Is chronic viral hepatitis serious?

The severity of chronic viral hepatitis cannot be generalized. In mild cases, you may live with it peacefully throughout your life without affecting the quality of life and longevity. In severe cases, it may progress to decompensated cirrhosis, liver cancer, or even liver failure in just a few years. The difference is so big that you can’t believe it.

I have been in the hepatology department for almost ten years, and the two hepatitis B patients of the same age who particularly impressed me were both diagnosed with major yang in physical examination when they were 32 years old. Their viral amounts were similar and their liver functions were normal. One of them is particularly caring. He strictly follows the doctor's instructions to recheck the viral load, liver function, liver B-ultrasound and elasticity every six months. In the past few years, the viral load has risen to meet the antiviral indications, so he has taken an antiviral pill every day, does not drink alcohol, and has a regular schedule. He is 44 this year, and every checkup index is normal. The last time he came to me, he told me that he had just taken his family to Xinjiang by car, and his condition was no different from that of a healthy person. The other one didn't take it seriously at all, saying that he didn't feel any discomfort at all. He stayed up late at night and drank white wine at social events. He never had a re-examination. As a result, he was hospitalized with ascites and jaundice at the age of 38. The examination showed that he had decompensated liver cirrhosis. He also suffered from gastrointestinal bleeding later and left within two years.

In fact, there are too many similar cases. It is obvious that the starting point is similar, but the final trend is very different. There are only two core influencing factors. One is whether there is early and standardized intervention, and the other is the specific type of virus infected. The chronic viral hepatitis we often talk about is basically three types: hepatitis B, hepatitis C, and hepatitis D. Hepatitis A and hepatitis E are basically acute infections and will not become chronic. There are now specific direct antiviral drugs for hepatitis C. As long as it has not progressed to irreversible cirrhosis when it is discovered, taking the drug for 3-6 months can completely eliminate the virus, which is equivalent to a complete cure, and there will be no subsequent sequelae. I previously treated a 26-year-old young man who was unfortunately infected with hepatitis C when he had his eyebrows tattooed. He was very panicked when he was diagnosed. However, after taking medicine for 3 months and then being re-examined, he found that the virus had completely turned negative. Now he is getting married and having a baby without any delay.

There is still some controversy in the academic community about the treatment of some situations. For example, for hepatitis B virus carriers whose liver function has always been normal and who have no signs of liver fibrosis, one school of thought believes that regular follow-up is enough and there is no need to initiate antiviral treatment in advance.； The other group believes that as long as the virus continues to replicate, it will cause hidden damage to the liver. Antiviral treatment as early as possible can further reduce the long-term risk of liver cancer. The specific choice must be made based on the individual's family history of liver cancer and the results of liver puncture. There is no absolute standard answer.

Speaking of which, the liver is really the most capable "model worker organ" in our body. It has a very strong compensatory capacity. Even if two-thirds of the liver cells are damaged, the remaining ones can still complete daily tasks. Therefore, many patients with chronic hepatitis do not feel any discomfort at all in the early and middle stages. By the time they develop symptoms such as fatigue, yellow eyes, and pain in the liver area, the damage is often severe. This is why many people feel that the disease "suddenly becomes serious." To put it bluntly, this disease is like a small fuse placed in the liver. If you keep an eye on it, check it regularly, and extinguish it in time when it is time to extinguish it, it will never explode in its lifetime. If you ignore it and keep tossing it, it may explode one day. Whether it is serious or not is really not the disease itself that has the final say. To a large extent, it depends on whether you pay attention to it and whether you deal with it in a standardized manner.