or exposed to it at some point in your life.
Hepatitis B Core Antibody (Anti-HBc)	You’ve been exposed to hepatitis B and have developed an antibody to just one part of the virus. This antibody does not give you immunity. You need more tests to find out if you have the disease.
Hepatitis B Surface Antigen (HBsAg)	You currently have a hepatitis B infection. You can spread the virus to others.
Hepatitis B e Antigen (HBeAg)	You may have very active hepatitis B and should be followed closely by your doctor. You may also need to take hepatitis B medications. You may be very contagious to others.

Treatment

Not all people with hepatitis B need treatment. Choosing the right time for treatment is not a simple decision. It’s based on the results of your lab tests, your age, and the amount of scarring and inflammation in your liver. A liver biopsy may also be required. If you have cirrhosis, you might be a candidate for treatment as well.

You will definitely need treatment if you have an active disease that causes a lot of damage to your liver. You’ll also need treatment if you’re going to take medications that weaken your immune system.

When and how to treat your hepatitis B are decisions between you and your doctor. Availability of medications may also vary based on health insurance plans.

Even if you don’t need treatment for your hepatitis B, you will need regular screening for liver cancer. This is done with abdominal ultrasound every 6 months. Cancers detected early may be cured. This screening needs to start at age 40 in males, age 50 in females, and at age 20 in those of African birth.

Types of Treatment Available

If you know you’ve been exposed to the hepatitis B virus in the last seven days, you can receive an injection of hepatitis B immune globulin. This might prevent you from developing the disease. Besides this, there is no treatment for acute hepatitis B.

There are two types of treatment for chronic hepatitis B:

1. Interferon. This is a medication given by needle. It’s rarely used due to its many side effects and the effective antiviral medicines noted below.
2. Antiviral medicines. These are oral medications (taken by mouth) and include adefovir, entecavir, lamivudine, telbivudine, and tenofovir. Hepatitis B can develop resistance to these drugs. To avoid this, remember to take your medications every day. Entecavir and tenofovir are the best choices with only a very small chance of the virus becoming resistant.

These medications can’t cure hepatitis B, but they do control the virus so that further damage to your liver can be prevented.

Taking Medications and Monitoring Your Hepatitis B

Your doctor will recommend hepatitis B medications if you have liver inflammation and a very active virus. These are indicated by a high viral load, which means a high amount of hepatitis B virus in your blood. You’ll also have a high level of ALT, one of the liver enzymes that helps the liver do its work. A high ALT level indicates the liver is being damaged.

Hepatitis B medications are important during phases of prolonged liver inflammation. Your healthcare providers will track the phase of your hepatitis B by the results of your lab tests. Because infected people go through various phases of hepatitis B, it’s recommended that they have lab tests regularly.

If you’re on hepatitis B medications, your healthcare providers will monitor you closely. You’ll need lab tests every 3 to 6 months to monitor your viral load and ALT level. You’ll also need other tests such as hepatitis B e antigen (HBeAg), and you’ll need to see your doctor regularly.

 

Q&A

Fatty liver disease is when fat builds up in the liver. The liver can be damaged and become enlarged. The scientific name for fatty liver disease is non-alcoholic fatty liver disease (NAFLD). It may take many years for NAFLD to become severe enough to cause liver damage.

When it does cause damage in some cases, the fat in the liver leads to inflammation and, with time, scarring. This more severe type of NAFLD is called non-alcoholic steatohepatitis (NASH). It may progress to cirrhosis and liver cancer.

Causes

Fatty liver disease occurs most often in people with diabetes, high blood pressure, obesity, or high cholesterol. These conditions tend to occur together, and when combined in one person, they’re referred to as metabolic syndrome. Metabolic syndrome is becoming increasingly common as our population becomes less active and eats an unhealthy diet.

Most people who have fatty liver disease are 40 to 50 years old and have one or more of the risk factors listed above. But fatty liver disease can happen in people who have none of these risk factors. We now even see it in children.

Symptoms

In the early stages of fatty liver disease, you may have no symptoms. Most people feel fine and don’t know they have it.

As the disease progresses and liver damage gets worse, you may have vague symptoms such as:

• an ache in the upper right part of your belly
• fatigue
• poor energy levels

Diagnosis

Fatty liver disease can be diagnosed with blood tests and radiology tests such as an ultrasound, CT scan, or MRI. A liver biopsy may also be needed. Talk to your healthcare provider if you’re overweight or if you have high blood sugar or cholesterol.

