Know more about hepatitis

HEPATITIS

INTRODUCTION

Hepatitis is an inflammation of the liver that is caused by a variety of infectious viruses and non-infectious agents leading to a range of health problems, some of which can be fatal.

• There are five main strains of the hepatitis virus, referred to as types A, B, C, D and E. While they all cause liver disease, they differ in important ways including modes of transmission, severity of the illness, geographical distribution and prevention methods. In particular, types B and C lead to chronic disease in hundreds of millions of people and together are the most common cause of liver cirrhosis, liver cancer and viral hepatitis-related deaths.

SIGNS & SYMPTOMS

• Many people with hepatitis A, B, C, D, or E exhibit only mild symptoms or no symptoms at all. Each form of the virus, however, can cause more severe symptoms.
• Symptoms of hepatitis A, B, and C may include fever, malaise, loss of appetite, diarrhea, nausea, abdominal discomfort, dark-colored urine, and jaundice (yellowing of the skin and whites of the eyes).
•  In some cases, the virus can also cause a chronic liver infection that can later develop into cirrhosis (a scarring of the liver) or liver cancer. These patients are at risk of death.
• Hepatitis D (HDV) is only found in people already infected with hepatitis B (HBV); however, the dual infection of HBV and HDV can cause a more serious infection and poorer health outcomes, including accelerated progression to cirrhosis. The development of chronic hepatitis D is rare.
• Hepatitis E (HEV) begins with mild fever, reduced appetite, nausea, and vomiting lasting for a few days. Some persons may also have abdominal pain, itching (without skin lesions), skin rash, or joint pain.

CAUSES

• Hepatitis A is caused by a virus that infects liver cells and causes inflammation.
• The virus most commonly spreads when you eat or drink something contaminated with fecal matter, even just tiny amounts. It does not spread through sneezing or coughing.

Here are some of the specific ways the hepatitis A virus can spread:

• Eating food handled by someone with the virus who doesn't thoroughly wash his or her hands after using the toilet
• Drinking contaminated water
• Eating raw shellfish from water polluted with sewage
• Being in close contact with a person who's infected — even if that person has no signs or symptoms
• Having sex with someone who has the virus

Risk factors

You're at increased risk of hepatitis A if you:

• Travel or work in areas of the world where hepatitis A is common
• Attend child care or work in a child care centre
• Live with another person who has hepatitis A
• Are a man who has sexual contact with other men
• Have any type of sexual contact with someone who has hepatitis A
• Are HIV positive
• Are experiencing homelessness
• Have a clotting-factor disorder, such as haemophilia
• Use any type of illegal drugs (not just those that are injected)

DIAGNOSIS

1. Your doctor will examine you and look for signs of liver damage, such as yellowing skin or belly pain. Tests that can help diagnose hepatitis B or its complications are:

• Blood tests. 
• Liver ultrasound. A special ultrasound called transient elastography can show the amount of liver damage.
• Liver biopsy. 

1. Screening healthy people for hepatitis B

PREVENTION

There are many ways you can reduce your chances of getting hepatitis:

• Get the vaccines for hepatitis A and hepatitis B.
• Use a condom during sex.
• Don't share needles to take drugs.
• Practice good personal hygiene such as thorough hand-washing with soap and water.
• Don't use an infected person's personal items.
• Take precautions when getting any tattoos or body piercings.
• Take precaution when traveling to areas of the world with poor sanitation. (Make sure to get your vaccines.)
• Drink bottled water when traveling.

There are vaccines for hepatitis A and hepatitis B that are available in the U.S. There is no vaccine for hepatitis C. Since you can only get hepatitis D if you have hepatitis B, getting the vaccine against B should protect you against hepatitis D. There is no FDA approved vaccine against hepatitis E, but vaccines against hepatitis E exist overseas (for example, in China).

TREATMENT

• Treatment for acute hepatitis B infection

If your doctor determines your hepatitis B infection is acute — meaning it is short-lived and will go away on its own — you may not need treatment. Instead, your doctor might recommend rest, proper nutrition and plenty of fluids while your body fights the infection. In severe cases, antiviral drugs or a hospital stay is needed to prevent complications.

• Treatment for chronic hepatitis B infection

Most people diagnosed with chronic hepatitis B infection need treatment for the rest of their lives. Treatment helps reduce the risk of liver disease and prevents you from passing the infection to others. Treatment for chronic hepatitis B may include:

• Antiviral medications. Several antiviral medications — including entecavir (Baraclude), tenofovir (Viread), lamivudine (Epivir), adefovir (Hepsera) and telbivudine (Tyzeka) — can help fight the virus and slow its ability to damage your liver. These drugs are taken by mouth. Talk to your doctor about which medication might be right for you.
• Interferon injections. Interferon alfa-2b (Intron A) is a man-made version of a substance produced by the body to fight infection. It's used mainly for young people with hepatitis B who wish to avoid long-term treatment or women who might want to get pregnant within a few years, after completing a finite course of therapy. Interferon should not be used during pregnancy. Side effects may include nausea, vomiting, difficulty breathing and depression.
• Liver transplant. If your liver has been severely damaged, a liver transplant may be an option. During a liver transplant, the surgeon removes your damaged liver and replaces it with a healthy liver. Most transplanted livers come from deceased donors, though a small number come from living donors who donate a portion of their livers.