All You Need to Know About Hepatitis

Hepatitis means inflammation of the liver. The inflammation is commonly caused by a viral infection, but there are other causes like drugs, alcohol, toxins and autoimmune disorders. Autoimmune hepatitis occurs when your white blood cells attack your liver tissue because your body makes antibodies against your liver due to some reasons.

How important is your liver?

Your liver is located in the upper right quadrant of your abdomen. It performs metabolism-related functions like;

• Production of bile. Bile breaks down fats into fatty acids. It contains cholesterol, bile acids bilirubin, water, potassium, sodium, copper and other metals.
• Filters toxins from the body
• Responsible for excreting compounds like bilirubin (bilirubin is formed when your red blood cells are broken down), drugs, hormones and cholesterol
• Responsible for breaking down carbohydrates, fats and proteins
• Activates some enzymes that are essential to body functions
• Stores glycogen, minerals, and the fat-soluble vitamins (A, D, E, and K)
• Synthesis of albumin and other blood proteins
• Synthesis of clotting factors

Types of hepatitis  (infectious and non-infectious)

Types of viral hepatitis

There are 5 major types of hepatitis caused by viral infections, and each type is caused by a different virus.

They include hepatitis A, B, C, D, and E.

Hepatitis B, C, and D tend to progress to the chronic stage while both A and E are acute, E can be very dangerous in pregnant women.

Hepatitis A

Hepatitis A is caused by the Hepatitis A virus (HAV). the major mode of transmission is by consuming food or water that is contaminated by the faeces of an infected person

Hepatitis B

This infection is majorly transmitted through contact with the body fluids like blood, vaginal secretions, semen of an infected person. Having unprotected sex with an infected partner, sharing a blade or any sharp objects with an infected person will increase your risk of getting the infection.

Hepatitis C

The cause of this infection is the hepatitis C virus (HCV). Like the hepatitis B virus, it is also transmitted through body fluids, intravenous blood use and sexual contact with an infected partner. There are many types of HCV, and the way they respond to treatment differs. Type 1 HCV is the most common type in the USA.

Stages of Hepatitis C

The virus has several stages, and it manifests in people in different ways.

• Incubation period: this is the time interval between when you are first exposed to the virus and when the symptoms start to manifest. It is usually between 14 to 80 days.

• Acute hepatitis C. This stage lasts for the first 6 months after exposure to the virus. Some people can get rid of the virus or clear the virus on their own during this stage.

• Chronic hepatitis C. hepatitis c infection progresses to the chronic stage in up to 85% of those infected, leading to serious health problems like liver cirrhosis and cancer.

• Cirrhosis. This infection leads to inflammation which stimulates the replacement of healthy cells of your liver with scar tissues. This usually takes about 20 to 30 years, but it can be hastened if you have HIV or drink alcohol.

• Liver cancer

Hepatitis D infection

This infection is also known as delta hepatitis, and it is caused by the hepatitis D virus (HDV). It is majorly transmitted through contact with the blood of an infected person. Hepatitis D is relatively rare, and it usually occurs in conjunction with hepatitis B infection because it cant multiply without hepatitis B.

Hepatitis E

Hepatitis E is a waterborne disease that is caused by the hepatitis E virus (HEV). It is majorly contracted by ingesting water supply that is contaminated with the fecal matter of an infected person.

Causes of non-infectious hepatitis

Alcohol and other toxins

Would you believe it if I tell you that alcohol causes hepatitis? Well, moderate alcohol consumption might not, but excessive alcohol consumption sure cause the liver to be inflamed and can damage the liver.

The alcohol directly causes injuries to the liver cells. When the liver is damaged, it tries to repair itself, but the damage leaves a scar. Over time, it can result in cirrhosis( scarring and thickening of liver cells), and liver failure.

Other common causes include medication overdose and poison exposure.

Autoimmune hepatitis

In autoimmune hepatitis, the immune system attacks the liver because it sees it as a foreign object. It causes a mild to severe inflammation that can hinder the liver functions. It is far more common in men than in women.

Common symptoms of hepatitis

Signs and symptoms of acute hepatitis appear quickly, unlike the chronic type where symptoms may not occur until there is liver damage.

Signs and symptoms of acute hepatitis infection include

• Loss of appetite (anorexia).
• Pale stool
• Abdominal pain
• Dark coloured urine
• Fatigue
• Sudden explained weight loss
• Jaundice (yellow skin and eyes)
• Joint pain
• Dark urine

Diagnosis of hepatitis

History and physical exam

Some risk factors increase your chances of getting hepatitis. Your doctor will ask for history to determine if you have any associated risk factor.

