Hepatitis

Definition

Hepatitis is inflammation of the liver, which can be caused by viruses, medications, or toxic agents.

Description

Hepatitis is usually characterized as viral hepatitis or non-viral hepatitis. Viral hepatitis can be considered "acute" (a condition that comes on rapidly with severe symptoms and a short course) or "chronic" (a condition that comes on slowly, may or may not have symptoms with has a long course).

Causes and Risk Factors

Currently, there are at least five (5) forms of viral hepatitis:

Hepatitis A - (formerly called infectious hepatitis), is most common in children in developing countries, but is being seen more frequently in adults and in the western world. Hepatitis A is thought to be spread by a virus from an infected person's feces directly or indirectly contaminating food, raw shellfish, drinking water, cooking utensils or someone else's fingers. The incubation period is two to six weeks after infection. Hepatitis A is considered an acute condition.

Hepatitis B - (formerly called serum hepatitis), is the most serious form of hepatitis.

Hepatitis B is thought to be spread by a virus from sexual contact, blood transfusion or exposure to an infected person's blood via cuts, open sores, needle sharing, razor sharing or ear piercing tools. Additionally, hepatitis B can be spread from mother to child at birth. The incubation period is four to 25 weeks.

Ninety percent of all hepatitis B cases are considered acute, while the other 10 percent are considered chronic and may progress to cirrhosis (a disease of the liver caused by chronic damage to its cells), liver failure or liver cancer. Note: a person is at greater risk of contracting hepatitis B if they are sexually active, have unprotected sex, have more than one sexual partner, have a sexual transmitted disease (STD), share needles for injecting drugs, work in health care, or if they are a native of or spend large amounts of time in Alaska, the Pacific Islands, Africa, Asia or the Amazon region of South America.

Hepatitis C - (formerly called non-A, non-B hepatitis), is transmitted primarily by direct blood contact - via blood transfusion or and contaminated needles. Less common ways are through sexual contact or from mother to child at birth.

The incubation period is five to 10 weeks. Twenty-five percent of the hepatitis C cases are considered acute, while the other 75 percent are considered chronic, which may result in cirrhosis. Note: a person is at greater risk of contracting hepatitis C if they had a blood transfusion prior to 1991, experimented with IV drugs or intranasal cocaine, have been a long-term hemodialysis patient, work in health care, or have been exposed to unsterile equipment used for body piercing, tattooing, manicures/pedicures or acupuncture.

Hepatitis D - (formerly called delta hepatitis), is found mainly in intravenous drug users who are carriers of the hepatitis B virus. Hepatitis D can cause both acute and chronic disease.

Hepatitis E - (formerly called enteric or epidemic non-A, non-B hepatitis) resembles hepatitis A, but is caused by a different virus from hepatitis C and is commonly found in the Indian Ocean area. Hepatitis E is considered an acute condition.

There are two main types of nonviral hepatitis, called alcoholic hepatitis and toxic/drug-induced hepatitis, and two less common types of nonviral hepatitis, called autoimmune hepatitis and granulomatous hepatitis.

Alcoholic hepatitis - the most common precursor of cirrhosis in the U.S. While it may not develop in many patients until several decades of alcohol abuse, it appears in a few individuals within a year after onset of excessive drinking.

Toxic/drug-induced hepatitis - caused after inhalation or ingestion of a toxin, such as carbon tetrachloride, vinyl chloride, poisonous mushrooms or the use of certain medications. Several widely used drugs can produce an adverse liver reaction: Isoniazid (used for the treatment of tuberculosis), methyldopa (a treatment for high blood pressure), acetaminophen (pain reliever), antibiotics such as erythromycin, chlorpromazine, oral contraceptives and anabolic steroids.

Autoimmune hepatitis - a condition in which the liver is attacked by the body's immune system.

Granulomatous hepatitis - a condition in which abnormal collections of white blood cells collect in the liver.

Fortunately, most people recover completely from hepatitis A, E and nonviral hepatitis. Mild flare-ups may occur over a period of several months with viral hepatitis. Each flare-up is usually less severe than the initial attack, and a relapse does not necessarily indicate that complete recovery will not take place.

Unfortunately, hepatitis B, C and D can linger in the body, producing chronic, perhaps lifelong, infection. Additionally, carriers of the hepatitis virus can infect others, even though they feel perfectly well. They may face risks of liver disease (cirrhosis and liver cancer) in the future.

