Hepatitis C is caused by a RNA virus. The virus is spread through blood and blood products and the common ways of acquiring infection are intravenous drug use, needle stick exposure, tattoos, sexual promiscuity (multiple partners, gay population), sharing razors and toothbrushes etc. Blood transfusion was an important route of transmission before 1993 when serological testing was not available but now this is not a method of transmission. In about 20% of patients no risk factor can be identified.

Hepatitis B is caused by a DNA virus. The virus is spread through blood and blood products and the common ways of acquiring infection are intravenous drug use, needle stick exposure, tattoos, sexual promiscuity (multiple partners, gay population), sharing razors and toothbrushes etc. In Asia, where the virus is very common vertical transmission from mother to fetus during childbirth is common. Such infection causes high viral load as the child’s immune system is not developed to mount a response to clear the virus. Due to excellent blood screening techniques, blood transfusion is not a method of transmission.

Inflammation of the liver caused by excess alcohol intake is known as Alcoholic hepatitis. Normally ingested alcohol is rapidly absorbed and metabolized in the liver. When alcohol intake in excess, in susceptible patients, it can damage the liver cells. This inflammation can lead to scarring (fibrosis) and cirrhosis (formation of nodules).

The big question remains – what is excess alcoholic intake? The rate of alcohol metabolism is variable from individual to individual. A genetic predisposition to develop alcoholic liver disease exists. Among people who drink, women are more likely to develop liver disease due their differential metabolism of alcohol.

Stones that form in the Gallbladder are mostly cholesterol stones. The liver makes bile that contains cholesterol, a form of fat, that is kept in solution by bile salts. In the gallbladder, in some patients the amount of cholesterol far exceeds the bile salts resulting in crystallization of cholesterol as Gallstones. Some patients form pigment stones that are dark and hard (calcium bilirubinate).

Pancreatitis refers to inflammation of the pancreas. This is a leaf shaped gland that is present behind the stomach and secretes enzymes that can digest starches, protein and fats. The pancreas also contains cells that secrete insulin. The duct of this gland joins the lower common bile duct and opens into the duodenum (small intestine) via a common orifice (Sphincter of Odi).

Pancreatitis results from two major causes: Gallstones or Alcohol use. Other causes include increased blood fats (triglycerides) or peptic ulcers.

Patients who have gallstones may pass small stones through the common bile duct and this may causes transient obstruction to the pancreatic duct resulting in pancreatitis.

Patients with Chronic alcohol use develop chronic pancreatitis.