HEPATITIS
Definition:
Inflammation of the liver characterized by patchy or generalized heptatocellular necrosis
Etiology:
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4 major types of hepatitis (A, B, C and D)
disease is viral in origin and although types A, B and D can be distinguished by their antigenic properties, all four
display a clinically similar picture; other less common infective causes of hepatitis include:
a. infectious mononucleosis
b. yellow fever
c. cytomegalovirus
d. leptospirosis
hepatitis maw also follow exposure to substances like carbon tetrachloried, benzene, tetracyclines, amanita
mushrooms, arsenic and alcohol
Hepatitis A:
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Hepatitis B:
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Hepatitis C:
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Hepatitis D:
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associated microorganism is an enterovirus and the disease is spread by the fecal-oral route
it is contagious during the incubation period of 2-6 weeks but only for a few days once symptoms appear
epidemics are frequent, as the virus is spread very easily through food and water
often, the disease ma be so mild it is unrecognized and only blood work would discern the virus’s presence
no carrier state
does not lead to chronic liver disease
unlike the other hepatitis types which are seen in all ages equally, hepatitis A is seen mostly in children
and young adults
incubation: 4-25 weeks (average is 30 days)
has a more varied range of expression, including subclinical carrier state, acute hepatitis, chronic hepatitis,
post-hepatic necrosis and liver cancer
spread parenterally, most notable through the infected needles of drug addicts, sexual contact and blood
out of body (has a 7 day life span outside of body)
risk of accidental transmission: medical personnel, esp. surgeons, dentists, dialysis staff, lab technicians
and others in contact with blood
presents with similar incubation time, biologic and clinical pictures as of hepatitis B
spread parenterally, most commonly through transfusion
lead to chronic hepatitis
lead to a chronic carrier state
can only infect a person who is in a carrier state of hepatitis B
Signs and Symptoms:
May range from a minor flu-like illness to a severe liver disease ending in hepatic failure and death; there are usually
several distinct stages:
Anicteric phase:
1. malaise
2. fever
3. aversion to cigarettes
4. altered liver function tests
Preicteric phase:
1. anorexia, N/V
2. malaise
3. fever
4. weakness
5. h/a
6. myalgia
7. enlarged, tender liver
8. dark urine
9. occasionally a patient will experience arthalgias and hives
Jaundice phase:
1. follows 3-10 days later
2. dark urine and jaundice including the sclera; jaundice worsens for 1-2 weeks and then gradually
disappears during the 2-4 week recovery period; when the jaundice, most the patients begin to feel
better, as the systemic symptoms decline
3. liver enlarged and tender; the edge is smooth
4. mild splenomegaly is present in 15-20% of patients
Lab Findings:
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HEPATITIS
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AST/SGOT: 1000-3000 units (does not correlate with disease severity)
ALT/SGPT: 1000-3000 units (does not correlate with disease severity)
(+) urinary bilirubin
(+) serum bilirubin (usually direct)
WBCs; low normal
differential: atypical lymphocytes
Hepatitis A:
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Hepatitis B:
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Hepatitis D:
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Course/Prognosis:
Hepatitis A:
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Hepatitis B:
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Hepatitis C:
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viral antigen HAAg during acute infection
IgM: appears early in the disease but disappears after a few weeks
IgG (anti-HA): appears a few weeks, and probably persists for life
active infection is recognized by the presence of hepatitis B surface antigen (HBsAg), which can appear
1-6 weeks before clinical disease is evident; it usually disappears during convalescence
related antibody (HBsAb) appears weeks to months later and usually; persists for life
in 10% of patients, HBsAg persists and HBsAb does not develop; these patients are likely to develop
chronic hepatitis or become subclinical carriers of the virus
the antibody (HBcAb) to the core antigen of the virus (HBcAg) typically appears at the beginning of the
disease, signifying viral replication and gradually decreases from then on
the antigen (HBeAg) is only found in HBsAg (+) serum: the meaning of its presence is debatable, although
it is generally thought to presage more serious sequelae, unless its antibody (HBeAb) is also present
in acute infection, anti-D antibody of IgM is detectable in the serum
serum shows large anti-D titers of both IgG and IgM if the disease becomes chronic
prognosis is very favorable
the disease is usually mild and benign
no carrier state exists
typically lasts for 4-8 weeks