Hemochromatosis is an inherited disease that causes the body to absorb too much iron. It’s one of the most common genetic diseases in Canada, affecting about 1 in 300. Normally, people absorb only enough iron to meet the body’s daily requirements. The remainder is usually excreted through the bowels. But with hemochromatosis, the body keeps absorbing iron and storing it in different organs and tissues long after its needs are met.

Your liver is the first organ to store iron. When its storage capacity is exhausted, iron continues to build up in the heart, the skin, the pancreas, the pituitary gland, and elsewhere in the body. If left untreated, it can create damage in the liver, which may lead to liver failure and liver cancer. Likewise, damage to the heart can result in heart failure or sudden death, and damage to the pancreas may lead to diabetes.

Causes

Hemochromatosis is hereditary. To have the disease, a patient must have inherited two defective genes, one from each parent. Siblings of an affected person have a 25% chance of getting this disease. Children of a parent with hemochromatosis are less likely to be affected, since the other parent must be also be a carrier of the defective gene.

Symptoms

In people with hemochromatosis, the liver begins to retain iron at birth, but it may take 20 to 30 years before symptoms begin to appear. In the early stages of hemochromatosis, there may be no signs. But when symptoms show, they include:

• arthritis (swelling in the joints, particularly in the knees and the knuckles of the middle and index fingers)
• fatigue

In the later stages of the disease, symptoms include:

• abdominal pain or tenderness
• ascites (enlarged abdomen from fluid buildup)
• bronze or grey-coloured skin
• diabetes
• heart failure
• jaundice (yellowing of the skin and eyes)
• bleeding varices (enlarged veins in the esophagus)

Diagnosis

Doctors use blood tests to detect hemochromatosis. They measure iron levels in the blood and the total amount of iron deposited in the tissues. The most common tests are for transferrin saturation and serum ferritin.

A genetic test is the most common test used to diagnose hemochromatosis. This requires a blood sample, which is analyzed by a lab that specializes in DNA testing. This genetic test has eliminated the need for a liver biopsy in many patients with hemochromatosis.

But sometimes it’s necessary for your doctor to order a liver biopsy to see the extent of liver damage and check the amount of iron stored there.

If someone is diagnosed with hemochromatosis, their siblings and children over the age of 18 should be checked. Screening is most important for siblings, since they have a 25% chance of inheriting both the defective genes from their parents.

Genetic screening has allowed for diagnosis at birth, before iron overload sets in. But testing for hemochromatosis within families usually starts in the teen years rather than with children or infants.

Treatment

The first goal of treatment is to reduce the amount of iron stored in your body. This is usually done by a process called venesection or phlebotomy (blood letting) on a weekly basis. It’s a lot like donating blood.

Red blood cells contain iron. When you undergo phlebotomy, you lose red blood cells and excess iron (caused by hemochromatosis). This treatment can take months or even two or three years depending on the amount of excess iron in your body.

You must continue to have your iron levels monitored regularly, even after the phlebotomy treatment has removed the excess iron. Phlebotomy may be reduced to a less frequent “maintenance” level, for example four times a year.

Generally, phlebotomy treatment isn’t used for patients with cirrhosis and low hemoglobin levels.

Injury to the liver from hemochromatosis is reversible if you start treatment before cirrhosis develops. However, there is an increased risk of liver cancer in hemochromatosis patients who have cirrhosis.

Q&A

Primary sclerosing cholangitis (PSC) is a liver disease that causes inflammation and scarring in the bile ducts, making them shrink over time. (Bile ducts are small tubes that bile flows through from within the liver to the gallbladder and intestines). This inflammation results from immune cells attacking the bile ducts. PSC is called “primary” because the cause is unknown, “sclerosing” because of the scarring, and “cholangitis” because the inflammation occurs in the bile ducts.

Bile is a yellow-green fluid produced by your liver to aid digestion. When bile ducts are damaged by inflammation and scarring (cholangitis), bile and other substances collect in the liver, which in turn damages liver cells.

PSC may sometimes be confined to the bile ducts within the liver, but most often it also attacks the large bile ducts outside the liver. The disease affects both sexes, but it’s more common in men. It occurs in people mostly between the ages of 30 and 50.

Symptoms

The progression of PSC is unpredictable and not well understood. A person can have the disease for many years before symptoms show. The most common symptoms include:

• Chronic fatigue. This can range from mild to disabling.
• Itching. Known medically as pruritus, itching can range from mild to intense. It can be relentless, disrupting sleep and quality of life. This itching usually attacks the whole body and may be the result of the liver’s inability to process bile.
• Jaundice. This refers to yellowing of the skin and eyes.
• Episodes of fever, chills, and abdominal pain. These may be signs of an infection within the bile ducts. Any patient with PSC who has fever and chills should go to the nearest hospital emergency room immediately.