During a physical examination, your doctor will check your skin or eyes to see if they are yellow. He will also check if your liver is enlarged and then press gently on it to see if there will be any painful sensation.

Laboratory examination

Liver Function Test (LFT): this test determines the level of liver enzymes in your blood. High levels can be an indication of the liver overworking, damaged or not working properly.

If the levels of liver enzymes are abnormal, other tests might have to be carried out in order to detect the source of the problem. These test can check for antibodies or viruses that cause hepatitis.

Ultrasound

An ultrasound machine works by using ultrasound waves to create an image. This test can be to assess the liver and the organs that are close to it. The test can reveal;

• Abdominal fluid
• Liver enlargement (hepatomegaly) or damage
• Liver tumors and gallbladder abnormalities

Liver biopsy

It is an invasive procedure where a sample of your liver tissue is taken. This procedure can be done through your skin with a needle, and the ultrasound is used to guide your doctor during the procedure. This test can be used to assess how your liver has been affected by infection or inflammation.  

Treatment of hepatitis

The type of treatment you will receive depends on the type of hepatitis and whether it is acute or chronic.

Hepatitis A

Hepatitis A is a short term illness and doesn’t generally require treatment, but you might benefit from bed rest, especially if symptoms are causing serious discomfort. Symptomatic treatments can also be initiated, e.g. your doctor can order for hydration and nutrition if you are vomiting or having diarrhoea.

The good news is that this infection can be prevented because there is a vaccine against this virus. Both children and adults can benefit from this vaccine, and it is usually administered to children between 12 and 18months. It can be combined with hepatitis B vaccine in adults.

Hepatitis B

This infection can either be acute or chronic, but the acute form doesn’t require a specific treatment.

Chronic hepatitis B is usually treated with antiviral medications which must be continued for several weeks. Continuous monitoring and evaluation is an important aspect of managing the infection in order to determine if the virus is responding to treatment.

Vaccine is available for this infection, and the CDC recommends that all newborns should be vaccinated in three series that is typically completed within the first six months. It is recommended that all medical personnel and healthcare are also vaccinated.

Hepatitis C.

Both the acute and chronic form of this infection can be treated with antiviral medications.

Patients who eventually develop liver cirrhosis due to this chronic hepatitis C infection might be a good candidate for a liver transplant.

There is no vaccine for hepatitis C yet.

Hepatitis D

There is currently No antiviral medications for the treatment of hepatitis D, but some drugs have been showing promising improvements.

Since hepatitis B is necessary for hepatitis D to develop, hepatitis D can be prevented by getting a vaccine for hepatitis B.

Hepatitis E

There is currently no specific effective therapy available to treat hepatitis E.  The infection usually resolves on its own because it is often acute. While infected pregnant women require close supervision and care, people with this type of infection are often advised to stay hydrated, have adequate bed rest, get enough nutrients and totally stay away from alcohol.

Autoimmune hepatitis

In early treatment of autoimmune hepatitis, Corticosteroids, like budesonide or prednisolone, are effective in about 80% of people with the condition.

Immunosuppressants like Azathioprine, mycophenolate, tacrolimus and cyclosporine can also be used alone or in combination with steroids.

How can I prevent hepatitis?

Hygiene

The importance of good hygiene in preventing hepatitis A and E cannot be emphasized enough.

If you plan to visit a developing country, you should avoid the following;

• Local water
• Raw fruits and vegetables
• Raw or undercooked fish, meat or related products
• Ice

Hepatitis B, C, and D are transmitted through contaminated blood and can be prevented by:

• Personalizing toothbrush, drug needles, or razors.
• Avoiding direct contact with spilled blood

Both hepatitis B and C can be transmitted through intimate sexual contact, and it is therefore imperative that you practise safe sex by using dental dams and condoms.

Vaccines

How can we talk about preventing hepatitis without talking about vaccines?

Vaccines are available for hepatitis A, B, and E while scientists are currently developing vaccines for hepatitis C

Complications of hepatitis.

People with chronic hepatitis B or C are at risk of developing serious health problems because the virus attacks the liver. They are at risk for:

• Liver cirrhosis
• Chronic liver disease
• Liver cancer
• Liver failure

Complications of liver failure include;

• Hepatocellular carcinoma ( a form of liver cancer)
• Hepatic encephalopathy with symptoms like fatigue, impaired mental alertness and abilities, memory loss due to build-up of toxins like ammonia that affect brain function.
• Kidney failure
• Portal hypertension (increase in blood pressure in the portal vein that enters the liver)
• Ascites (build-up of fluid in the abdomen)
• Bleeding disorders
• death