conventional treatment and prophylaxis comprises injection of immune globulin
prognosis is guarded and is worse with age and debility
the disease can be severe and 5-10% of patients will develop the chronic state
carrier state
prophylactic treatment comprises injection of hepatitis B vaccine
prognosis is guarded
the disease is moderate in expression
carrier state can follow in 10-50% of patients
no conventional treatment
Rarely, hepatitis may develop into:
a. submassive hepatic necrosis (fatal in about 20%)
b. fulminant hepatitis (70-95% mortality)
Differential Diagnosis:
1. hepatitis variants
2. other abdominal infections
3. bile duct obstruction
4. infectious mononucleosis
Nutrition:
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high protein, lacot-ovo vegetarian diet
high fiber diet
dandelion greens, burdock root, mustard greens, black radish, apples and saffron, watercress, beets, parsley,
artichokes, cherries, grapefruit, parsnips, endive, garlic, onion, chicory, carob, horseradish, kumquats, limes,
quinces, grapes, wheat germ, lecithin, yogurt, tofu, soy, Ganoderma mushrooms
Remedies:
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lemon juice mixed with water, upon rising in the morning 30 min. before eating
eat 3-4 oz. fresh white mushrooms TID
take 4 oz. fresh grapes and boil in 1 pint water until reduced by half, drink and eat
Avoid:
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HEPATITIS
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saturated fats, meat, trans-FAs, hydrogenated oils (margarine, vegetable shortening, imitation butter spreads, most
commercial peanut butters, oxidized fats [deep fried foods, fast foods, ghee, BBQ meats])
hot sauces, spicy, fried, fatty, rich and/or salty foods
cow’s milk and dairy products
refined and processed foods, white bread
refined simple carbohydrates: sucrose, white flour, sugar and sweet foods
catarrh forming foods: tofu, meat, ice cream, shellfish
alcohol, coffee, caffeine
Supplements:
1. vitamin B-12 (IM)
2. vitamin B-12 and folic acid
3. vitamin C (40-100mg QD)
4. catechin
Hydrotherapy:
1. hot enema: to relieve liver pain
2. lower-half body pack: while also applying thick steam pack over the lower chest and upper abdomen for 15 min.,
then give thorough cold rub and repeat 4 times, do this once a day for several days
3. cold water: applied over lower portion of right chest and epigastrium to enhance liver circulation
4. heating compress: around abdomen over night, for chronic hepatitis
5. poultice: over liver of clay, cabbage or bran-cabbage-onion
6. castor oil pack
7. wet sheet pack
8. constitutional hydrotherapy
Physiotherapy:
1. breathing exercises (chronic)
2. walking daily (chronic)
3. stretching exercises: for trunk
4. no strenuous exercise
5. massage: abdominal self-massage, use circular motion from lower right chest to upper right abdomen, 100-200
times
6. spondylotherapy: concussion T7
Botanicals:
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Aconitum napellus (toxic): according to indications
Achillea millefolium: as compress for warm to liver
Atropa belladonna (toxic): onset of inflammation (according to indications)
Berberis spp.: cholagogue, cholecystitis, cholelithiasis, jaundice
Bryonia alba (toxic): chronic with deep seated soreness and quick, shooting pains esp. with some elevation in
temperature
Chelidonium majus (toxic): chronic
Cichorum intybus: jaundice
Chionanthus virginica: chronic
Conium maculatum (toxic): pains of chronic hepatitis
Podophyllum peltatum (toxic): chronic
Silybum marianum
Taraxacum officinale: jaundice
Veronicastrum virginicum
Nutritive and tonic herbs:
Eleutherococcus senticosus, Medicago sativa, Panax spp., Rumex officinalis, Taraxacum officinale, Urtica dioica
Formulas:
a.
Veronicastrum virginicum + Ceanothus americanus + Urtica urens + sunlight and vitamins A, B, C, E
Homeopathy:
1. Bryonia: sticking pain < coughing, deep breathing, > lying painful side; thirsty for cold water; nausea while sitting in
bed; weakness < getting up, before noon
2. Chelidonium: dirty yellow, esp. sclera, face, palms; violent pruritis; pain > eating; desire warm drinks; bilious
vomiting
3. Cinchona: pain < touch, light pressure, > strong pressure, gigantic abdominal distention from gas; tympanism not >
passing flatus; great weakness
4. Chionanthus virginica: dull pain; enlarged, painful liver, icterus; variable stools
5. Lycopodium: pain < right side, palpation, touch, eating to satiety; great abdominal flatulence; < on waking, 4-8pm
6. Mercurius solubilis: profuse sweat doesn’t ameliorate; excessive salivation; pain < touch, lying right side
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HEPATITIS
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Natrum sulphuricum: great amelioration after bowel movement; pain < lying left side; noisy flatus which ameliorate;
diarrhea < before rising or morning
Phosphorus: hypertrophied liver; unable to lie on right side; intense thirst for cold; fear of death
Ptelea: sensation of stone in epigastrium; frontal h/a; bitter taste
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