In its advanced stages, PSC may lead to extensive scarring in the bile ducts and eventually, liver failure.

As liver damage progresses in PSC, other symptoms may appear. These can affect parts of your body outside your liver. These symptoms are the same as for advanced liver disease from any cause.

Diagnosis

Because people with PSC may have no symptoms for many years, PSC is often diagnosed when patients show abnormal results from standard blood tests. Additional diagnostic tests such as MRI (magnetic resonance imaging) or ERCP (endoscopic retrograde cholangiopancreatography) may be necessary to confirm PSC.

ERCP combines the use of X-ray and an endoscope, which is a long, flexible tube. Through this form of endoscopy, your doctor can see inside your stomach and duodenum and inject dyes into your bile ducts. This creates a high-quality X-ray that can show strictures (narrowing) caused by inflammation in your bile ducts.

Treatment

There is no specific treatment for slowing the advance of PSC. Unfortunately, PSC is relentless over time. It leads to liver failure and the need for liver transplant with almost all patients.

However, doctors can treat PSC symptoms with varying success using antibiotics, vitamins, and medications.

To help relieve itching (pruritus), a common symptom, your doctor may prescribe various medications such as cholestyramine, antihistamines, or other drugs such as naltrexone or rifampicin. For patients with extreme itching, doctors will occasionally prescribe ultraviolet light therapy.

Sometimes, doctors will use ERCP to dilate a stricture or insert a stent in the bile ducts. This may alleviate jaundice and other symptoms over the short term.

Causes

The causes of primary biliary cholangitis (PBC) remain unknown. But current evidence suggests that PBC occurs in people with a genetic predisposition—in other words, there may be a hereditary factor. However, there may also be other factors that combine with genetics to trigger the disease.

Medical scientists believe that PBC is an autoimmune disease. This means that your immune system, which protects against infections and cancer, mistakes cells in the bile ducts as being abnormal and attacks them. (The bile ducts are small tubes that bile flows through from within the liver to the gallbladder and intestines.) Some factors—such as an infection or some form of toxic exposure from the environment—may trigger your immune system into making this mistake.

PBC usually develops and progresses slowly, which means that liver damage typically gets worse over a long period of time. Medication can slow this progression, especially if you get treated early. It’s important to note that PBC is not caused by alcohol consumption.

PBC used to be known as primary biliary cirrhosis.

Symptoms

The most common symptoms of PBC are fatigue and itching in any part of the body.

Many people have chronic fatigue. This can range from mild to disabling.

Itching, which is referred to medically as pruritus, can also range from mild to intense. It can be unrelenting to the point of creating stress for some patients. It often occurs on palms or soles of the feet and may be the result of the liver’s inability to process bile.

Additional PBC symptoms might include:

• gradual darkening of the skin
• small yellow raised areas under the skin (usually at the inside corners of the eyes)

Other symptoms not directly related to PBC are also often reported by people with PBC:

• arthritis
• dry membranes (nose, eyes, mouth, vagina)
• fingers and/or toes that change colour in the cold (Raynaud’s disease)
• thyroid problems

If liver damage gets worse, other symptoms may appear. These can affect parts of your body outside your liver. These symptoms are the same as for advanced liver disease from any cause.

Many people with PBC never develop any symptoms related to the disease.

Diagnosis

PBC is usually diagnosed with the following blood tests:

• Antimitochondrial Antibody (AMA). An antibody is a protein made by your body’s immune system to attack an “invader.” AMA is an important indicator of PBC.
• Alkaline Phosphatase (ALP or Alk-Phos). Another sign of PBC is increased levels of ALP (also commonly called alk-phos). Alk-phos is an enzyme released into the blood by damaged bile ducts.
• Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST). Increased levels of these enzymes may not be as common in PBC as increased alk-phos. They measure inflammation relating mainly to liver cell damage or destruction rather than cell damage in the bile ducts. (Note: ALT is also known as alanine transaminase. AST is also known as aspartate transaminase.)
• Immunoglobulin (IgM). Increased levels of IgM can also be an indicator of PBC.

Other tests might include:

• Abdominal ultrasound. This is done to check the condition of the bile ducts and ensure there’s no other cause of decreased bile flow out of the liver.
• Liver biopsy. Doctors use this test to view the condition of the liver at the cellular level.

