Hepatitis and Cirrhosis: Similarities and Differences

What is the Difference Between Hepatitis and Cirrhosis?

woman on bed with hands over eyes
What is the difference between hepatitis and cirrhosis?. Tara Moore/Cultura/Getty

What are the differences between hepatitis and cirrhosis? How are the symptoms of the two diseases, the causes, and the treatments different and how are they alike?

Similarities and Differences Between Hepatitis and Cirrhosis

Hepatitis and cirrhosis are both diseases which affect the liver. There are important differences, but in general, hepatitis may or may not be reversible (curable) whereas cirrhosis refers to permanent scarring of the liver, often as the end result of chronic hepatitis.

As hepatitis and cirrhosis are in many ways on a continuum of disease, the symptoms may be very similar. While some forms of hepatitis may come on very rapidly, cirrhosis tends to develop more gradually.

Let's take a look at the symptoms which may occur with both diseases, a description of the basics of the diseases, and then outline some of the main similarities and differences.

General Symptoms of Liver Diseases

Liver disease symptoms may be present with hepatitis, cirrhosis, or any other conditions which results in dysfunction of or damage to the liver. These may include:

  • Jaundice - Jaundice, or a yellowish discoloration of the skin and the whites of the eyes (the sclera) is a common symptom of liver disease, but has many possible causes. Jaundice occurs due to a build up of bilirubin, a yellow pigment, in the blood (hyperbilirubinemia.) (Jaundice also occurs in babies but this is a normal physiological process.)  Jaundice can develop rapidly and dramatically (as with acute hepatitis or bile duct obstruction) or instead develop gradually and subtly.
  • Enlarged breasts in male patients - Enlarged breasts, referred to as gynecomastia are common with liver disease due an increase in estrogen caused by liver dysfunction.
  • Itching of your skin - Chronic itching (pruritis) is common with liver disease, and is due to bile salts which build up in the skin. This itching usually occurs without a rash.
  • Vomiting of blood - Vomiting of blood can be related to liver disease in several ways. One of the more ominous is esophageal varices. Esophageal varices are essentially varicose veins in the esophagus. Varicose veins in the legs develop due to poor blood flow in the legs causing blood to back up and pool, blood flow to the esophagus may reduced due to damage of the liver which causes portal hypertension, and increased blood pressure in the liver. Portal hypertension is much more common with cirrhosis than hepatitis, as scaring acts as a "kink in the hose" for blood vessels traveling through the liver.
  • Bleeding gums.
  • An enlarged liver - With hepatitis the liver often becomes tender and enlarged and can be felt below the ribs in the right upper quadrant of the abdomen. With cirrhosis, the liver often becomes small and firm, and may feel like a rock when it is felt in the upper abdomen.
  • Edema or swelling of your legs.
  • Bacterial peritonitis - Peritonitis refers to an infection in the abdominal cavity.
  • Ascites or also known as fluid in the abdomen - Ascites can cause abdominal swelling and bloating, and when severe, can result in shortness of breath due to the pressure of the abdomen pushing upwards on the chest cavity.
  • Sleep reversal and other sleep disorders.
  • Loss of consciousness.
  • Mental confusion or forgetfulness - One of the primary functions of the liver is to "detoxify" the blood, that is, remove toxins and other substances from the blood. When the function of the liver is compromised, these toxins can build up in the bloodstream. Hepatic encephalopathy is a condition which is characterized by lethargy, confusion, abnormal muscle movements, amnesia, and often a dramatic personality change. It is sometimes mistaken as Alzheimer's disease, but is in some cases, at least partly reversible.
  • Fatigue - Chronic tiredness, the kind of tiredness which does not respond to a good night of rest, is extremely common with both hepatitis and cirrhosis.

    The big list of acute hepatitis symptoms discusses more possible symptoms of hepatitis.

    Hepatitis vs Cirrhosis

    In order to understand the important similarities and differences between hepatitis and cirrhosis, it's helpful to first define and describe these two conditions. There is a significant overlap between these two conditions, which will be noted below.

    Hepatitis

    Hepatitis is the inflammation of the liver and can be caused not only by the well-known viruses such as hepatitis B, but a host of other things. Forms of hepatitis include:

    Infectious hepatitis - There are several infectious causes of hepatitis. These include hepatitis A, B, C, D, and E, as well as viral infections like infectious mononucleosis (Epstein-Barr virus) and cytomegalovirus.

    Drug-induced hepatitis - There are many drugs which can cause liver dysfunction.

    Alcoholic hepatitis - Alcohol can affect the liver in many ways such as alcoholic hepatitis, fatty liver, and cirrhosis.

    Obesity - Non-alcoholic fatty liver disease is a condition which is increasing in the United States which can progress into a disease known as NASH or non-alcoholic steatohepatitis. As with many other types of hepatitis, NASH can progress to scaring (cirrhosis) of the liver.

    Autoimmune hepatitis - Autoimmune diseases are those in which our bodies make antibodies against our own tissues.

    Toxin/chemical exposures - There are a number of compounds which are toxic to the liver from insecticides to chemicals found in ordinary household cleaners.

