Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Patients infected with hepatitis B and hepatitis C can develop chronic
hepatitis. Doctors define chronic hepatitis as hepatitis that lasts longer than
6 months. In chronic hepatitis, the viruses live and multiply in the liver for
years or decades. For unknown reasons, these patients' immune systems are unable to eradicate the
viruses. The viruses cause chronic inflammation of the liver. Chronic hepatitis
can lead to the development over time of extensive liver scarring (cirrhosis),
liver failure, and liver cancer. Liver failure from chronic hepatitis C infection is the
most common reason for liver transplantation in the United States. Patients with
chronic viral hepatitis can transmit the infection to others.
Diagnosis of viral hepatitis is based on symptoms,
physical findings as well as blood tests for liver enzymes, viral antibodies,
and viral genetic materials.
Symptoms and physical findings
Diagnosis of acute viral hepatitis often is easy, but
diagnosis of chronic hepatitis can be difficult. When a patient reports symptoms
of fatigue, nausea, abdominal pain, darkening of urine, and then develops jaundice, the diagnosis of
acute viral hepatitis is likely and can be confirmed by blood tests. On the
other hand, patients with chronic hepatitis due to hepatitis B and hepatitis C often have no
symptoms or only mild nonspecific symptoms such as chronic fatigue. Typically,
these patients do not have jaundice until the liver damage is far advanced.
Therefore, these patients can remain undiagnosed for years to decades.
Blood tests
There are three types of blood tests for evaluating patients with hepatitis:
liver enzymes, antibodies to the hepatitis viruses, and viral proteins or
genetic material (viral DNA or RNA).
Liver enzymes. Among the most sensitive and widely used blood tests for
evaluating patients with hepatitis are the liver enzymes, called
aminotransferases. They include aspartate aminotransferase (AST or SGOT) and
alanine aminotransferase (ALT or SGPT). These enzymes normally are contained within
liver cells. If the liver is injured (as in viral hepatitis), the liver cells
spill the enzymes into the blood, raising the enzyme levels in the blood
and signaling that the liver is damaged.
The normal range of values for AST is from 5 to 40 units per liter of serum (the liquid
part of the blood). The normal range of values for ALT is from 7 to 56 units per
liter of serum. Patients with acute viral hepatitis (for example, due to
hepatitis A or
hepatitis B) can develop very high AST and ALT levels (sometimes in the thousands of
units per liter range). These high AST and ALT levels will become normal in
several weeks or months as the patients recover completely from their acute
hepatitis. In contrast, patients with chronic hepatitis B and hepatitis C infection
typically have only mildly elevated AST and ALT levels, but these abnormalities
can last years or decades. Since most patients with chronic hepatitis are
asymptomatic (no
jaundice or nausea), their mildly abnormal liver enzymes are
often unexpectedly encountered on routine blood screening tests during yearly
physicals or insurance physicals.
Elevated blood levels of AST and ALT only means that the liver is inflamed, and
elevations can be caused by many agents other than hepatitis viruses, such as
medications, alcohol, bacteria, fungus, etc. In order to prove that a hepatitis
virus is responsible for the elevations, blood must be tested for antibodies to
each of the hepatitis viruses as well as for their genetic material.
Viral antibodies. Antibodies are proteins produced by white blood cells that
attack invaders such as bacteria and viruses. Antibodies against the hepatitis
A, B, and C viruses usually can be detected in the blood within weeks of
infection, and the antibodies remain detectable in the blood for decades
thereafter. Blood tests for the antibodies can be helpful in diagnosing both
acute and chronic viral hepatitis.
In acute viral hepatitis, antibodies not only help to
eradicate the virus, but they also protect the patient from future infections by
the same virus, that is the patient develops immunity. In chronic hepatitis,
however, antibodies and the rest of the immune system are unable to eradicate the virus. The viruses
continue to multiply and are released from the liver cells into the blood where
their presence can be determined by measuring the viral proteins and genetic
material. Therefore in chronic hepatitis, both antibodies to the viruses and
viral proteins and genetic material can be detected in the blood.
antibody to hepatitis B core, an antibody directed against the inner core
(nucleus) of the virus
(core antigen)
antibody to hepatitis B surface, an antibody directed
against the outer surface envelope of the virus (surface antigen)
antibody to hepatitis B e, an antibody directed
against the genetic material of the virus (e antigen)
hepatitis C antibody-antibody against the C virus
Viral proteins and genetic material. Examples of tests for viral proteins and
genetic material are:
hepatitis B surface antigen
hepatitis B DNA
hepatitis B e antigen
hepatitis C RNA
Other tests. Obstruction of the bile ducts, from either gallstones or cancer,
occasionally can mimic acute viral hepatitis. Ultrasound testing can be used to
exclude the possibility of gallstones or cancer. For more information, please
read the Ultrasound article.
Infectious mononucleosis is a virus infection in which there is an increase of white blood cells
that are mononuclear (with a single nucleus) "Mono" and "kissing
disease" are popular terms for this very common illness caused by the
Epstein-Barr virus (EBV).
Liver cancer is the fifth most common cancer in the world and the majority of patients with liver cancer will die within one year as a result. Patients with associated cirrhosis caused by chronic hepatitis B or C infections, alcohol, and hemochromatosis are at the greatest risk of developing liver cancer. Many patients with liver cancer do not develop symptoms until the advanced stages of the tumor which usually makes prognosis poor. The combination of an imaging study (ultrasound, CT, or MRI scans) and an elevated blood level of alpha-fetoprotein will most effectively diagnose liver cancer, while a liver biopsy can make a definitive diagnosis. Medical treatments, including chemotherapy, chemoembolization, ablation, and proton beam therapy, are not very effective. Surgical removal of the tumor or a liver transplant may be most effective in certain cases.
Cirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections. Symptoms include yellowing of the skin, itching, and fatigue.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Sexually transmitted diseases, or STDs,
are infections that are transmitted during any type of sexual exposure,
including intercourse (vaginal or anal), oral sex, and the sharing of sexual
devices, such as vibrators. Women can contract all of the STDs, but may have no symptoms, or have different symptoms than men do.
Hepatitis C is an inflammation of the liver due to the hepatitis C virus (HCV), which is usually spread by
blood transfusion, hemodialysis, and needle sticks, especially with intravenous
drug abuse. Chronic hepatitis C may be treated with interferon, usually in combination with anti-virals.
Jaundice is a yellowish staining of the skin and whites of the eyes (sclerae) with bilirubin, the pigment found in bile. Jaundice can be an indicator of liver or gallbladder disease, or it may result from the rupture of red blood cells (hemolysis).
The hepatitis B virus is a unique, coated DNA virus belonging to the Hepadnaviridae family of viruses. The course of the virus is determined primarily by the age at which the infection is acquired and the interaction between the virus and the body's immune system. Successful treatment is associated with a reduction in liver injury and fibrosis (scarring), a decreased likelihood of developing cirrhosis and its complications, including liver cancer, and a prolonged survival.
Ascites, the accumulation of fluid in the abdominal cavity is most commonly caused by cirrhosis of the liver. Some of the other causes of ascites include portal hypertension, congestive heart failure, blood clots, and pancreatitis. The most common symptoms include increased abdominal girth and size, abdominal bloating, and abdominal pain. Treatment depends on the cause of ascites.
The spleen enlarges if it is asked to do excessive work in filtering or manufacturing blood cells, if there is abnormal blood flow to it, or if it is invaded with abnormal cells or deposits. Symptoms of an enlarged spleen may include weakness and fatigue, easy bleeding, and poor white blood cell function. Treatment of an enlarged spleen is focused toward the cause of the splenomegaly. Surgery may be required to remove the spleen.
Sexually transmitted diseases, or STDs, are infections that are transmitted during any
type of sexual exposure, including intercourse (vaginal or anal), oral sex, and
the sharing of sexual devices, such as vibrators. Although treatment exists for many STDs, others currently are
usually incurable, such as those caused by HIV, HPV, hepatitis B and C, and HHV-8.
Encephalopathy means brain disease, damage, or malfunction. Causes of encephalopathy are varied and numerous. The main symptom of encephalopathy is an altered mental state. Other symptoms include lethargy, dementia, seizures, tremors, and coma. Treatment of encephalopathy depends on the type of encephalopathy (anoxia, diabetic, Hashimoto's, hepatic, hyper - hypotensive, infectious, metabolic, infections, uremic, or Wernicke's) are examples of types of encephalopathy.
The liver is the largest solid organ in the body, and is actually an gland. The liver has a wide variety of critical functions such as manufacturing proteins and metabolizing fats and carbohydrates. The liver also eliminates harmful biochemical waste products from the body (alcohol, drugs, toxins). The liver secretes bile that aids in digestion. Examples of diseases of the liver include cirrhosis, hepatitis, cancer, and fatty liver. Symptoms of liver disease include bleeding, easy bruising, edema, fatigue, and jaundice.
Male breast cancer accounts for 1% of all breast cancers, and most cases are found in men between the ages of 60 and 70. A man's risk of developing breast cancer is one in 1,000. Signs and symptoms include a firm mass located below the nipple and skin changes around the nipple, including puckering, redness or scaling, retraction and ulceration of the nipple. Treatment depends upon staging and the health of the patient.
Fatigue can be described in various ways. Sometimes fatigue is described as feeling a lack of energy and motivation (both mental and physical). The causes of fatigue are generally related to a variety of conditions or diseases for example, anemia, mono, medications, sleep problems, cancer, anxiety, heart disease, drug abuse, and more. Treatment of fatigue is generally directed toward the condition or disease that is causing the fatigue.
Pregnancy planning is important to help prevent exposure of the mother and fetus to potentially harmful medications and substances during the early days, and throughout the pregnancy. Nutritional planning, prevention of birth defects, conditions such as high blood pressure, heart disease, diabetes, and kidney disease need careful monitoring. Gestational diabetes, preeclampsia, and pregnancy induced hypertension are conditions that may arise during pregnancy. Immunizations, inherited disorders, exercise, air travel, intercourse, and birth control are important factors to consider when planning a pregnancy.
Hepatitis means inflammation of the liver. Hepatitis A is one type of liver disease caused by a virus. Since hepatitis A is a virus, it can pass from person to person from eating or drinking contaminated food or coming into contact with contaminated materials containing the virus. Symptoms of hepatitis A include stomach pain, diarrhea, dark yellow urine, jaundice, and more. There is a vaccine to prevent contracting hepatitis A.
Hepatitis A and hepatitis B are the two most commnon viruses that infect the liver. Hepatitis A and Hepatitis B can be prevented and treated with immunizations (vaccinations) such as Havrix, Vaqta, Twinrix, Comvax, Pediarix, and hepatitis b immune globulin (HBIG).
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