Symptoms

Hepatitis produces an initial “acute phase,” often with few if any symptoms. If there are symptoms, they tend to mimic "flu-like" symptoms such as:

• mild fever

• muscle or joint aches

• nausea

• vomiting

• loss of appetite

• slight abdominal pain

• diarrhea

• fatigue

The acute phase and its symptoms is rarely serious or fatal, although occasionally a so-called fulminant or rapidly progressing form leads to death.

As the condition worsens, the person also may experience these additional symptoms:

• jaundice (yellowed skin, mucous membranes and eye-whites)

• dark urine

• light colored stools that may contain pus

• itching

• enlarged spleen (symptom of alcoholic hepatitis only)

• hives

• headache (symptom of toxic/drug-induced hepatitis only)

• dizziness (symptom of toxic/drug-induced hepatitis only)

• drowsiness (symptom of toxic/drug-induced hepatitis only)

• circulation problems (symptom of toxic/drug-induced hepatitis only)

The course of the hepatitis and the different outcomes after the acute phase that distinguish the various types.

Diagnosis

The doctor will take a thorough medical history with emphasis on the patient’s medications, alcohol consumption, previous surgeries and sexual activity. He or she may palpate the area over the liver to check for tenderness or enlargement.

If the skin becomes jaundiced and the person is exhibiting other symptoms of hepatitis, the doctor will do various lab tests, such as blood tests and liver panel tests. Additional lab tests include the antibody tests (ELISA II, RIBA II) and the hepatitis C RNA test via PCR technology for diagnosis of hepatitis C only.

If needed, the doctor may also perform a liver biopsy where a small portion of the liver would be taken for further examination under a microscope.

Treatment

There is no specific treatment for hepatitis A. The doctor will recommend the abstinence of alcohol and drugs during recovery. Most cases of hepatitis A resolve themselves spontaneously.

The only treatment for hepatitis B is rest, combined with a high protein/high carbohydrate diet to repair damaged liver cells and protect the liver. If hepatitis B persists, the doctor may recommend an antiviral agent called interferon.

The only approved treatment for hepatitis C virus, and the only one with demonstrated efficacy, is interferon alfa-2b (Intron A).

Currently, there is not effective treatment for hepatitis D and E.

For treatment of nonviral hepatitis, the doctor will first remove the harmful substance by flushing out the stomach via inducing vomiting or hyperventilation. If necessary, the patient with drug-induced hepatitis will be treated with corticosteroids.

Prevention

To prevent hepatitis A, remember to:

• Wash hands well after using any washroom.

• Eat only freshly cooked foods.

• Drink only commercially bottled water or boiled water in places where sanitation and the water supply are questionable and do not eat non-peelable raw fruits or vegetables unless cleaned thoroughly.

• Get a hepatitis A vaccination before traveling to areas such as Mexico, eastern Europe and developing countries.

To prevent hepatitis B, remember to:

• Tell your sex-partners if you are a carrier.

• Practice safe sex.

• Don't share needles, razors, toothbrushes, manicure tools or other items that could bear contaminated blood.

• Get the hepatitis B vaccination series if you are at risk.

• Don't allow yourself to be pierced with non-sterile equipment.

To prevent hepatitis C, remember to:

• (if carrier) Cover open wounds, don't share razors or manicure tools.

• Practice safe sex.

• Don't share needles, razors, toothbrushes, manicure tools or other items that could bear contaminated blood.

• Don't allow yourself to be pierced with non-sterile equipment.

• Limit alcohol intake.

• Never share IV drug needles or other drug equipment.

To prevent hepatitis D:

Since the hepatitis D virus cannot infect on its own without hepatitis B, use the preventive measures outlined in hepatitis B.

To prevent hepatitis E, remember to:

• Wash hands well after using any washroom.

• Eat only well and freshly cooked foods.

• Drink only commercially bottled water or boiled water in places where sanitation and the water supply are questionable, and don't eat non-peelable raw fruits or vegetables unless cleaned thoroughly.

To prevent alcoholic hepatitis, remember to:

• Limit the amount of alcohol consumption.

To prevent toxic/drug-induced hepatitis, remember to:

• Be aware of the lethal contents of all chemicals.

• Face the spray away from the body.

• Wear protective equipment if applicable.

Questions to Ask Your Doctor

What type of hepatitis is it?

What is the severity of the hepatitis?

What tests are performed to give an accurate diagnosis?

How much damage has been done to the liver?

Is the liver damage permanent or reversible?

What kind of therapy is recommended for this type of hepatitis? What are the risks?

What precautions should be taken for the family?