    Cirrhosis of the Liver

    Cirrhosis is the scarring of the liver. The liver is fairly unique in its ability to regenerate after injury, yet with repeated injury or chronic infections such as chronic hepatitis, this process is interrupted. Eventually, the liver becomes incapable of working effectively and scarring begins to develop.

    The causes of cirrhosis are essentially all of those which cause hepatitis, but overcome the ability of the liver to heal itself, such as when the insult to the liver is repeated or as with chronic infections. The most common causes in the United States include alcoholic liver disease and hepatitis C.

    Cirrhosis may also be caused by conditions other than hepatitis incuding hemochromatosis (a hereditary iron overload disease,) alpha-1-antitrypsin deficiency, a hereditary absence of an enzyme, and blocked bile ducts, such as with congenital biliary atresia (when the bile ducts are absent.)

    As cirrhosis worsens, the function of the liver is lost and, simultaneously, the organ becomes smaller and it solidifies. If you have an unhealthy liver, fluid accumulates in the legs and abdomen. Bile salts can easily build up in skin which can lead to jaundice and itching. Bleeding from the large veins in your GI tract and esophagus may also occur. Toxins can also accumulate in the blood which can result in confusion and mental slowing. For those individuals with advanced cirrhosis, the only true, absolute, treatment for this disease is a liver transplant. Unfortunately, there are many possible complications of cirrhosis including liver failure and liver cancer.

    Cirrhosis is also a condition where healthy liver tissue is replaced with nonfunctional scar tissue. This condition often occurs in individuals who don’t control their alcohol intake. According to research, there isn’t a medicinal cure for cirrhosis. Nonetheless, proper treatment will reduce the severity of the symptoms and slow the progression of the disease. The first step that you should consider to reduce the symptoms of cirrhosis is to stop drinking alcohol. If you continue to drink alcohol, it can lead to liver damage and premature death. New research is looking at further methods for preventing the progression of hepatitis to cirrhosis and the worsening of cirrhosis. For example, statins may reduce the risk of cirrhosis in people with liver disease. If you have hepatitis or have developed cirrhosis, it's important to find a specialist who is familiar with these studies.

    Similarities Between Hepatitis and Cirrhosis

    • Both hepatitis and cirrhosis are conditions involving the liver which can cause abnormal liver function tests and symptoms of liver dysfunction.
    • Both hepatitis and cirrhosis can lead to liver cancer, liver failure, or the need for a liver transplant.

    Differences Between Hepatitis and Cirrhosis

    There are many important differences between hepatitis and cirrhosis, even though they may be caused by the same thing.

    • Reversibility - By definition (scaring) cirrhosis is irreversible, whereas hepatitis may be completely reversible depending on the cause.
    • Blood tests - Liver enzymes (such as AST and ALT) are often very elevated with hepatitis, especially acute hepatitis. With cirrhosis, however, at least in the early stages, liver function tests may be only slightly abnormal.
    • Conditions other than hepatitis can lead to cirrhosis - For example, hemochromatosis, alpha-1-antitrypsin deficiency, and more can lead to cirrhosis.
    • Treatments - With hepatitis, the goal is usually to alleviate the disease, for example, treat the infection, remove a drug causing drug-related hepatitis, or decrease weight and increase metabolism with NASH. With cirrhosis, the scaring is permanent and cannot be treated. Therefore, the goal is to treat symptoms related to the cirrhosis and to prevent any further liver injury.
    • Symptoms - Portal hypertension (see above) leading to esophageal varices, an enlarged spleen, a low platelet count, and a low protein level in the blood (leading to other problems) are more common with cirrhosis than with hepatitis.

    Bottom Line on the Differences Between Hepatitis and Cirrhosis

    In many ways, hepatitis and cirrhosis are similar processes but on a continuum. Thankfully, many of the causes of liver inflammation which lead to cirrhosis are reversible in the early stages with good medical care. For example, quitting drinking can make an enormous difference in alcohol-related cirrhosis and treatment of chronic hepatitis C may help to prevent cirrhosis and the many complications of cirrhosis. It's been found that treatment of hepatitis C can result in the resolution of at least 90 percent of infections, yet many people are unaware that they have the disease until they develop cirrhosis. It's now recommended that not only people with risk factors for hepatitis be tested, but also anyone born between 1945 and 1965 should undergo hepatitis C testing.

    Sources:

    Faria, R., Woods, B., Griffin, S., Palmer, S., Sculpher, M., and S. Ryder. Prevention of Progression to Cirrhosis in Hepatitis C with Fibrosis: Effectiveness and Cost Effectiveness of Sequential Therapy with New Direct-Acting Anti-Virals. Alimentary Pharmacology and Therapeutics. 2016. 44(8):866-76.

    Kasper, Dennis L.., Anthony S. Fauci, and Stephen L.. Hauser. Harrison's Principles of Internal Medicine. New York: Mc Graw Hill education, 2015. Print.

    Li, J., Chaung, K., Nguyen, P., Le, A., Hoang, J., and M. Nguyen. Higg Rate of Progression to Cirrhosis in Chronic Hepatitis B (CHB) Patients with Non-Alcoholic Fatty Liver (FL). Gastroenterology. 2017. 152(5):Suppl 1:S1081-1082.

    Continue Reading