The liver performs numerous vital functions, making liver diseases particularly serious conditions requiring expert management and regular monitoring.
• Hepatitis B Virus
Disease Overview
Hepatitis B is a viral infection affecting the liver, ranging from acute self-limited illness to chronic infection with risk of cirrhosis and hepatocellular carcinoma. Chronic infection affects millions worldwide, particularly in endemic areas.
Symptoms
Acute hepatitis B may cause fatigue, nausea, abdominal pain, and jaundice, though many infections remain asymptomatic. Chronic infection is often silent until complications develop, emphasising the importance of screening in at-risk populations.
Diagnosis
Serological markers including HBsAg, anti-HBc, anti-HBs, HBeAg, and HBV DNA levels determine infection status, activity, and treatment requirements. Regular monitoring assesses viral load, liver function, and fibrosis progression.
Treatment
Chronic hepatitis B treatment aims to suppress viral replication and prevent disease progression. Antiviral agents including entecavir, tenofovir, and others achieve viral suppression in most patients. Treatment decisions consider viral load, liver inflammation, and fibrosis stage.
• Hepatitis C Virus
Clinical Course
Hepatitis C infection becomes chronic in approximately 80% of cases, with variable progression to cirrhosis over decades. The infection often remains asymptomatic until advanced liver disease develops.
Modern Treatment
Direct-acting antiviral (DAA) therapy has revolutionised hepatitis C treatment, achieving cure rates exceeding 95% with 8-12 week oral regimens. Treatment selection considers viral genotype, previous treatment history, and presence of cirrhosis.
Post-Treatment Care
Successful treatment eliminates the virus but doesn’t reverse established cirrhosis. Patients with advanced fibrosis require ongoing surveillance for hepatocellular carcinoma and monitoring for complications of portal hypertension.
• Non-Alcoholic Fatty Liver Disease
Disease Spectrum
NAFLD encompasses a spectrum from simple steatosis to non-alcoholic steatohepatitis (NASH) with potential progression to cirrhosis. The condition closely associates with metabolic syndrome, diabetes, and obesity.
Diagnosis
NAFLD is suspected in patients with elevated liver enzymes and risk factors, confirmed by imaging showing hepatic steatosis. Liver biopsy may be necessary to distinguish NASH from simple steatosis and assess fibrosis stage.
Management
Treatment focuses on lifestyle modifications including weight loss, dietary changes, and regular exercise. Management of associated metabolic conditions including diabetes and dyslipidaemia is essential. Various medications are under investigation for NASH treatment.