Treatment

PBC is a chronic liver disease: a lasting condition that can be controlled in most people but not cured. The prognosis for people with PBC has improved over the last two decades due to earlier diagnosis and improved treatment. Early access to treatment can delay the progression of the disease. Treatment improves outcomes for people with PBC, and sometimes, it can even improve outcomes so that they are similar to people without the disease.

Medications

A drug called ursodeoxycholic acid (also called UDCA or URSO) mimics a bile acid your body produces naturally. URSO can improve liver function and slow the onset of fibrosis (scar tissue) in the liver. In turn, this can delay or eliminate the possibility of liver failure and the need for a liver transplant. 80 to 90% of people with PBC on URSO manage to avoid the need for a liver transplant after 10 years. Patients usually take this drug indefinitely. Fortunately, it’s well tolerated and has minimal side effects.

Researchers are working on new medicines to treat PBC, typically for use with URSO. Obeticholic acid (OCA), a manufactured bile acid that helps reduce liver inflammation and cholestasis (restricted bile flow), is available in Canada.

To help relieve itching (pruritus), a common symptom, your doctor may prescribe various medications such as cholestyramine, antihistamines, or other drugs such as naltrexone or rifampicin. For people with extreme itching, doctors will occasionally prescribe ultraviolet light therapy.

Other Treatments

Your doctor will also discuss other treatments for you to consider. These can include calcium and vitamin D to preserve your bone health. It may also involve other fat-soluble vitamin supplements and treatments for managing symptoms such as dry eyes, mouth, or vagina.

The best way to describe autoimmune hepatitis is to break down the term “autoimmune.” Autoimmune refers to the body’s own immune system attacking another part of the body. In this case, the immune system attacks the liver and causes liver inflammation.

Autoimmune hepatitis is not contagious. Also, it’s not considered an inherited disease. But a tendency to autoimmune diseases may run in some families.

Causes

We don’t yet know exactly why or how the body’s immune system attacks its own liver. But we do know it happens because of a mistake made by certain types of white blood cells, the cells that fight infections. It appears that white blood cells misread liver cells as harmful foreign substances and attack them. This causes liver inflammation. With time, this ongoing inflammation might lead to fibrosis (scarring of the liver) and eventually cirrhosis (severe scarring of the liver).

Several other things can cause identical patterns of liver damage. These include viruses such as hepatitis B and hepatitis C, certain types of drugs, and an overload of certain metals in the liver such as copper and iron. There are also other causes that are very rare.

Symptoms

In many people, there are no symptoms at all. They feel perfectly healthy. Other people may experience:

• aches or pains in the muscles or joints
• decreased appetite
• drowsiness
• fatigue
• jaundice (yellowing of the eyes and skin)

Diagnosis

Autoimmune hepatitis may be detected with a series of blood tests.

The initial clue from blood tests is high levels of ALT and AST, which are two enzymes made by the liver. However, ALT and AST levels go up in many liver diseases or conditions, so the next step to diagnose autoimmune hepatitis is to measure specific antibodies directed against parts of different cells. These are called autoantibodies.

Your doctor will also examine you and may find signs such as a large liver and jaundice.

Finally, a liver biopsy is usually necessary to confirm the diagnosis, determine the extent of liver damage, and ensure there aren’t co-existing liver conditions.

Treatment

Since we don’t know exactly what causes autoimmune hepatitis, we don’t yet have a medical cure. But we do have effective treatments.

If the disease is mild or inactive, you might not need any type of treatment. When medications are needed, corticosteroids are the first treatment of choice. Corticosteroids are different from anabolic steroids, which are used to build muscle mass. Corticosteroids such as prednisone are potent anti-inflammatory drugs. They reduce inflammation throughout the body, including the liver. There are side effects, however, so your doctor will try to use the smallest amount possible to control the disease.

Your doctor may also prescribe other anti-inflammatory drugs such as azathioprine, methotrexate, or mycophenolate mofetil. All these drugs have side effects your doctor will explain in detail. These can also help to limit the dose of corticosteroids you require.

After drugs have reduced the initial inflammation caused by autoimmune hepatitis, about 90% of people need ongoing treatment to stay in remission. This treatment is usually azathioprine. About 10% don’t need ongoing treatment. They remain in remission with no symptoms and no active inflammation in the liver for many years. But they do require monitoring with simple blood tests.

Since the intensity of the disease goes up and down, some people suffer from relapses—even those who have been receiving ongoing treatment. Relapses are usually treated by a temporary course of corticosteroids.

Note: This section was adapted (with permission) from content on the website of the Canadian Liver Foundation.